Training of Basic Rehabilitation Medicine on Volunteers
in Disaster Management
Widjajalaksmi Kusumaningsih
Department of Physical Medicine and Rehabilitation, Dr.Cipto Mangunkusumo General Hospital,
Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
Keyword: Disaster, Rehabilitation Responders, Training, Volunteers.
Abstract: Geographically of Indonesia is located in potential disaster area. Disaster divided into natural and man-made
disaster. Natural or man-made disasters are serious problems that should be managed. One of the problems
is health problem that should get disaster management, including rehabilitation medicine. Rehabilitation
medicine is important to normalize all aspects in post-disaster area. Many responders or volunteers that
affiliated or unaffiliated were involved to rehabilitation management in disaster. All responders consist of
doctors, paramedics, organization, non-government organization, military, international organization.
Responders who have rehabilitation skill give better outcome to the victims.
1 INTRODUCTION
Geographically Indonesia archipelago are located
within the confluence of three tectonic plates. This
three tectonic plates lies within two Continents, Asia
and Australia, and the Pacific Ocean. There were
many volcanos in Indonesian archipelago along the
northeastern islands adjacent to and including New
Guinea and the Alpide belt along the south and west
from Sumatra, Java, Bali, Flores, and Timor called
The Ring of Fire. These conditions made Indonesia
very prone to disasters such as volcanic eruptions,
earthquakes, tsunamis, landslides, and others (BNPB,
2017).
Disaster is defined by World Health
Organization (WHO) as a serious disruption of
functioning of a community or a society causing
widespread human, material, economic or
environment losses which exceeds the ability of the
affected community or society to cope using its own
resources (WHO, 1980).
2 DISCUSSION
2.1 Respond to Disaster
During and after a disaster event, there are many
different types of people who respond and at
different times, those people mention as responders
or volunteers. Responders are those people who
respond the disasters and want to help the victims of
the disaster based on humanity with no limits. There
are two types volunteers: affiliated and unaffiliated
volunteers. Affiliated volunteers generally
participate in formal volunteering actions while
unaffiliated volunteers are those who volunteer in an
informal way and not attached to a recognized
agency (Helen, 2016).
2.2 The Role of Volunteers in Disaster
Affiliated volunteers contribute with their unpaid
time to the activities of the organizations. These
organizations give the necessary training, skills, and
information that should they have prior to the
occurrence of a disaster. Meanwhile, unaffiliated
volunteers, also known as spontaneous volunteers,
are motivated by a sudden desire to help others in
times of disaster or emergency. They assist directly
with the situation and genuinely want to help, but
without being part of a formal organization.
Typically, they are from the devastated area caused
by the disaster (Helen, 2016).
One of the volunteer type is the Emergency
Medical Team (EMT). EMT are group of health
professionals organization that serve victims
affected by a disaster. This group comes from
governments, non government organization (ngo),
54
Kusumaningsih, W.
Training of Basic Rehabilitation Medicine on Volunteers in Disaster Management.
DOI: 10.5220/0009062200540057
In Proceedings of the 11th National Congress and the 18th Annual Scientific Meeting of Indonesian Physical Medicine and Rehabilitation Association (KONAS XI and PIT XVIII PERDOSRI
2019), pages 54-57
ISBN: 978-989-758-409-1
Copyright
c
 2020 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved

militaries, national organization, international
organization such as the international red cross, red
crescent movement, and charities. The work of EMT
is regulated with classification and minimum
standards set by World Health Organization (WHO)
and its partners (WHO, 2017).
2.3 Classification of EMT
About EMT, WHO has classified EMT into three
types and one specialized team. Type 1, provides
outpatient initial emergency care of injuries and
other significant health care needs. There are two
subtypes of type 1; first is type 1 mobile there are
able to treat minimum fifthy outpatients per day, day
time service only, and mobile team and equipment
and no temporary clinical facility and fixed (100
patients/day). Type 1 fixed is same as type 1 mobile,
but work put of a fixed structure and provide up to
12 hours per days of care, 7 days of weeks. Type 2
provides emergency care including surgery, 24 hours
a day, and deploys field hospitals with at least 20
beds and can replace and support small district
hospital. Type 3 provides inpatient referral care and
complex surgery with large 40-100 beds facilities
and support and replace tertiary hospitals.
Specialized teams are the teams with specialty in
specific medical area. The teams consist of 2 or 3
senior specialists or a specialist facility eg. Ebola or
Rehabilitation (WHO, 2019; WHO, 2015).
There are various model of EMT around the
world. In USA, National Disaster Medical System
(NDMS) is coordinated system within the US
Department of Health and Human Services that
serves the Federal response by providing disaster
medical care to the US and more recently with
responses to the Bam Earthquake in Iran and the
Earthquake in Haiti, to the world. NDMS are
Disaster Medical Assistance Teams (DMAT),
Disaster Mortuary Operational Response Teams
(DMROT), International Medical Surgical Response
Team (IMSURT), and National Veterinary Response
Team (NVRT). Each DMAT consist of 35 members
team with various professions (physicians, nurses,
emergency medical technicians, pharmacists, and
support personnel). Currently there are eighty
DMAT in USA (Fuse and Yokota, 2010; Mace et al,
2007, Aziman, 2015).
DMAT in Japan (J-DMATs) were different from
US-DMATS, because the nature of disasters that
occur in these two countries are different. J-DMATs
consists of 1 or 2 medical doctors, 2 or 3 nurses, and
1 or 2 logisticians. J-DMATs do not participate in
international missions, but Japan supports
international mission by Japan Disaster Relief (JDR)
that operates under Japan International Cooperation
Agency (JICA) (Fuse and Yokota, 2010; Mace et al,
2007, Aziman, 2015).
In Canada, it is named as Disaster Assistance
Response Team (DART), a 200-Canadian Armed
Force (CAF) member military organization that can
be deployed internationally in response to situations
ranging from natural disasters to complex
humanitarian emergencies. DART can provide
assistance for up to 40 days. They serve three critical
needs in emergencies: water purification, primary
medical care, and engineering assistance. DART is
composed of 6 main elements: DART Headquarters
(about 45 members), DART Company Headquarters
(about 10 members), Engineer Troop (about 40
members), Medical Platoon (about 45 members),
Logistics Platoon (about 20 members), and Defence
and Security Platoon (about 45 members) (Fuse and
Yokota, 2010; Mace et al, 2007, Aziman, 2015).
Different with other country, Turkey reorganized
the disaster and emergency management
organization, in 2004 National Medical Rescue
Teams (NMRT) was established under ministry of
health. A NMRT consist of 5 healthcare personnel
with at least one doctors. Based on different local
risks, NMRTs may include mountain rescue teams,
water rescue teams, CBRN teams, air rescue and/or
evacuation temas (Fuse and Yokota, 2010; Mace et
al, 2007, Aziman, 2015).
2.4 The Role of EMT in Indonesia
Based on the Republic of Indonesia Constitution,
number 24 in the year of 2007 concerning Disaster
Mitigation, a government regulation was issued that
is Number 8 in the year of 2008 Presidential
Regulation concerning the National Disaster
Management Agency (BNPB). BNPB is an
organization that consists of disaster management
directors and disaster management implementing
elements. This organization has the function of
coordinating the implementation of disaster
management activities, in a planned, integrated and
comprehensive manner. BNPB organization consists
of disaster management education and training
center, deputy for rescue and preparedness,
emergency maintenance, rehabilitation and
reconstruction, logistics and equipments (BNPB,
2017; BNPB, 2017) (Ginanjar E dan Tarigan TE,
2006)
Training of Basic Rehabilitation Medicine on Volunteers in Disaster Management
55

2.5 Health Problem in Disaster
Effects of disasters depend on the type of disaster, in
generally disaster can cause injury and loss of
human life (Carter, 2008a). There are two types of
disaster, natural and man made (Carter, 2008b).
Other importance of health impacts caused by
disaster are spinal cord injury, traumatic brain injury,
limb amputation, fractures, crush injury, peripheral
nerve injuries, and psychological impairment (Khan
et al, 2012).
Another natural disaster such as forest fire that
happened in Kalimantan and Sumatera lead to air
pollution. Air Pollution causes medical problems
such as respiratory tract infection, asthma, bronchitis,
chronic obstructive pulmonary disease, and in the
long time may lead lung cancer (PDPI, 2019).
Disaster whether from natural or man made may
cause trauma. Trauma may lead to disability for over
45 million people each year worldwide (WHO,
2011). A systematic review analysis show in USA
the costs of lifetime for all injured patients were
estimated to be $158 billion in 2001, while in
Australia, lifetime costs were $4 billion to trauma
survivors. Those health problems have potential to
increase the incidence of disabilities among disaster
survivor.
2.6 Rehabilitation Medicine Program
In Disaster
There were many changes related to health problems
after a natural disaster. Some of those problems were,
an increase of respiratory infection and airborne
diseases. Epidemic and outbreaks of vector borne
and zoonoses diseases. Beside of that, water
condition for drinking and sanitary in the polluted
area was contaminated.
Adequate Rehabilitation Medicine program
should be applied to prevent the disability among
survivor. Comprehensive Rehabilitation Program
there should be Rehabilitation is the adequate
improvement and recovery of all aspects about
public or community services in post-disaster areas,
with main target for the normalization of all aspects
in government and community life (The Right No.
24,2007).
The volunteers have an essential role in
Rehabilitation Medicine program, according lack of
the number of the official medical staff. Responders
or affiliated volunteers can be a significant resource
during and after disaster, because they possess
proper information about disaster management.
Responders or volunteers had an understanding of
the existing tools and disaster management
procedures, received adequate training, and have
relevant knowledge that contribute effectively to
disaster response and recovery.
The responder or volunteers were divided into;
the spontaneous volunteers, and the affiliated
volunteers. The spontaneous volunteers are needed
to aid disaster victims, rebuild communities, educate
and prepare the public for future disasters. They can
be categorized in six categories: helpers, returnees,
the anxious, the curious, fans or supporters and
exploiters.
There were categories of person in the place
of disaster, i.e. The helpers were peoples who have
come to help victims or responders in some way.
The returnees were peoples who lived in the
disaster-impacted area but were evacuated. The
Anxious were peoples from outside the impacted
area who are attempting to obtain information about
family and friends. The Curious were peoples who
are motivated primarily to view the destruction left
after the disaster. The fans or supporters were
peoples who gather to display flags and banners
encouraging and expressing gratitude to emergency
workers. Exploiters were peoples who try to use the
disaster for personal gain or profit. From the six
categories Helpers should be identified first because
they are the only group likely to offer any tangible
support to the response and recovery effort (National
Community Service, 2007).
The affiliated and selected spontaneous
responder or volunteer should have training on the
basic Rehabilitation Medicine to prevent disability
in disaster survivor.
3 CONCLUSION
The impacts of disaster will always lead to the health
problems, that lead to increasing the prevalence of
disability. There were many professions involved in
disaster management, and lack of number of
Rehabilitation Medicine Team. The management of
disaster was a Team, consisted government, non-
government organization, affiliated volunteers and
unaffiliated volunteers. Affiliated volunteer and
selected unaffiliated volunteer should have trained
for the basic Rehabilitation Medicine to prevent
disability.
KONAS XI and PIT XVIII PERDOSRI 2019 - The 11th National Congress and The 18th Annual Scientific Meeting of Indonesian Physical
Medicine and Rehabilitation Association
56

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