The demand for carbon fuels is taking oil and gas companies to increasingly challenging and remote locations. As these companies go farther to explore and drill the logistics of ensuring their employees’ health and safety become complex. Dr Phil Sharples examines how an integrated approach to medical delivery and assistance is helping ensure optimum health for employees in the oil and gas industry
When a company’s staff are days from the nearest hospital, making sure they are safe in the event of an emergency requires detailed planning and training. Solutions are inevitably tailored to location, the political climate and local resources, so when it comes to providing medical care and assistance to workers on remote oil fields, it’s unlikely that any two contingency plans for any two locations will be the same. Understanding each project is key to ensuring things go right when something goes wrong.
Assessing the risks
The traditional focus for assistance in the oil and gas industry has been managing medical emergencies, where a local risk assessment is fundamental to good planning. But this is just one aspect of an intricate process: designing appropriate health, safety and assistance services is a product of many factors. These are typically detailed in a Medical Emergency Response Plan – or MERP – tailored for each individual oil and gas client.
A MERP is a detailed document that identifies both key stakeholders and the medical and logistical resources available in the event of a medical emergency. The stakeholders include all the players that interact to make sure a patient is well taken care of: the captain/master or operations managers at the rig; the company’s Health, Safety and Environmental department; the shore agents; the assistance company; and the health insurance company. The MERP clarifies the roles and responsibilities for each person involved in co-ordinating the necessary assistance, and assesses local medical assets together with alternative international destinations where more appropriate healthcare could be accessed. The end product is a document that includes a clear process for primary evacuation from the rig to an appropriate nearby hospital and evacuation to an international centre of excellence. It details contingency contacts including local agents, such as those that might be used to co-ordinate a ground ambulance to get into a port, for example; and describes the information needed from the medic, the rig master, or ops manager – or any combination of them – when making an assistance call. Such information will include passport details, a medical report, and socio-cultural data for the patient. The MERT also identifies pre-accredited hospitals and those to avoid, and examines resources for transportation – both air and ground. It also looks at security information pertaining to the primary evacuation city, such as kidnapping risks, political issues and any security issues potentially affecting transportation to the airport. If a significant risk is detected, the assistance company will involve its security department to best manage that risk.
A MERP is a detailed document that identifies both key stakeholders and the medical and logistical resources available in the event of a medical emergency
It’s a valuable resource that keeps control of the decision to initiate an assistance procedure firmly in the hands of the client. Most importantly, in an emergency, the MERP can be put into action immediately – no intermediaries, no delays.
Minimising the risks
Besides carrying out a local risk assessment, the second key factor in evaluating what assistance services are needed in any given situation is to look at the employees’/crew’s overall fitness – an issue that is increasingly important when dealing with oil and gas clients. A medical director in the oil and gas industry recently revealed that employees working at his remote site finish their first year away an average of 10 kilograms heavier than the day they started. Many organisations are tracking a rise in Body Mass Index among their employees – the oil and gas industry is no exception.1 Chronic diseases, such as heart disease, high blood pressure and diabetes, are a daily challenge for teams trying to ensure duty of care for oil and gas crews.
In a sector at the forefront of health and safety, the oil and gas industry has, however, achieved a significant reduction in work-related injuries over the last 30 years. Yet this success is not reflected by an equivalent fall in the number of medical evacuations. The real health threats to oil and gas workers are acute medical conditions rather than trauma and accidents.2
Pre-deployment screening can identify employees who carry a significant medical risk, such as a staff member who may be suffering from diabetes that is not well-controlled. In this situation, the best advice might be that the staff member does not take part in a particular remote project because of the high risks it would involve.
Innovation through integration
One of the most significant factors attributable to enhancing assistance to remote exploration operations is the ability to integrate essential services to improve the speed and appropriateness of response. This often involves combining the support of an onsite medic and integrated medical case management with international network reach, security analysis and family support.
In an emergency, the factors for success are often the things that lead to the best medical decision-making. The analysis and support provided by an onsite medic means that sometimes an unnecessary medevac, which is never without risk, can be avoided. An integrated global network of pre-accredited hospitals gives the assistance team greater flexibility in planning their response: the right solution and equipment may not be in-country, but still only a short hop away.
At the point when an incident becomes an emergency, a close relationship between the medic and the assistance team is vital to improving outcomes. The mutual understanding between medic and assistance team of each other’s practices, protocols and skill levels can significantly enhance decision-making for all parties, saving valuable time when time is of the essence.
Self-sufficiency at sea
A remote medic is essential for off-shore operations where crews are operating so far from land that an emergency evacuation by helicopter isn’t an option. The solution is to be medically self-sufficient onboard, with a trained emergency medic and equipment to stabilise a patient while the ship or transfer vessel heads for shore. In addition, where there is an onsite medic, they can help the crew enhance its life-saving skills, improving overall response in an emergency, through first-aid training.
At the point when an incident becomes an emergency, a close relationship between the medic and the assistance team is vital to improving outcomes
Here’s a real-life example of how such training has been used: In Turkey, in September 2012, a FrontierMEDEX remote medic was able to stabilise and evacuate four oil and gas personnel injured with gunshot and shrapnel wounds when their outbound helicopter was hit by heavy small-arms fire. At the medic’s side was a client drilling team, one member of which had been trained by the medic onsite to help in worst-case scenarios. This member’s ability to perform life-saving tasks – applying pressure to bleeding and maintaining airways – under extreme duress was critical in the successful evacuation and outcomes of all involved personnel.
Localisation on land
For long-term, land-based operations, oil and gas companies are now looking to develop local resources, building medical delivery and assistance solutions around investment in local communities that will leave a long-term legacy, not only for the company itself, but often for the whole country. In Iraq, FrontierMEDEX is helping one oil company train local people as ambulance drivers, with a view to launching a local ambulance service, the first of its kind in-country and an innovation in planning assistance. The company has also opened a clinic staffed by Western doctors in the Rumaila oilfield in Iraq and helped a leading African oil company to pioneer the training of local doctors in Uganda. The integration of Western-standard clinics able to provide emergency treatment and in-country diagnostics, together with more local doctors trained to Western standards, will help the oil and gas industry rethink its approach to assistance, replacing a reliance on evacuation by air with an ability to support more employees on the ground, while at the same time saving on costs without compromising on standards.
Offshore – in reach
Alongside localisation initiatives, new technology is transforming medical delivery and assistance in remote places. Telemedicine – medical and communications technology – is channelling expert medical advice from around the world right to the heart of offshore seismic vessels and drilling rigs, providing vital support in a crisis. Remote patient monitoring means onshore levels of care can be achieved with offshore delivery, real-time resources can be placed directly at the bedside, diagnosis and decision-making capabilities are improved; and a worldwide network of dedicated trauma and emergency medicine specialists can be integrated into the offshore assistance process.
Planning for change
The oil and gas industry has been hit by more than just medical challenges over the last few years. Political instability across the Middle East and other parts of Africa put a sharp focus on the need to prepare for uprising and unrest. Rapid response planning and up-to-date security intelligence are becoming essential for an industry that is increasingly a target, especially when considering that costs for organisations who prepare are ten times less than those that leave it to chance.
"The oil and gas industry has been hit by more than just medical challenges over the last few years"
In a world of change, one thing is constant. Wherever it goes, the oil and gas industry continues to set challenges for the assistance industry, and the assistance industry continues to look ahead and rise to them. It’s a process of enhancement that makes us all, wherever we are, safer and more productive.