Sumbawa is an Indonesian island, in the middle of the Lesser Sunda Islands chain, with Lombok to the west, Flores to the east, and Sumba further to the southeast. It is part of the province of West Nusa Tenggara, but there are presently steps being taken by the Indonesian government to turn the island into a separate province. Traditionally the island is known as the source of sappanwood used to make red dye, as well as honey and sandalwood. Its savanna-like climate and vast grassland is used to breed horses and cattle and to hunt deer.

Sumbawa has an area (including minor offshore islands) of 15.448 square kilometres (three times the size of Lombok) with a current population in January 2014 of around 1,39 million. It marks the boundary between the islands to the west, which were influenced by religion and culture spreading from India, and the region to the east that was less influenced. In particular this applies to both Hinduism and Islam.

Sumbawa Regency (Indonesian: Kabupaten Sumbawa) is a Regency (Kabupaten) of the Indonesian Province of West Nusa Tenggara, the others are West Sumbawa Regency, Dompu Regency, Bima Regency and City of Bima. It is located on the island of Sumbawa and covers an area of 6.643,98 km2. It includes the substantial island of Moyo, lying off the north coast of Sumbawa. The population of the Regency at the 2010 Census was 415.363, but the latest official estimate (as at January 2014) is 434.469. The capital is Sumbawa Besar, a town with 56.337 inhabitants at the 2010 Census and covers an area of 1.277,81 km2 .

In Sumbawa Regency, there are two goverment hospital, one own by the regency and the other own by the province. Cardio-Cerebrovascular disease and trauma are the principal cause of deaths in hospital.

Pre hospital care system in Sumbawa is complex. Eventhough mainly the system based in hospital, but there are ambulances operating from community clinic and from the local red crescent agent. Major portion of ambulance activities is interfacility transfer. Only few call for true emergency cases. EMS services ranging from providing basic transportation (scoop and run), first aid or basic life support up to offering advanced care with the presence of trained healthcare providers.

Rural parts of Sumbawa Regency are extremly limited in the accessibility of helath care and sometimes impossible at night and during local disaster like landslide or flooding. In these areas, to develop infrastructure for initial resuscitation and stabilization as well as efficient and efective retrieval medicine may be a priority.

There are many components of essential EMS can be implemented in pre hospital care system in Sumbawa, but two components are reasonable to be targeted at the initial stage, with gradual implementation of the others as the system matures.

1. Training

There is no standardised certification for prehospital care providers in Indonesia. In some training, they will get 5 days General Emergency Life Support (GELS), or 5 days Basic Trauma Life Support (BTLS), or only 1 day Basic Life Support (BLS). Ambulances are staffing by nurses that have no specific training in prehospital care, occasionally together wth medical doctor. Ambulance driver has no formal medical training and no spesific training to handle such vehicle.

Spesific national paramedic training institute do not existed. Few private ambulance providers have started their own paramedic training programs, but their curriculum have not been evaluated as a standardized curriculum.

All of this resulted in wide range variety quality of prehospital care, no standard management protocol and many interfacility transfer policy.

Short term target:

1. to define what is the appropiate level of knowledge, skills and competency among EMS personels.

2. to have policy by the local goverment authority to legislate EMS.

3. to form a group of doctors and nurses trained as instructor in Prehospital Life Support or Emergency Life Support Basic (EMT-B) or Basic Life Support (BLS), so that they can formulate local EMS training center.

4. to develop training and regulary re-certificate all of healthcare personnel manned the ambulance involve in EMS.

2. Dispatch

Accurate data about cardiac arrest in Sumbawa Regency is not known. Most of the cases happened at home. Community is not aware the incident is cardiac arrest and an emergency critical situation. Whenever someone collapse suddenly, it is common to relate it as fainted or superstitious beliefs. AED or defibrillator only available in hospital. Even the community clinic do not have it.

Coordination cross agencies is not well developed. Whenever an incident occurred, police-fireman-SAR team-ambulance have no clear and understanding position. Commonly victims brought directly to the hospital by non trained personnel, and no notification calls to Emergency Department.

Recently there is no dedicated dispatch center in Sumbawa Regency. One number already used for emergency call, that is 119, but minimal effort has been done to socialized the number. Most of community still don't know where to call when there is emergency. All crew in emergency department can pick up the calls, but there is no protocol system how to handle the calls neither logbook to document the calls. 119 as number for emergency call only has one line, so whenever a call comes in, other people calling the number may encounter a busy notification.

Ambulances in Sumbawa Regency varies in design and equipment. There are few types of ambulances, each hospital has their own 'standards' ambulances. Nationally there was regulation by the Minister of Health in 2009, but adherence by ambulance providers are low because there is no penalty. All of ambulances have not tested for safety. Decision to purchase new ambulance is based by availability of spare parts within the region.

Short term target:

1. to rise public knowledge and willingness to learn CPR and AED.

2. to coordinate with local goverment authorities to gain more AED and put them in public areas.

3. to initiate a dedicated place to be a dispatch center.

4. to socialize 119  as an emergency call in the community.

5. to form a dedicated and trained a dispatch team.

6. to formulate a logbook and a protocol system.

7. to obtain, analyze, and present pre hospital care data to local goverment authorities.

8. to have multiple line for 119.

9. to define a clear plan about budget for manpower and infrastructure.

10. to coordinate and support medically with other specialists, goverment officials, police and SAR (Search and Rescue) Team when there is an incident.

11. to define type, standard design and safety of ambulance.

Tentang Penulis

dr. Jollis, Sp.EM adalah kepala instalasi gawat darurat di RSUD Sumbawa, Menyelesaikan pendidikan spesialis emergency pada tahun 2011, menyelesaikan Emergency Medical Service (EMS) fellowship di singapore general hospital tahun 2016, dan fellowship in critical and emergency ultrasound tahun 2017 di Malaysia.