Emergency medicine and social safety

Recently, the disaster emergency medical system (DEMS) has been considered an important component of social safety, since the incidence of various kinds of disasters such as man-made disasters, biological disasters, chemical disasters and nuclear disasters are increasing each year. To minimize the mortality of emergency patients and mass casualties, emergency physicians should directly participate in both emergency care and DEMS. However, most primary emergency care in hospitals depends on residents of emergency medicine, especially at night and holidays, and few certified emergency physicians work at emergency control centers, military hospitals, and rural hospitals that are part of the DEMS. To strengthen DEMS and improve the quality of emergency care, emergency physicians are needed at emergency centers at all times to provide emergency care, and to maintain communication with the DEMS offices that are outside of hospitals. To make DEMS cost-effective, the governments should unify the 119 and 1339 emergency call centers, and also establish a plan for integrating the DEMS components of the Ministry of Health and Welfare, National Emergency Management Agency, and Military Services. By securing the financial support plan for emergency centers, the survival rate of emergency patients and disaster victims will be improved.

The Difficulty with the Social Safety Net Health Sector Program in Indonesia: Case Study of Health Card Program / 国際保健医療

<b>Introduction</b><br>Republic of Indonesia was badly affected by the economic crisis that began in Thailand in mid 1997. The crisis increased the incidence of poverty in Indonesia, and now it is time to grapple with this chronic poverty from various angles. The objective of this paper was to assess the impacts of the Social Safety Net (SSN) program on the health sector, which aimed to mitigate the effects of economic crisis. We focused on one of the SSN's health sector programs, the health card program, which provided free medical service for poor families. <br>We examined the usefulness and limitations of this program from an administration perspective.<br><b>Methods</b><br>Based on the ‘wealth ranking’ which is used in the field of development assistance, we chose 26 and 34 households that were classed as ‘relatively poor families’ from two villages in a rural area of Central Java, and interviewed households to understand how the health card program was delivered to them.<br><b>Results</b><br>The results indicated that 30 % (8/26) and 56 % (19/34) of the ‘relatively poor families’ have a health card, although half of these households had never used their cards, and half of them couldn't find their cards. Lack of awareness and indifference of medical staffs to the health card are considered to be possible reasons hindering people from using the card. Another reason was that some households felt ashamed to use the health card.<br><b>Conclusions</b><br>We suggest two methods to promote the increased usage of the SSN's health card as follows; first, choose the target household objectively, and secondly, enhance the management of the health sector program by taking advantage of midwives and teachers, as they have experience and can view the situation from a broader perspective. In addition, like any kind of public service, accessibility is an important factor to promote the usage of this health card.