EVAKUASI MEDIK

BLOK XXI

triase

Survei primer

Resusitasi & stabilisasi

transportasi

Survei sekunder

Ugd / rs rujukan

Tindakan definitif

LEARNING OBJ
Define medical evacuation Identify evacuation assets Identify the principles of the medical evacuation system Select planning considerations for medical evacuation Identify the proper mode of evacuation

DEFINITION
process of moving soldiers from the point of injury or illness to a medical treatment facility (MTF) or between MTFs. Each stop in the process provides medical treatment to enhance the soldiers early return to duty (RTD) or to stabilize him/her for further evacuation.

 DEFINITION
process of MOVING VICTIMS from the point of injury or illness to a medical treatment facility (MTF) or between MTFs. Each stop in the process provides medical treatment to enhance or to stabilize the VICTIMS for further evacuation.

GOAL
Preserve life, Prevent further injury, Promote Recovery

CONSIDER BEFORE MEDICAL EVACUATION

1. 2. 3. 4. Patient condition Location of patient Destination of journey Transport availability ( Ground Ambulance, Speed Boat, Helicopter, Commercial flight, Air charter and Air Ambulance)

PRINCIPLE OF MEDICAL EVACUATION

1. Rapidly and efficiently moving the sick, injured, and wounded to an MTF. 2. En route care of patients is essential for optimum success. 3. Evacuation assets must have equal 4. A single, dedicated medical command authority is essential to manage all evacuation assets. 5. Considerations for selecting the appropriate mode of evacuation.

6. Use non-medical assets for casualty transport when necessary 7. Includes both ground and air assets. Augment with medical personnel to provide en route care whenever possible

Patients condition Availability of resources Destination medical treatment facility Tactical situation

PHASE OF MEDICAL EVACUATION

Fase 1
draw the wounded person out from the mined area

Fase 2
complex (urgent) medical help procedures, transport preparations and transport of injured person to the inpatient medical institution

Fase 3
is planned and performed at the in-patient medical institution selected according to the workplace location and type of injuries

Fase 4
consists of injured persons rehabilitation and it is performed by the specialized medical institutions

PHASE 1
Prepared patient to evacuated / transport to collecting point or ambulance

Hospital attendance
Instrument..
First aid and medical equipment

Activities
temporary blocking ( STOP ) of bleeding establishment of blood flow through the veins, primary treatment of wounds, immobilisation and transport preparations PRIMARY SURVEY

PHASE 2
complex urgent medical help procedures, transport preparations and transport of injured person to the inpatient medical by the physician with the medical technician. INSTRUMENT ACTIVITIES
first aid and medical equipment, kit and medications; permanent blocking of bleeding, prevention of occurrence and development of shock, introduction of required therapy, fluid compensation, stabilisation of injured person general state, psychical support, immobilisation and transport to the adequate in-patient medical institution (medical centre, hospital, clinic, clinical hospital etc.) TRIAGE ; PRIMARY & SECONDARY SURVEYS

PLANNING CONSIDERATION
1. Mission, Time
Affects the employment of all units, the medical evacuation must consider the basic tenets which influence the employment of medical evacuation assets.

2. Risk assessment patiemt clinical problem, stability of ABC, D How far forward is it safe to go? 3. Other
Reasonable/unreasonable risks vs. need

Anticipated patient load Expected areas of patient density Availability of medical evacuation resources Availability, location, and type of supporting MTFs Protection afforded medical personnel, patients, and medical units,

COMMUNICATION
Established standards for communicational network of all participants. Effective and efficient communication network is necessary for the safety of all operations Obliged to establish the communications system at the location where the injured is being executed with the Police (police station) and nearest health institution able to provide urgent medical intervention.

TEAM ; QUALIFICATION
Medical technician should be trained to plan the Evacuation, help the physician works. Physician should be trained FOR setting the priorities as well as planning and implementation of training for team and Quality Assurance Officers at skills of administering first aid.
Physician is in constant contact with the nearest medical institution in relation to the workplace. Physician plans and performs the activities of wider healthrelated interest such as vaccination, hygienicepidemiological protection etc., also monitors psycho-physical state and behaviour of deminers and submits

EQUIPMENT
Equipment of medical technician/hospital attendant Doctor equipment Reusable equipment
Bandage and other spending material

Ambulance equipment

MODES (TECHNIQUE) OF EVACUATIONS

Patient acquisition Wounded or ill patients enter the evacuation process by one of the following modes: Walking wounded Manual carries Litter Teams Non-medical evacuation Ground Medical evacuation Air Medical evacuation

GROUND EVACUATION

Advantage Weather has minimum impact Can move with supported unit Less resource- intensive

disadvantage Low speed Short range Must circumvent obstacles Dependent on established road network

AIR EVACUATION
advantage disadvantage High speed Long range Helicopters Adverse weather can transport patients over terrain where evacuation by other means Resource intensive would be difficult or impossible Movement of medical supplies and personnel Reduces patient discomfort

EVACUATION PRIORITY

ABC,D
CATEGORY ACUTE CHANGE FOR LIFE EXAMPLE SHOULD BE EVACUATED SHOULD BE EVACUATED WIYHIN 2 HOURS CONSEQUENCES PRIORITY I ( URGENT ) PRIORITY I

SEVERE INJURY
MINOR INJURY NO INJURY DECEASED

SHOULD BE EVACUATED WITHIN 4 HOURS

PRIORITY II
PRIORITY III,RUTINE PRIORITY CONVENIENCE

DEAD ON IDENTIFICATION DEAD ON ARRIVAL DOWNGRADED FROM ABOVE

COLLECTION OF GUARDING

TO MOVE OR NOT TO MOVE

(1) the nature of the injury; (2) the distance to safety; and (3) the number of people available to help. victims who have minor injuries to the upper extremities or a minor leg injury ought to be able to hobble out with some help. If the injury is serious, the wisest course is to send a reliable member for help while at least one person remains to care for the victim. Never leave someone alone who is disoriented or unconscious. do not attempt to transport anyone who has chest, spine, abdominal, or head injuries unless waiting for a rescue party will be of greater risk than moving the victim.

STEPS IN INJURED MAN HANDLING

1. Casualties evacuated by manual means must be carefully handled. 2. Rough or improper handling may cause further injury to the casualty. 3. The evacuation effort should be organized and performed methodically. 4. Each movement made in lifting or moving casualties should be performed as deliberately and as gently as possible. 5. Casualties should not be moved before the type and extent of their injuries are evaluated and the required first aid (self-aid, buddy aid, or combat lifesaver) or Emergency Medical Treatment (combat medic or ambulance crew) is administered.

STEPS TAKEN PRIOR TO MOVING THE CASUALTY:

1. 2. 3. Many lifesaving and life-preserving measures are carried out before evacuating injured Except in extreme emergencies, the type and extent of injuries must be evaluated before any movement of the casualty is attempted Measures are taken, as needed, to:
Open the airway and restore breathing and heartbeat Stop bleeding prevent or control shock Protect the wound from further contamination

4.

1. 2. 3.

1.

When a fracture is evident or suspected, the injured part must be immobilized

Every precaution must be taken to prevent broken ends of bone from cutting through muscle, blood vessels, nerves, and skin When a casualty has a serious wound, the dressing over the wound should be reinforced to provide additional protection during manual evacuation

2.

RULES FOR BEARERS

1. Improper handling of a casualty can result in injury to the bearers as well as to the casualty 2. To minimize disabling injuries (muscle strain, sprains, or other injuries) that could hamper the evacuation effort
1. 2. 3. 4. 5.

6.
7.

Use the body's natural system of levers when lifting and moving a casualty. Know your physical capabilities and limitations Maintain solid footing when lifting and transporting a casualty Use the leg muscles (not the back muscles) when lifting or lowering a casualty Use the shoulder and leg muscles (not the back muscles) when carrying or standing with a casualty Keep the back straight; use arms and shoulders when pulling a casualty Work in unison with other bearers, using deliberate, gradual movements. .Slide or roll, rather than lift, heavy objects that must be moved Rest frequently, or whenever possible, while transporting a casualty

MANUAL CATEGORIES CARRIES

One man carries Two man carries Special manual evacuation technique
Limited access position From the vehicle, tank, car, Drawning

POSITION OF INJURED
1. 2. 3. 4. The first step in any manual carry is to position the casualty to be lifted. If conscious, the casualty should be told how s/he is to be positioned and transported. This helps to lessen the casualty's fear of movement and to gain cooperation. It may be necessary to roll the casualty onto their abdomen, or back, depending upon the position in which s/he is lying and the particular carry to be used.
1.
1. 2. 3. 4.

To roll a casualty onto their abdomen

Kneel at the casualty's uninjured side Place his arms above his head; cross his ankle which is farther from you over the one that is closer to you Place one of your hands on the shoulder which is farther from you; place your other hand in the area of his hip or thigh Roll the casualty gently toward you onto their abdomen

2.

To roll a casualty onto their back, follow the same procedure described in above, except gently roll the casualty onto his back, rather than onto their abdomen

CARRY THE INJURED ON A LITTER

1. 2. 3. 4. 5. 6. 7. Position one rescuer at the head to serve as leader and to monitor head and neck stability. Position the other rescuers along the sides of the litter, at least two to a side, trying to keep people of roughly equal height opposite each other. Grab the litter through the appropriate hand-hold. Use whichever hand is appropriate to the direction you'll be walking. Lift on the leader's call: "Lift on 3 - 1, 2, 3! Adjust each rescuer's lifting height as necessary to keep the injured person level. Begin moving on the leader's call: "Move on 3 - 1, 2, 3! Walk for as long as you can before resting, following the leader's calls, commands and warnings at all times. Leader: be scanning ahead for obstacles and dangers, as well as monitoring the stability of the head and neck and issuing commands as necessary to keep the injured person level. Stop when necessary (to monitor injuries, to re-secure knots, or to rest): notify the leader that you need to stop and follow the leader's calls: "Stop on 3 - 1, 2, 3!" and "Down on 3 - 1, 2, 3! Attend to any injuries that require monitoring. Re-secure the ropes wherever they may have come loose. Readjust the padding as necessary, especially under the buttocks and under the heels, since a spine-injured person will not sense a cutoff in circulation. Repeat the above steps in order when you're ready to start again.

8. 9. 10. 11. 12.

Back pack carry

Fire man carry

Four hands carry

Pole carry