Summary Of National Management Guidelines: Fill & Download for Free

The United Nations Convention on the Law of the Sea (UNCLOS) codifies international agreements concerning the oceans and seas of the world.The Law of the Sea Convention defines the rights and responsibilities of nations with respect to their use of the world's oceans, establishing guidelines for businesses, the environment, and the management of marine natural resources.A summary of the United Nations Division for Ocean Affairs and the Law of the Sea efforts can be found here.In addition, individual nations establish laws and policies regarding protection of the oceans. For example, in the US, the EPA has a variety of international cooperation programs regarding protection of the marine environment. It also has a variety of programs for protecting the waters and coasts around the USA.When I flew patrol planes for the Navy, we occasionally witnessed ships cleaning their ballast tanks. There are rules concerning where they can do this - if they were doing it in the wrong place, we would alert the Coast Guard.

The cell culture is generally decided by identifying the situation (cells, eggs, cultured bacteria) that allows preparation of lots of vaccine, with maximum safety.About the only case where allergies are relevant is when the vaccine is grown in eggs (i.e. flu vaccine). In that case, it was recommended that people allergic to eggs should not get the shot. More recently, it's been determined that even most people who are allergic to eggs can get the flu shot, though there are more caveats attached:All currently available influenza vaccines are prepared by inoculation of virus into chicken eggs. Hypersensitivity to eggs has been listed as a contraindication to receipt of influenza vaccine on most package inserts. However, several recent studies have documented safe receipt of TIV in persons with egg allergy (21--29), and recent revisions of some TIV package inserts note that only a severe allergic reaction (e.g., anaphylaxis) to egg protein is a contraindication. In general, these studies include relatively fewer persons reporting a history of anaphylactic reaction to egg, compared with less severe reactions. Several documents providing guidance on use of influenza vaccine in persons with egg allergy have been published recently (30--32).--Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2011The references cited in that paragraph are:21. Bierman CW, Shapiro GG, Pierson WE, Taylor JW, Foy HM, Fox JP. Safety of influenza vaccination in allergic children. J Infect Dis 1977;136(Suppl):S652--5.22. James JM, Zeiger RS, Lester MR, et al. Safe administration of influenza vaccine to patients with egg allergy. J Pediatr 1998;133:624--8.23. Esposito S, Gasparini C, Martelli A, et al. Safe administration of an inactivated virosomal adjuvanted influenza vaccine in asthmatic children with egg allergy. Vaccine 2008;26:4664--8.24. Chung EY, Huang L, Schneider L. Safety of influenza vaccine administration in egg-allergic patients. Pediatrics 2010;125:e1024--30.25. Gagnon R, Primeau MN, Des Roches A, et al. Safe vaccination of patients with egg allergy with an adjuvanted pandemic H1N1 vaccine. J Allergy Clin Immunol 2010;126:317--23.26. Greenhawt MJ, Chernin AS, Howe L, Li JT, Sanders G. The safety of the H1N1 influenza A vaccine in egg allergic individuals. Ann Allergy Asthma Immunol 2010;105:387--93.27. Owens G, MacGinnitie A. Higher-ovalbumin-content influenza vaccines are well tolerated in children with egg allergy. J Allergy Clin Immunol 2011;127:264--5.28. Webb L, Petersen M, Boden S, et al. Single-dose influenza vaccination of patients with egg allergy in a multicenter study. J Allergy Clin Immunol 2011;128:218--9.29. Howe LE, Conlon ASC, Greenhawt MJ, Sanders GM. Safe administration of seasonal influenza vaccine to children with egg allergy of all severities. Ann Allergy Asthma Immunol 2011;106:446--7.30. National Institutes of Health. Guidelines for the diagnosis and management of food allergies in the United States: summary of the NIAID-sponsored expert panel report. December 2010. Available at Food Allergy Clinical Practice Guidelines. Accessed August 15, 2011.31. Greenhawt MJ, Li JT. Administering influenza vaccine to egg allergic recipients: a focused practice parameter update. Ann Allergy Asthma Immunol 201;106:11--6.32. Bernstein HH. Guidance offered on giving influenza vaccine to egg allergic patients. AAP News 2010;31:12.

Thank you for the A2A. Wow these are multiple questions at once! Prepare for a long answer. Probably the longest one I’ve ever written!Original question: How is disaster response organized in Indonesia? How does BNPB work at disaster? How is medical help organized?-PART ONE: How is disaster response organized in Indonesia? How does BNPB work at disaster?Answering these two questions together. You might want to quick read my answer about disaster management cycle in general first to get a picture how the whole strategy is designed. Let me show the illustrated cycle:Variety of the 4 phases of the cycle exists around the world but these 4 phases are the main ones you should know first:[1][2]Mitigation - Minimizing the effects of disaster.Examples: building codes and zoning; vulnerability analyses; public education.Preparedness - Planning how to respond.Examples: preparedness plans; emergency exercises/training; warning systems.Response - Efforts to minimize the hazards created by a disaster.Examples: search and rescue; emergency relief .Recovery - Returning the community to normal.Examples: temporary housing; grants; medical care.The whole disaster cycle is done by the organization structure Incident Command System practiced on many nations that is used for emergency response against various population threat (hostage crisis, terrorist attack, natural and man-made accidents, etc).Back to IndonesiaWhat you first need to know is that in Indonesia a rough equivalent of USA’s FEMA, called the BNPB (Badan Nasional Penanggulangan Bencana/Indonesian National Board for Disaster Management), is the highest authority that reports directly under the President. It is one of the non-ministrial goverment agency formed in 2008 with the following duty:[3]Provide guidance and direction on disaster management effort that includes disaster prevention, emergency response, rehabilitation, and reconstruction in a fair and equitableAssigning the standardization and implementation of disaster management needs based on laws and regulationsDelivering information to community disaster management activitiesDisaster management reporting to the President once a month in normal conditions and at all times in a state of emergencyUse and account for donations / support national and internationalAccount for the use of funds received from the State BudgetCarry out other obligations in accordance with laws and regulationsDevelop guidelines for the establishment of the Regional Disaster Management AgencyThey are at the top center of the whole system, overseeing how the whole 4 phases of the disaster cycle are run. They coordinate how civilian, military, NGO, and government agencies of various sectors work together to as a joint task force.[4] External supports from both NGOs and international organization (such as those from UN) are to coordinate with BNPB to be integrated into the task force. To be more specific, the local/regional disaster management board (BPBD: Badan Penanggulangan Bencana Daerah) is directly responsible for the joint task force. [4] Inside the joint task force there are various units such as: Law&security, logs, information, storage, search and rescue, psychological, sheltering, sanitary, communication, medical, transportation, public relations, evacuation, and more I’ve yet to mention.Other than leading the various regional BPBDs for all 4 phases of disaster cycles, the BNPB have their own quick rapid response teams, they are called The Indonesia Rapid Response and Assistance (INDRRA) or Satuan Reaksi Cepat Penanggulangan Bencana (SRCPB). They are specific stand-by team (see team structure below) that goes ahead while the BNPB coordinates the BPBD and external forces to form joint task force from various organizations. Usually they either arrive first, with or after local search-rescue team or Basarnas. Their main job includes immediate rapid assessment of damage & needs while administering rescue and relief efforts.[5] On their way of doing rapid response, other rapid response team/tim reaksi cepat (from community based/volunteers, local Red cross, etc) may join together as part of the SRC team to help in medical assistance, search and rescue, sanitation, logistic, etc. Take note that in disaster always expect that the demand for help may be beyond current their capacity. So any help will be organized quickly for efficiency.Below is how BNPB and BPBD hierarchy relates to the government level. BNPB is on the same level or ministries, while BPBD works on both provincial and regency level. [7]Disaster management law and status declaration [4] [5]Disaster management in Indonesia is governed by the LAW OF THE REPUBLIC OF INDONESIA NUMBER 24 OF 2007 CONCERNING DISASTER MANAGEMENT (English)[6]Regarding disaster status declaration let me quote the text from Indonesia: Disaster Management Reference Handbook 2015 page 48:As authorized by the disaster management law, the Government decides on the disaster emergency status dependent on the scale of the disaster.• National disaster emergency status declared by the President• Provincial disaster emergency status declared by the Governor• Regency/City disaster emergency status declared by the Regent/MayorOnce a disaster emergency status has been declared the National and Regional Disaster Management Agencies (BNPB & BPBD) obtain easy access to:• Mobilization of human resources, equipment, and logistics• Immigration, excise, and quarantine• Licensing• Procurement of goods/services• Management and accountability for money and/or goods• Rescue• Command over sectors/institutionsThe 2004 Indian Ocean earthquake and tsunami, is an example of national disaster emergency status declared by the president (which would’ve been led by BNPB if it was formed before that time). The recent mount Agung volcano evacuation is mainly led by BPBD of Bali province together with the lower BPBD of its regency.Other regulations follows after the 2007 initial organization (table taken from here) [7]Now so many different government and external agencies of various sectors, it can look confusing how one is given task and another. The table below is example of programs outline for tsunami disaster from the appendix of the BNPB national disaster management plan book.[5] It’s divided into Mitigation, preparedness, early warning, emergency response, and rehabilitation & reconstruction. See how various agencies such as the BMKG, LIPI, ministry of maritime affairs, LIPI are involved in mitigating disasters by mapping disaster risk areas. Kementrian PU is involved on structural mitigation. Contigency plan is designed, led by BNPB, with joint effort with Ministry of Health,TNI, Polri, Ministry of Energy and Mineral Resource, etc. Early warning is led by BNPB. Initial assessment and emergency response is led by the SRC, followed search-rescue, evacuation and medical response by Basarnas (National search and rescue agency), TNI (Indonesian National Armed Forces), POLRI (Indonesian National Police), Ministry of Health, and the Indonesian Red Cross. During rehabilitation-reconstruction, the Bappenas (Badan Perencanaan Pembangunan Nasional/Ministry of National Development Planning) is involved in starting the reconstruction until finishing. Finance minister is involved in damage & loss assessment and reconstruction planning. Ministry of Health and Social continues their ongoing medical-psychosocial support. See table below for the comprehensive list. Other NGOs with their specific skills assist the following disaster management roles accordingly.-PART TWO: How is medical help organized?Prior to reading this part I strongly recommend reading my other answer here to get a picture how medical help is organized on the field during emergency response phase:Alrein Putrananda's answer to What is the first aid in an accident?-Below are the three official medical providers during disaster management. More often than not, their work overlap each other. By official agencies, I exclude NGOs.A. Center for Health Crisis Management (Pusat Penanggulangan Krisis Kesehatan: PPKKOrganized planned medical response to disasters by the ministry of health started in 1991. Today, i’s called the Center for Health Crisis Management (Pusat Penanggulangan Krisis Kesehatan: PPKK).[7]See table below for it’s history.It’s a specific department under the Ministry of Health consisting of monitor-information, emergency response-recovery, and prevention-mitigation & preparedness unit. They coordinate with BNPB or BPBD with and the local public health office (Dinas Kesehatan/Dinkes). [7]B. Medical Response Team (MRT)Almost every local health office and hospital has a Medical Response Team (MRT) that includes, doctors, nurses, logisticians and drivers. The regional PPKK is involved in quality assurance of the MRT in accordance with their guideline.[8] Below is a summary of the MRT: [7] [8]The Ministry of Health has regulation on the Guideline of Human Health Resources on Disaster Management (as of Kepmenkes No. 66/Menkes/SK/II/2006), composition and minimum qualification requirements:[7] [8]C. The Indonesian Red CrossThe Indonesia Red Cross (PMI) in coordinance with the BPBD-BNPB part of the joint-task force on medical sector, sets up a command post (a.k.a POSKO) at its headquarters and the disaster scene. The HQ’s POSKO coordinates with regional PMI and the International Federation of Red Cross and Red Crescent Societies (IFRC), as well as other concerned organizations such as POSKO of the local government, BNPB/BPBD.PMI also privdes Medical Action Team (MAT) at the request of the central/local government, foreign government or IFRC. They are usually mobilized by a district PMI in cooperation with volunteer groups (TSR/Tenaga Suka Rela) registered from medical education institutions. MAT is composed of doctors, nurses, midwives, pharmacologists, drivers, logisticians, and first responders. When emergency response and rehabilitation phase have passed, PMI provides first aid training for volunteers, private companies, and community-based organization as part of their emergency preparedness education for the community.I’ve yet to explain about field hospital. But, I’m close to falling asleep. That is all for today I will update this as soon as possible.Footnotes[1] The Disaster Management Cycle[2] Disaster Management: A Disaster Manager's Handbook[3] BADAN NASIONAL PENANGGULANGAN BENCANA[4] Indonesia: Disaster Management Reference Handbook 2015[5] https://www.bnpb.go.id//uploads/renas/1/BUKU%20RENAS%20PB.pdf[6] http://www.ifrc.org/docs/IDRL/956EN.pdf[7] The survey on the current situation of disaster/emergency medicine system in the ASEAN region : fina l report. -[8] Buku Pedoman Teknis PKK-AB