preparedness emergency management system among …

Preparedness Emergency Management System among Nurses on Disaster in Banda Aceh

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Proceeding of The 8th AIC: Health and Life Sciences 2018 – Syiah Kuala University

PREPAREDNESS EMERGENCY MANAGEMENT SYSTEM AMONG

NURSES ON DISASTER IN BANDA ACEH

Cut Husna1,2*, Teuku Tahlil3, Hajjul Kamil4, Mustanir5, Rizka Hayaturrahmi6

1Medical and Surgical Nursing Department, Faculty of Nursing, Syiah Kuala University,

Darussalam-Banda Aceh, Indonesia 2Mathematic and Applied Science Department, Postgraduate Program, Syiah Kuala University,

Darussalam-Banda Aceh, Indonesia 3Community Nursing Department, Faculty of Nursing, Syiah Kuala University

Darussalam-Banda Aceh, Indonesia 4Management of Nursing Department, Faculty of Nursing, Syiah Kuala University Darussalam-Banda

Aceh, Indonesia 5Chemistry Department, Faculty of Science, Syiah Kuala University, Darussalam-Banda Aceh,

Indonesia 6Faculty of Nursing, Syiah Kuala University, Darussalam-Banda Aceh, Indonesia

*Corresponding author e-mail: [email protected]

ABSTRACT

Nurses are leading professionals as providers of care in emergency or disasters. The health care system

in the emergency response situation will succeed in preventing and reducing the mortality rate of the victims by

implementing emergency response system at the health care facilities. The study aimed to identify nurses’

preparedness in emergency response systems on disaster management at Maternal and Child Hospital Banda Aceh.

The variables of research are disaster response system, communication network, and ambulance transportation

system. The research of study is descriptive quantitative with cross sectional study design. The sample of the study

was total sampling of 103 nurses in Maternal and Child Hospital Banda Aceh. Data was collected by questionnaires

in dichotomous scale consisted of 33 questions developed by the researcher. The questionnaires consisted of

disaster emergency response system, communications network, the ambulance transport system tested validity and

reliability with scored 0.611, 0.698, 0.621, and 0.962 respectively. The results of the study showed that nurses’

preparedness in emergency respond system in disaster management was well prepared (73.8%). The variables of

the study showed that for disaster emergency response system (53.4%) was unprepared, communications network

(64.1%) and the ambulance transport system (77.7%) of respondents were well prepared respectively. The nurses

preparedness in emergency response system on disaster management in the hospital was well prepared, particularly

on communications network and the ambulance transport system. The hospital could effectively conduct to disaster

management, disaster simulation exercises, and develop standard operating procedures related of disaster

management systems in the future.

Keywords: disaster, emergency, hospital, nurse, preparedness.

INTRODUCTION

Indonesia is a vulnerable country and has a high risk of disaster. Disaster is a series of

events that threaten and disrupt the life caused by both natural factors, non-natural factors and

human factors resulting in the occurrence of human casualties, environmental damage, property

loss and psychological impact (Undang-Undang No.24, 2007). Disasters can also cause damage

to the social life of the community and have significant effects on the physical, emotional and

psychological health of the community (Thobaity, Plummer, & Williams, 2017; Park & Kim,

2017). Disaster is a disturbance that involves a community or society causing harm in material

and environment (Hammad, Arbon, Gebbie, & Hutton, 2012). Disasters are a serious disruption


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that affects the people, causing harm to human, material and environmental life that exceeds

the community's ability to cope (Al Khalaileh, Bond, Beckstrand, & Al-Talafha, 2010).

Disaster preparedness should be a priority especially in areas at risk of disaster. The

tsunami disaster and earthquake on 26 December 2004 with involving 13 countries reached

127,672 people, while data on the number of casualties in the province of Nanggroe Aceh

Darussalam and North Sumatra around 110,229 people died, 12,132 people disappeared,

703,748 people displaced and 925 people in hospital (Baghdady, 2005). Due to efforts to reduce

the impact of the disaster, the need for quick response and preparedness from health workers,

especially nurses who have a critical role in every phase of disaster management (Thobaity,

Plummer, & Copnell, 2016). Disaster does not only require the provision of necessary resources

and requests but also it is necessary to anticipate through effective collaboration with other

professionals including nurses (Park & Kim, 2017).

The hospital is one of the most urgent public health center which deal some events when

disaster occured. Hospital preparedness in responding and delivering emergency is critical to

the overall success of health care services. Nurses are the largest population in hospitals that

have a major roles in the disaster response phase in providing health care services efficiently.

Hospitals should be able to prepare the availability of resources, equipments, places and spaces,

medical and non-medical personnels through emergency and hospital disaster preparedness,

disaster plan, disaster drill, and assessment of hospital disaster plan (Kaji, Langford, & Lewis,

2008).

Maternal and Child Hospital is the referral hospital in emergency cases speciallly care of

mothers and children, hence it requires good emergency preparedness (Rencana Pembangunan

Jangka Menengah Daerah Aceh, 2017). Based on data obtained from medical records Maternal

and Child Hospital mentioned that the hospital already has disaster management team and

available 110 nurses. The hospital also has emergency respond system, policies and procedures

to respon fires disasters. The hospital had available information boards which is responsible for

the evacuation patients to every ward. The hospital had conducted trainings for nurses with

emergencies such as triage training for emergency nurses, code red and code blue training for

emergency cases and APAR training (fire disaster management), and simulation to evacuation

of earthquake and fire victims. Those are part of the hospital preparedness in anticipation

emergency case and disaster (RSIA, 2018). According to interview found that the mechanism

of communication networks in RSIA using Hospital Management Information System (SIM

RS), LAN and internet, and telephone between wards up to emergency services. Another

preparedness is the provision of emergency and disaster emergency ambulances and available


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equipment such as infusion sets, oxygen, nasal cannulas, beds, first-aid kits and certain

medications.

Nurses as health workers should be ready to handle the emergency situation include

disaster. Nursing preparedness is one of the keys to success in preventing, reducing the impact

of disasters, and decreasing mortality rate of victims. The objective in preparedness is to have

the ability to carry out emergency response activities before disaster will happened (LIPI &

UNESCO/ISDR, 2006). The results of a study conducted on three hospitals related to disaster

preparedness reported 474 respondents with characteristics of nurses found that disaster

preparedness in the weak level. The assessments of nurse preparedness showed only 11% have

ever participated in the real drill disaster (Al Khalaileh et al., 2010).

Based on the Regulation of the Minister of Health of the Republic of Indonesia No. 19,

2016 on Emergency Management System aimed to strengthen preparedness in emergency

management. So, need some important component there are development of implementation of

emergency response system, communication network, and ambulance transportation system

(Kemenkes RI, 2016). Implementation of disaster emergency response system will reduce and

save disaster victims through the improvement of health care quality related to disaster

preparedness and handling (Kemenkes RI, 2011).

Communication during disasters is an important component of disaster respon, to know

about emergencies response, and improve inter-sectoral coordination related emergency

planning processes (National Emergency Communications Plan, 2014). The ambulance

transport service system is part of the first series in health care in the event of a disaster and can

contribute significantly in programs treating and transferring patients to health care facilities

(Heide & Scanlon, 2007).The research objective was to identify the nurse' preparedness in

emergency management system on disaster consisted of emergency response system,

communication network, and ambulance transportation system.

MATERIALS AND METHODS

The study used descriptive quantitative with cross sectional study design. Data collection

techniques used questionnaires of 33 items in dichotomous scales. The questionnaires passed

the validity and relibiality testing. The study was conducted in April, 2018 at Maternal and

Child Hospital of Aceh Province, Banda Aceh, Indonesia. The sampling method using total

sampling of 110 nurses who worked at Maternal and Child Hospital of Banda Aceh. However,

the sample met criteria is 103 respondents. Data analysis used univariate: frequency,

percentage, mean, mode, and standard deviation. This study passed the ethical test of the ethics


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committee team from Faculty of Nursing Syiah Kuala University Banda Aceh with

No.111072260318.

RESULTS AND DISCUSSION

Demographic Data

Demographic data collected at Maternal and Child Hospital of Banda Aceh consisted of

age, sex, duration of work, educational level, workplace/ward, employment status, and

attending emergency/disaster training.

Table 1. Demographic Data Respondents in Hospital Maternal and Child Hospital Banda Aceh

(n = 103)

N Data Frequency Percentage

1 Age (year)

25-35

36-45

46-55

Mean (33.3)

72

26

5

69.9

25.2

4.9

2 Gender

Male

Female

10

93

9.7

90.3

3 Length of working (year)

1-5

6-10

>10

Mean (8.5)

38

40

25

36.9

38.8

24.3

4 Educational level

Diploma III

Diploma IV

Bachelor

63

6

34

61.2

5.8

33.0

5 Place of work

Pediatric ward

Adult ward

PICU

NICU

ICU

EDs

VIP ward

18

11

10

19

11

22

12

17.5

10.7

9.7

18.4

10.7

21.4

11.7

6 Employee status

Gov. employee

Non-Gov. employee

62

41

60.2

39.8

7 Attending emergency training

Yes

No

68

35

66.0

34.0

Nurse’ Preparedness in Emergency Management System on Disaster

Based on the results of the study, nurse’ preparedness in emergency management system

on disaster is ready with the value ≥17 and not ready with the value <17 as showed in the Figure

1. The result of study showed that nurse’ preparedness in emergency management system on

disaster is ready with 76 respondent (73.8%). According to Pourvakhshoori, Norouzi, Ahmadi,

Hosseini, and Khankeh (2017) nurse preparedness is defined as the preparatory actions


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undertaken focusing in the context of disaster management. The result is supported with the

research from Rifai and Harnanto (2016) on the nurse and midwife preparedness in carrying

out the Preparedness for Emergency and Disaster Hospital management in Surakarta hospital

with cross sectional study design. The sample in the study were nurses and midwives for 30

respondents. The results showed that the majority of nurses and midwives had good prepare for

disaster preparedness with the majority of respondents answered ready (86.7%) and not ready

(13.3%). According to the study, the nurse is the first professional care and has a very important

role when disaster occurs.

Figure 1. Nurse’ preparedness in emergency management system on disaster at Maternal and Child Hospital

Banda Aceh

The results of the studies are supported by Geum (2017) mentioned that the

nurse’perception and competency of disaster nursing in South Korea with a sample of 163

nurses who worked in tertiary hospitals in Seoul, Korea.The results showed that core

competency in disaster nursing regarding nurse’ perception and competency on education and

disaster preparedness is good with score 3.14, SD (± 0.79). It is found that awareness and

disaster preparedness is influenced by education of disaster nursing. Thus, ongoing training to

improve core competencies and understanding of disaster nursing should be developed.

Based on the result of the study, showed that nurse’ preparedness in emergency

management system on disaster management at Maternal and Child Hospital Banda Aceh, in

terms of ready (73.8%). This can be supported by the majority of respondents with 6-10 years

working experiened (38.8%), the majority of nurses are in emergency department (EDs) of 22

respondents hence all of the EDs nurses are always ready in case of emergency, and the majority

of nurses have attended in emergency/disaster trainings of 68 respondents (66%). This indicates

that most of nurses in the EDs, intensive care unit, neonatal intensive care unit, perinatal

73.8

26.2

Per

cen

tage

of

Res

po

nd

ent

(%) Ready

Not ready


108


intensive care unit, and inpatient wards are ready to deal with unpredictable catastrophic events

suh as a disaster.

According to observations and interviews conducted by researchers, indicate that all the

care and intensive unit or emergency department at Maternal and Child Hospital already have

good preparedness in respon to disaster. For example, emergency response system has been

available hospital disaster plan and has a disaster management team, nursing support tools and

adequately human resources. In addition, communication networks have been available

optimally such as communication system code red (fire emergency) and code blue (medical

emergency), and the chain of command on disaster response. Furthermore, ambulance

transportation as well as ambulance officers have been stand by if emergency and disaster

struck. The hospital also have worked with several organizations such as government and

local, national dan internatioanl non government organization (NGO) to respon to disaster.

Disaster emergency response in emergency management system on disaster

Based on the results of the study, emergency response system is s ready with the value ≥

4 and not ready with the value <4 as showed in the Figure 2. Based on the results of the study

showed that 55 respondents (53.4%) considered that nurse preparedness in terms of emergency

response system is not ready. The results are supported by a study conducted by Tzeng et al

(2016) mentioned that nurse’ preparedness in disaster response system in Taiwan with 311

respondents found that the majority of respondents are not ready in the disaster response system

(21.38%) including the training aspect related disaster, experience in disaster response and

experience of emergency/intensive care.

Figure 2. Disaster Emergency Response System in Emergency Management System on Disaster.

The results study by Oztekin, Larson, Akahoshi, and Oztekin (2016) studied about nurse’

perceptions of knowledge, skills, and preparedness in disaster with 902 respondents found that

nurses unable to respond in unpredictable situations and disaster. In disaster, The nurses had

46.6

53.4

Per

cen

tage

of

Res

po

nd

ent

(%) Ready

Not ready


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attending a disaster emergency plan but they are not able to perform according to the the real

procedures. It proved that nurses need to know about information in preparation of emergency

disaster, so that they have readiness to respon disaster in the future.

Furthermore, the results of study by Labrague et al (2018) said that nurses is not ready to

response disaster. Exposured to disaster events and provision of disaster-related training and

simulations is an effective way to prepare nurses for disaster management and adequate

response systems. The findings of this review can be informed to nurse educators, hospital

administrators in supporting nurses to have preparedness in emergency response.

Based on interviews and observations conducted by the researchers at Maternal and Child

Hospitals of Banda Aceh, the disaster emergency response system has been set up according to

the hospital disaster plan, in which disaster management team that will provide command

during the disaster through the information center, and evacuation handling procedures are well

managed. The hospital also available standard operating procedure (SOP) for emergency

response and disaster in the hospital but not yet inform optimally to service units such as

inpatient ward, EDs, ICU, PICU, and NICU.

In terms of training, emergency response training has the principles of emergency

handling, bleeding and shock management, cardiopulmonary resuscitation, airway breathing

problem and management. Some of nurses have been trained such as Basic Trauma Life

Support (BTCLS), Hospital Preparednes for Emergencies and Disaster, and Hospital and

Advanced Cardiac Life Support (ACLS). Emergency training such as BTCLS has been trained

annually for all nurses with 73.8%. According to study mentioned that the frequent of training

and disaster simulation will support in the coordination and handling disaster management

effectively so that the impact of disasater can be reduced.

The results of this study is accordance with Kasmawati and Dirhamsyah (2016) on the

analysis of hospital disaster plan policy implementation in the Maternal and Child Hospital

Banda Aceh in respon to earthquake and tsunami disaster. The results obtained are the policies

that have been developed by the hospital still not fully meet the principle of hospital disaster

plan. Maternal and Child Hospital Banda Aceh in implementing disaster preparedness is far

from perfect. The policies that must be considered by the the hospital by making Standard

Operational Procedures (SOP) disaster management team and specify the fuction and tasks of

team.

Communications network in emergency management system on disaster

Based on the results, the communication network is ready with the value ≥ 4 and not

ready with the value <4 as showed in the Figure 3. The results showed that the number of 66


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respondents (64.1%) indicates that communication networks that support nurse’ preparedness

is ready in the hospital. Based on Emergency Response System, communications network used

is guided by the rapid response that emphasizes “time saving is life saving” and is managed by

national command center with has function to providing information in a disaster event and

handling emergency cases as well as should be integrated with PSC 119 P2KK (crisis

management health center) Aceh.

Figure 3. Communication Networks in Emergency Management System on Disaster.

The result of this research supported by Hidayati (2008) about the knowledge of nurses

of the Emergency Department at dr. Sardjito Hospital in disaster preparedness of 45 respondents

using cross sectional study design. Based on the study showed that the communication networks

for knowledge disaster preparedness is good (82%). Furthermore, the study by Simatupang

(2017) on the preparedness of RSPAD Gatot Soebroto Hospital in disaster mitigation to

anticipate the threat of bioterrorism showed that the hospital’ preparedness is good in

communication system (76.90%). The conclusion that the communication should be set

effectively to respon the disaster, hence every health worker have to understand with clear

information and communication.

Based on the study by Budi (2012) on disaster communication: The system coordination,

information and cooperation explained that disaster preparedness, the communication aspect

include by accurate information, coordination and cooperation aspects of disaster events. At the

disaster event, the four aspects of communication, information, cooperation and coordination

are the keys to success of disaster management, especially for the handling of the victims. This

finding can be concluded that an effective communication system can prevent or reduce

mortality and morbidity rate of the victims and disaster response time in emergency response

is to be a first priority.

Based on the results of interviews and observations by researchers found that the

communication network conducted by internal and external organization using the telephone

64.1

35.9

Per

cen

tage

of

Res

po

nd

ent

(%)

Ready

Not ready


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network. Hand talky (HT) is not yet available in the service unit of Maternal and Child Hospital.

Emergency communication still use the coordination of the information center which will notify

the actions or procedures to be performed when emergency service occurs in every ward using

the telephone. In accordance with the research by Anjarsari et al., (2014) explained that

communication planning in disaster preparedness in information delivery, coordination and

control because it is needed communication tools other than telephone and mobile phone, such

as HT to anticipate when disaster occurs when telephone network is disconnected causing

phone off and no signal. This can make it difficult to communication or coordination in the

hospital.

Preparedness in communications network used to by Maternal and Child Hospital based

on “time saving is life saving”, in which every service unit always communication before

transfer patient to the treatment unit. In terms of external hospitals, the hospital is ready to

communication with the Public Safety Center (PSC) 119 Center for Crisis Response of Health

Banda Aceh if has medical emergency cases. The communication network carried out by

Maternal and Child Hospital with other external organization such as with other hospitals is

well established which involves transferring patients to other hospitals using referral letters and

telephone. However, for the communication system for the code blue (medical emergency) is

available in all service units by using telephone communication to EDs.The Maternal and Child

Hospital also available for the code red communication system (fire emergency) in all health

care units with the ready team.

An ambulance transport system in emergency management system on disaster

Based on the results, the ambulance transport system is ready with the value ≥ 3 and not

ready with the value <3 as showed in the Figure 4. The results of the study in Table 5.4, the

majority of respondents (77.7%) indicated is ready in the ambulance transport system.The result

is accordance with study by Soemarko (2004) on evaluation of effectiveness of training and

pre-hospital management education referred to Saiful Anwar Hospital with observational

research method. The results showed that the emergency ambulance transport system was

changed of ± 250% from 1999 to 2003 by operating several new ambulances with trained

personnel in ready preparation. The results of this study found that in case of emergency, the

ambulance transport system has the principle of timeliness such as, when the travel time

increased, the possibility of safety decreased.


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Figure 4. Ambulance Transportation System in Emergency Management System on Disaster.

According to research by Montjai, Mulyadi, and Jill (2017) studied about the description

of the accuracy ambulance personnel used in referring emergency patients at Prof. Dr. R. D.

Kandou Manado hospital, showed that the use of emergency ambulance in referring to

emergency patients is good (86.25%), the patients referred by using emergency ambulances

available with medical emergency equipments. The result of services analysis of emergency

ambulance showed that the operational of service system is good.

According to the clinical policy review literature: non-emergency ambulance transport

showed that the effectiveness of an emergency ambulance transport system is directly related

to the accuracy of medical care needed for patients. The quality of emergency care performed

by health workers and the patient reaches the health care center influence patients survival to

the response time when health workers receive ambulance calls (Clinical Policy: Ambulance

Transportation Non Emergency, 2017).

The interviewed with ambulance officers and observation of facilities and infrastructure

in ambulances conducted by researchers showed that ambulance transportation at Maternal and

Child Hospital is always stand-by in case of emergency medical and emergency disaster. In

March 2018, the hospital received a complete ambulance unit of emergency from non-

government organization (NGO) with complete facilities in handling medical emergency. This

condition was strengtheness the hospital ambulance transport is ready. Furthermore, the hosptal

already had 2 emergency ambulances transport units which consisted of emergency kit, shock

management equipment such as infusion set, infusion liquid, tourniquet, ECG monitor and

cardiopulmonary resuscitation equipments such as bag valve mask, oxygen and nasal cannula

and well-functioning ambulance unit.

According to the researcher, the ambulance readiness with the support of the emergency

set facilities can assist the victim in obtaining the emergency services, hence find quick and

precise handling according to the principle of integrated emergency management system that is

“time saving is life saving”.

77.7

22.3

Per

cen

tage

of

Res

po

nd

ent

(%)

Ready

Not ready


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CONCLUSIONS

The conclusions about the preparedness in emergency management system among nurses

on disaster at Maternal and Child Hospital Banda Aceh are as follows: 1) Nurse preparedness

in emergency management system on disaster in ready (73.8%); 2) Disaster response system

based on nurse’ preparedness in emergency management system on disaster in not ready

(53.4%); 3) Communication network based on nurse’ preparedness in emergency management

system on disaster in ready (64.1%); and 4) An ambulance transport system based on nurse’

preparedness in emergency management system on disaster in ready (77.7%).

ACKNOWLEGEMENTS

The authors would like to thank all the respondents at Maternal and Child Hospital of

Banda Aceh for their full participation in the research, as well as to chief of training and

research of the hospital for their assistance in this research.

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