CHAPTER 2 ADOPTION OF ICT IN INDONESIA
3.2 S YSTEM REQUIREMENTS
The Indonesian Government estimates that there was a total of 129 775 deaths, with 38 786 people missing and 504 518 displaced in Aceh; an area of 886 km2 was destroyed by the tsunami. (BNPB 2009) The Yogyakarta earthquake of 2006 killed 5 716 people, injured 37 927 and caused destruction over an area of 32.5 km2. (BAPPENAS 2006; Hadi 2008) To provide an effective emergency medical communications service, the system that would make a significant impact by reducing casualty mortality and morbidity must first be defined. Figure 3 shows the areas surrounding Banda Aceh city and the Bantul region affected by the disasters. (UN 2009)
Figure 3. Disaster areas in Aceh (left) and Yogyakarta.
Recent studies conclude that early and specialized prehospital patient management contributes to emergency case survival, especially in cases of serious injuries of the head, the spinal cord, and internal organs. Unfortunately, medical staffs in
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the most remote medical posts who usually are the first to handle such situations do not have the required advanced theoretical knowledge and experience. In this situation the proper medical services and applications allow specialized physicians located at a hospital site to coordinate medical staff at field hospital, and the forward and rear medical posts via interactive teleconsultation applications.
Once an emergency medical communication system is provided for doctors and relief staff, to be effective it should be supported by the available medical referral system in a disaster-affected area. This is needed to assist in arranging a triage system to determine the order and priority of emergency treatment. All aspects of an emergency medical service rely on the availability of communications.
The development of any emergency medical communications system in an Aceh or Yogyakarta situation should consider what requirements will meet communication needs, expectations and measures of effectiveness in the disaster-affected area. In order to design a precise specification for an emergency medical communications service, the specific content and operational requirements in such locations are defined below.
To deliver the content, type of service and its requirements for medical emergencies:
1. Voice. Clear voice service is needed to provide:
(a) an interface between doctors and relief staff to ensure proper and efficient treatment for sick and injured disaster victims
(b) on-site control to support incident command in making or responding to immediate requests for assistance and additional equipment for triage and treatment.
According to Komnakos (Komnakos, Vouyioukas, Maglogiannis, and Constantinou 2008) the technical specification for Voice over Internet Protocol
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(VoIP) in emergency medical service support includes a bit rate starting at 12.2 kbps per user for clear voice service, usually using Adaptive Multi-Rate (AMR) codec.
2. Data. Clear multiplex transfer and display of data (text and graphics) are needed to provide:
(a) transmission of text such as secure and non-secure individual and group messaging, multilayered geographic information system (GIS) data, as well as real-time data such as automatic vehicle and personnel location monitoring (b) automatic communication of location information generated to report accurate
location of vehicles and personnel into a synthesized computer command and control system
(c) data transfer of patients’ vital and diagnostic data. There are two important types of data transmitted by relief staff in a disaster-affected area: physiological symptoms and the supporting information about advanced treatment. Vital physiological symptoms should be attached: level of consciousness, heart rate, respiratory rate, systolic and diastolic blood pressure and temperature, together with triage classification information. The supporting information regarding treatment management during transportation should be attached: solutions and administration of drugs for resuscitation, cardio-pulmonary resuscitation (CPR) treatment etc. Although a higher data rate would support better communication quality, these important patient data can be adequately transferred starting from 12 kbps. (Sutiono, Qiantori, Prasetio, Santoso, Suwa, Ohta, Hasan, and Murni 2008)
In order to deliver a collaborative working environment for specialized physicians located at a hospital site and medical staff at dispersed locations,
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teleconsultation service which supported by data transfer of patients’ vital data is required. The important data from digital devices such as digital blood pressure monitor, digital thermometer, respiration, digital audio stethoscope, and electrocardiogram mostly needed to support medical decision in emergency cases. Data rate required to transfer these important data less than 120 kbps (Komnakos, Vouyioukas, Maglogiannis, and Constantinou 2008) 3. Video. Clear and smooth transfer of video images is needed to deliver
patient-specific information to units throughout the medical referral system. Having the capacity for doctors to view the actual patient in conjunction with voice and data assessment information greatly enhances patient care and survivability. A clear video service for emergency medical teams requires a video application codec based upon H.264 or MPEG-4 standards at 384 kbps. (Komnakos, Vouyioukas, Maglogiannis, and Constantinou 2008)
The basic operational requirements for emergency medical services consist of:
(PSWAC 2009)
1. Comfortable terminal (i.e. where computer or mobile device user can work with the terminal server via a network) for quick responses in emergency situations:
The availability of an ad hoc communications network that can routinely adapt an existing comfortable terminal is desirable because it decreases client terminal costs and, more importantly, avoids adaptation constraints so that if new equipment were introduced in an emergency, the system’s ability to support standard and/or popular equipment would reduce set-up and preparation times. In general, such easy-to-use, portable, “comfortable” equipment would help doctors and relief staff to better communicate with each other.
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2. Ubiquitous coverage within a given disaster-affected area.
In cases like the Aceh tsunami where the immediate provision of medical treatment is essential to minimize the death toll, an emergency medical communications infrastructure would be expected to be established within hours and be able to complete a certain basic level of communication service within a couple of days.
However, gradual deployment of a service that progressively increases both the coverage area and the capacity of the service are highly desirable so as to ensure cost-effectiveness of the system.
How large a coverage should such an ad hoc system be designed for, based on the required communication links of a medical referral system? Coverage of service areas that comprise every aspect of health care helps to ensure that the care is not administered in isolation. A medical referral system would enhance the communication linkage with other community health resources and integrate them within the health care system.
The area of service covered by a medical referral system is the top priority of this system. In this study we have defined the area of service as 61.36 km2 for Banda Aceh city for the Aceh tsunami disaster, and 65 km2 within the Bantul region for the Yogyakarta earthquake disaster; the populations of these two areas suffered most from these disasters.
3. Availability of dedicated network capacity to handle unexpected emergencies.
Determining how much network capacity is sufficient depends on the amount of communications traffic among medical staff in a medical referral system, especially in the early stages of a disaster: in the Great Hanshin earthquake (Kobe, Japan, 1995) 29 simultaneous communication channels with a guaranteed service quality were
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needed for the emergency medical services. (Nakajima, Natoria, Takizawab, and Kaiharaa 2001)
4. Highly reliable networks which are engineered and maintained to withstand natural disasters and other emergencies.
Most natural disasters in Indonesia have occurred in isolated areas where natural challenges such as topography, climate, lack of transportation etc. have hampered emergency relief efforts. In order to establish an effective, reliable network which supports communication of voice, data and video in large disaster affected areas, a high bandwidth wireless solution is the most highly recommended. (Komnakos, Vouyioukas, Maglogiannis, and Constantinou 2008)