Managing healthfor field operationsin oil and gasactivitiesA guide for managers and supervisorsin the oil and gas industryPhotographs reproduced courtesy of the following: cover, upper left: Shutterstock.com; upper centre and bottom:iStockphoto.com; upper right: Photos.com pages 12, 13, 14 and 34: Shutterstock.com; pages 4, 6, 9, 11, 15,16, 19, 20, 21: iStockphoto.com; page 18: Corbis.
IPIECA • OGPiiMANAGING HEALTH FOR FIELD OPERATIONS IN OIL AND GAS ACTIVITIESContentsIntroduction 1Health management systems 1Occupational health 2Health risk assessment and planning 3Industrial hygiene and control ofworkplace exposures 4Medical emergency management 5Management of ill healthin the workplace 9Fitness for task assessment andhealth surveillance 16Health impact assessment 17Health reporting and recordmanagement 17Public health interface andpromotion of good health 19Glossary 22Annex 1Health audit for managers 23Annex 2Guidelines for medical evacuation byground, air and water 28Annex 3Guidelines for health-care professionals:knowledge, skills and medical kits 31Annex 4Local medical facility audit template 35
All companies, whether operators or contractors,have a commitment to protect and promote thehealth of those affected, either directly or indirectly,by field operations in the oil and gas industry. Thisis best achieved by establishing an effective healthmanagement system. The purpose of this documentis to assist companies working within this sector toachieve and maintain high standards of healthmanagement for all people associated with fieldoperations.This document supersedes the previous editionpublished by OGP in May 2003. The aim has beento simplify and integrate into one document therecommendations that the OGP/IPIECA HealthSubcommittee considers essential for optimal healthmanagement, from conception and throughout theentire duration of a field operation.The following section on Health management systemsprovides a basis for the establishment of an effectivehealth management system. The subsequent sectionsprovide guidance on the specific occupational healthaspects of such a system which should be appliedduring field operations in oil and gas activities, asdescribed in the OGP/IPIECA report number 393,Health performance indicators: a guide for the oiland gas industry.1MANAGING HEALTH FOR FIELD OPERATIONS IN OIL AND GAS ACTIVITIESIntroductionA health management system enables anorganization to control its health risks and toachieve higher standards of performance by meansof continuous improvement.The system should convey the company’s structure,responsibilities, practices, procedures and resourcesfor implementing health management, includingprocesses to identify root causes of poorperformance, prevent recurrences and drivecontinuous improvement.The benefits of effective health management include:G ensuring patient safety;G eliminating illness related to work;G managing medical care;G maintaining a healthy workforce;G optimizing business performance andreputation;G meeting legal requirements; andG ensuring cost-effectiveness.The system should be designed to complementnational and international standards andregulatory requirements as necessary, as well asindividual corporate health guidelines within whichcompanies and contractors conduct their business.For further guidance on how contractors andsubcontractors should be incorporated into thehealth management system of contracted fieldoperations, see OGP report number 4231. The keyoutcome of a successful health management systemis that health performance meets both companyand statutory requirements and demonstratescontinual improvement.The key components of any health managementsystem are similar and should include the following(E&P Forum, 1994)2:G leadership and commitment;G policy and strategic objectives;G organization, responsibilities, resources,standards and documentation;Health management systems1 OGP, 2010. HSE Management—guidelines for working together in a contract environment. (OGP report number 423)2 E&P Forum (now OGP), 1994. Guidelines for the development and application of health, safety and environmentalmanagement systems. E&P Forum report number 210.
G risk management;G planning and procedures;G implementation and performance monitoring;andG audit and management review.Examples of health management systems that areutilized within the industry have been published byOGP1, API3 and the OHS Group4.An example of a health self-audit template for useby managers can be found in Annex 1.IPIECA • OGP2Occupational health is an integral part of thehealth management system. It is concerned with theinterrelationship between work and health, i.e. theeffects of work on health and the effects of people’shealth on their capacity to work.The purpose of an occupational health service is to:G protect, promote and maintain the health, safetyand welfare of people at work;G advise on the provision of safe and healthyconditions by informed assessment of thephysical and psychological aspects of theworking environment;G identify and advise management on the causesof occupational disease and injury and themeans of their prevention;G advise on the rehabilitation and placement insuitable work of those temporarily orpermanently incapacitated by illness or injury;andG assist in the planning and preparedness ofemergency response plans.To achieve these aims, a team approach shouldbe taken by occupational physicians,occupational nurses, industrial hygienists, otheroccupational health professionals, andadministrative and other staff.The business caseField operations present unique challenges, and thepeople involved are an important asset. To protectthat asset, an occupational health serviceintegrated into the operation can yield importantbenefits:G Leaner company profiles mean that there arenow fewer employees in organizations: it istherefore crucial that employees are notincapacitated or lost through preventable illhealth.G Taking positive steps to improve employees’health will help to increase productivity, recruitand retain staff, reduce staff turnover andenhance company standing.G Sound advice on compliance with legislation willreduce the risk of costly litigation and loss ofimage.G Increasingly, employees and former employeesclaim compensation for work-related illness andinjury, whether or not a particular hazard iscovered by legislation; these losses arepreventable.G Employers’ liability insurers insist that employersdemonstrate adequate protection of employeehealth; involvement of an occupational healthservice can help to control the premiums.Occupational health3 API, 1998. Model environmental, health and safety (EHS) management system and guidance document. (API Publication 9100)4 The Occupational Health and Safety Group. OHSAS 18000 Occupational Health and Safety Toolkit:www.ohsas-18001-occupational-health-and-safety.com/ohsas-18001-kit.htm
Industrial or occupational hygiene is defined as ‘thescience devoted to the anticipation, recognition,evaluation and control of those workplaceenvironmental health hazards/stressors which maycause sickness, impaired health and well-being, orsignificant discomfort among workers or membersof the community’.The focus is on identification and control ofoccupational health hazards. Industrial hygieneprogramme components include: (1) hazardidentification; (2) risk evaluation relative to hazardexposure; (3) hazard monitoring; (4) control plandevelopment; (5) employee training and controlplan implementation; and (6) evaluation of theeffectiveness of controls.Workplace environmental health hazards include:G Chemical: dusts/fibres, fumes, mists/aerosols,gases, vapours, smokes.G Physical: noise, vibration, radiation (ionizingand non-ionizing), temperature (heat or coldstress), illumination, pressure, ventilation,NORM, asbestos.G Biological: bacteria, viruses, fungi, moulds,parasites, insects, and animals.G Ergonomic/human factors: repetitive motions,manual handling, fatigue, work stationdesign/operations, shift work.G Psychosocial: workplace stress related toworkload, organizational changes, conflictmanagement, job satisfaction, employee-job fit,fatigue, aging workforce.Occupational health programmes shouldcomplement industrial hygiene risk assessments toidentify health hazards, control worker exposure,protect the health of employees, and preventoccupational illnesses and injuries.Infection control measures in fieldmedical operationsThe focus of the general principles outlined here ison reducing the risk of disease transmission in thehealth-care setting, rather than in the widercommunityPrevention strategies in thehealth-care settingThe core prevention strategies include:a) Standard precautions:• Hand hygiene—wash hands thoroughly withsoap and water or use an alcohol-based rub.Hand hygiene is required for ‘standard’precautions (previously called universalprecautions, and assumes blood and bodyfluid of ANY patient could be infectious) and‘expanded’ precautions (to include contactprecautions, droplet precautions and airborneinfection isolation).• Respiratory hygiene and cough etiquette.• Sterilization and disinfection of medicalmaterials.• Prevention and management of injuries frommedical instruments.IPIECA • OGP4Industrial hygiene and control of workplace exposuresThe identificationand control ofoccupational healthhazards in the fieldis key tomaintainingappropriatestandards ofindustrial hygiene.
b) Early detection of disease and isolationprecautions:• worker placement in relation to activities; and• use of PPE.Isolation precautions can be categorized as‘standard’ precautions (which assumes that bloodand body fluids of ANY person could beinfectious), or ‘expanded’ precautions (to includecontact precautions, droplet precautions, andairborne infection isolation.c) Environmental and engineering infection controlmeasures. The basic issues related to health-careworkers’ health include:• pre- and post-employment screening to identifyconditions that may put workers at risk; and• vaccinations.d) Personal protective equipment (PPE):The types of PPE which should be utilized byhealth professionals, dependent on the identifiedhazard, include:• gloves for hand protection;• masks and respirators for mouth and noseprotection;• goggles for eye protection;• face shields for face, mouth, nose and eyeprotection; and• gowns or aprons for skin and/or clothingprotection.Contact precautions require the use of gown andgloves for contact with persons or environment ofcare (i.e. medical equipment, environmentalsurfaces). Droplet precautions require the use ofsurgical masks within three feet of the person.Airborne infection isolation requires a particulaterespirator.5MANAGING HEALTH FOR FIELD OPERATIONS IN OIL AND GAS ACTIVITIESA medical emergency is a situation in which, dueto an acute illness or injury, there is an immediaterisk to a person’s life or long-term health.To manage medical emergencies, each locationshould develop a site-specific medical emergencyresponse plan (MERP), taking into account thepotential for individual and multiple casualties,describing the response to various medicalemergency scenarios based on the health risk andimpact assessments, and utilizing availableresources. The MERP should consider specificneeds of the work activities and the generalsituation of the country in which these activitiesare carried out, as well as any collaboration withlocal authorities.Resources required for theimplementation of the MERPResources required for the successfulimplementation of a MERP are discussed below,and include:G effective means of communications;G first responders and trained competent health-care professionals, e.g. doctors, nurses,paramedics, emergency medical technicians;G adequate means of transportation (ground,water, air); andG adequate medical structures (primary, secondaryand tertiary health-care units).Medical emergency management
Effective means of communicationCommonality of language is critical to effectiveemergency response. The ability to transmit andexchange information clearly and efficientlybetween the field, designated medical facilities andsupport structures is essential to minimize adverseimpact and assure a successful outcome. SeeCommunication on page 14 for further details.First responders and trainedcompetent health-care professionalsBasic (Level 1) and Advanced (Level 2) first aidFirst aid is the immediate application of first linetreatment following an injury or sudden illness,using facilities and materials available at the time,to sustain life, prevent deterioration in an existingcondition and promote recovery.The content and duration of training courses andthe titles given to trained first-aiders vary widelyfrom country to country and even between traininginstitutes within the same country. Assessment of afirst-aider’s qualifications will require scrutiny oftheir training, experience and references. First-aiders should carry a valid recognized certificate offirst-aid training which should at least meetnational requirements.There are two levels of first-aiders: basic first-aiders(Level 1 health-care providers) and advanced firstaiders (Level 2 health-care providers). Emergencymedical technicians (EMTs) used in some countriesmay come under Level 2.The number of first-aiders and their level ofcompetence will depend on both the size of theworkforce exposed and the degree of risk. Thus, atwo-man team operating in a remote or dangerouslocality may require one member to have basicfirst-aid capability and the other to have moreadvanced skills, while a team of 25 operating closeto high-quality medical facilities with good meansof communication and evacuation may require onlyone basic first-aider. In addition, certain countriesmay have national guidelines stipulating thenumbers of first-aiders required for given numbersof workers.Level 3 health-care professionalsThese are individuals with specialized training inemergency care; they are accredited by variousprofessional organizations around the world, andare usually employed in field operations to managemedical emergencies with remote support from aLevel 4 health professional.Level 4 health-care professionalsThe designated primary health-care unit (HCU)should be staffed by registered and licencedhealth professionals. These could be doctors,nurses, physician assistants or other trainedpersonnel with experience in emergency andprimary care. They would be expected to provideadvanced emergency medical care to resuscitatea patient, and to participate in the MERP in casethe patient is to be transferred to the secondary ortertiary HCU.Level 5 health-care professionalsThe designated secondary HCU (usually a hospital)and tertiary HCU (usually a critical care centre)would ideally be staffed by medical specialists—medical personnel who have undertakenpostgraduate medical training and obtained furthermedical qualifications, and whose competence hasbeen certified by a diploma granted by anappropriate specialist medical college. They wouldbe expected to assess, diagnose and treatspecialized and complex medical conditions.IPIECA • OGP6Health-carepersonnel rangefrom trained first-aiders to medicalspecialists capableof diagnosing andtreating complexmedical conditions.
The response time for provision of basic life supportand immediate aid should be less than 4 minutes,and for advanced life support (Levels 2 and 3) lessthan 20 minutes. Access to more advanced levelhealth-care units should be based on the results ofthe site-specific health risk assessment. Prescriptivetimings should be as short as reasonablypracticable. See Table 1 for guidance.Adequate means of transportationEvacuation procedures will need to take intoaccount the available resources, the urgency of thetransfer and the medical condition of the casualty.Transportation could be by ground, by water or byair. The casualty escort could be a doctor, nurse orparamedic and in some cases a certified first-aider,dependent upon the severity of the condition. Allshould be trained and familiar with the equipmentthat they are expected to use.In certain circumstances, the use of a specialistmedical evacuation organization may be desirable.In this case, a contract with the assistance companyor specialist transport company must be part of theemergency plan.All components of the medical evacuation process(personnel, vehicles, equipment, training,communications, etc.) should be audited at regularintervals by the company.See the Annexes for further details.Adequate medical structuresThe medical emergency chain includes primary,secondary and tertiary HCUs:G The primary HCU is the local unit covering theentire workforce involved in the operations. Itcould be the worksite clinic or a designatedthird-party clinic nearby. Its key functions are:• the provision of emergency response andmedical care to resuscitate a casualty; and• participation in the MERP in case the patientis to be transferred to the secondary ortertiary HCU.G The secondary HCU is usually a hospital, and isused when the capabilities of the primary HCUare exceeded. Its key functions are:• the management of inpatient medical andsurgical cases requiring investigation and/ortreatment;• the emergency resuscitation and stabilizationof casualties, in preparation for their referralto a tertiary HCU if necessary; and• participation in the MERP in case the casualtyis to be transferred to the tertiary HCU.G The tertiary HCU shall be able to handlecritical conditions that exceed the capabilitiesof the secondary HCU. Such conditionsinclude, but are not limited to: major trauma;neurosurgery; severe burns; cardiac surgery;high-risk pregnancy; complex tropical diseases;organ failure and transplant; oncology; andmajor psychoses. This advanced tertiary HCUmay not be available in some countries, inwhich case it is desirable to identify such a7MANAGING HEALTH FOR FIELD OPERATIONS IN OIL AND GAS ACTIVITIESTable 1 Guidance on response times for provision of basic life support and immediate first aidResponse time Responder Site of health careSite of the incidentSite of the incident (Level 2) orfield first-aid station (Level 3)Designated primary health-care unitSecondary and tertiary health-care unitLevel 1 health-care providerLevel 2 health-care provider orLevel 3 health-care professionalLevel 4 health-care professionalLevel 5 health-care professional< 4 minutes< 20 minutes< 1 hour< 6 hours
facility in another country or in the country oforigin of the casualty.Medical emergency response plan(MERP)The medical emergency response plan should:G be risk and scenario based (e.g. pandemic,food-borne illness outbreak, infectious diseasessuch as varicella and influenza-like illnesses),and should include mass casualty planning;G identify the designated health/medicalprovider(s) involved in the plan, together withtheir capabilities and limitations (these providerscould be under the direct control of the companyor a third party; if the latter, a formal agreementon the level of medical support should be made);G determine the likely evacuation route(s) andmeans of transport from the incident location tothe place(s) of medical care—particularattention is required regarding transportationlimitations (e.g. distances, mode of transport,weather limitations, etc.) and considerationshould be given to requirements for localauthority/government authorization prior toevacuation out of the country;G include contact details for key personnel; andG include contact information for all individualswho are covered by the MERP—such personsshould be advised that they must have a validpassport and appropriate visa in caseevacuation out of the country is required.Effectiveness of a MERPTo be effective, the MERP should be:G developed systematically before the start of anyactivity;G communicated effectively and well understood;G designed so that important actions are taken inparallel (different actions should be taken at thesame time) and not in series (actions should notbe taken one after the other);G integrated into the company’s more generalemergency response plans;G under the responsibility of line management;G organized in collaboration with both companyand client health-care professionals wheresubcontractors are involved; andG tested and reviewed regularly through structureddrills.Drills, review and revisionDrillsOnce the MERP has been developed it should bepractised regularly and should include testing of alllogistical support required, e.g. communications,transport. The results of drills should be reviewedand the plan revised if necessary.The extent of resource deployment during drillsshould be predetermined by management andcompany-designated health-care professionals. Thisshould include scenario planning, as well assimulated events addressing triage for multiplecases, followed by a thorough debriefing.Review following medical emergencyA debriefing should be conducted after each use ofthe MERP so that the company can makeimprovements if necessary.Regular revisionThe MERP should be audited and revised ifnecessary, at least annually and following anysignificant change in circumstances, e.g. type ofoperation, location or health-care resources.ContractorsWhere suitable, contractor companies shoulddevelop their own MERP, compatible with that ofthe client company. Alternatively, the company mayinclude contractors in its own MERP but this mustbe formally established prior to the start ofoperations.IPIECA • OGP8
A system should be established which providesaccess to primary, secondary and emergencymedical facilities, as well as to occupational healthexpertise where appropriate, and which isunderpinned by a systematic approach tomaintaining and improving the quality of carewithin the health system.GovernanceThis approach to improving the quality of health-care is described in some countries as ‘clinicalgovernance’. The important elements of thisgovernance system that are applicable to oil andgas field medical activities are described below,and include:G managing clinical effectiveness;G managing risk;G patient safety and incident reporting; andG using evidence.Managing clinical effectivenessClinical effectiveness can be described as the rightperson doing:G the right thing (evidence-based practice);G in the right way (skills and competence);G at the right time (providing treatment/serviceswhen the patient needs them);G in the right place (location of treatment/services);andG with the right result (clinical effectiveness/maximizing health gain).Evidence that clinical effectiveness is being utilizedin a health-care system includes the followingimportant activities:G Clinical or medical audit to critically reviewcurrent practice.G The identification of treatment outcomemeasures.G The presence of protocols/processes in supportof clinical governance.Managing riskThere are various day-to-day risks involved in therunning of field medical operations. Things thatcould, and can, go wrong include: slips, trips andfalls involving medical staff, patients and the public;administrative errors that impact on patient care;and clinical incidents that have a direct effect onthe outcome of patient care.Risk management is a standardized process used inindustry to reduce occupational injuries, errors,faults and accidents, and at the same time improvequality. Companies need to manage risk at twooverlapping levels:G the strategic/management level; andG the day-to-day staff/patient operational level.Risk management is seen as an essentialcomponent in the delivery of safe and effectivecare. The development of a risk managementmatrix will be influenced by a mix of locallegislative and regulatory requirements as well asby specific standard-based company guidance.Evidence that risk management is being utilized ina health-care system includes the followingimportant activities:G Availability of risk management documents, e.g.risk assessment protocols, logs, register, actionplans, etc.G Identifying and learning from risks across thecompany; this could involve coordinating andcommunicating information from different sources.9MANAGING HEALTH FOR FIELD OPERATIONS IN OIL AND GAS ACTIVITIESManagement of ill health in the workplaceRisk management isan essentialcomponent in thedelivery of safe andeffective care;creating a culturethat valuescomplaints and thereporting ofincidents is anessential part of riskmanagement.
G Incident reporting of errors and near misses.G Clinical effectiveness and audit projects that mayimpact or influence risk.G Complaints and claims management that identifyrisks.G Clinical outcome indicators that tell you whetheryou have achieved what you want from anintervention.Company health-care professionals need to knowthat they will be supported in the identification,reporting and management of risks in their workarea. Creating a culture that values complaints andthe reporting of incidents is an essential part of riskmanagement.Patient safety and incident reportingResearch indicates that, in developed healthmanagement systems, around 10% of patientcontacts result in harm to patients or staff. It isestimated that half of these harmful or adverseincidents are preventable. Clinical incidents andnear misses, where there is no harm to the patient,highlight the need for appropriate action to betaken to reduce or manage risks. Reporting andlearning from such events is part of the riskmanagement process to protect the safety ofpatients and health-care staff.Evidence that patient safety and incident reportingare being utilized in a health-care system includes:G Procedures for reporting and analysis of clinicalerrors and incidents.For further information on patient safety seeScally and Donaldson 19985, IoM 19996 andDH 20007.Using evidenceClinical decisions about treatments and servicesshould be made on the basis of the best availableevidence to make sure care is safe and effective.Health professionals need to have the correct skillsto identify and assess information from a variety ofevidence sources to help them make decisionsabout care. Health-care professional developmentinvolves keeping up to date and reviewing practiceon a regular basis.Activity in the following important areasdemonstrates that evidence is being used in ahealth-care system:G Use of evidence-based practice.G Development of clinical guidelines.G Procedure for continuing professionaldevelopment (CPD) of health-care staff.Medical facilities at locationStrategic health management (SHM) principles shouldbe applied wherever needed and practicable8.SHM involves systematic, cooperative planning ineach phase of the lifecycle of a project to protectthe health of the workforce and promote lastingimprovements in the health of the host community.Primary care facilityIn some locations it may be sufficient to appoint alocal doctor as a general practitioner to provide forthe workforce. In other locations it may benecessary to develop a company clinic, whichcould include bringing in expatriate medical staff toprovide care or work alongside local medical staff.IPIECA • OGP105 Scally, G. and Donaldson, L. J., 1998. Clinical governance and the drive for quality improvement in the new NHS in England.In BMJ (British Medical Journal) 317:61, pp. 61–65. Published 4 July 1998.6 IoM, 1999. To Err is Human: Building a safer health system. Institute of Medicine of the National Academies. Washington DC, USA.7 DH, 2000. An organisation with a memory: Report of an expert group on learning from adverse events in the NHS.Department of Health, London, UK.8 OGP, 2000. Strategic health management: principles and guidelines for the oil & gas industry. OGP report number 6.88/307.
Secondary care facilityIn most locations the company will identifyapproved local clinics or hospitals for further care.Emergency medical careThe requirements for provision of emergencymedical care are described on pages 5 to 8.Annex 3 provides further information about theknowledge and skill requirements for healthprofessionals, and the medical equipmentrequirements for primary, secondary andemergency medical facilities.An example of a template to assist with auditing alocal medical facility can be found in Annex 4.Occupational health-care facilityAn occupational health-care facility may be set upto provide the following:G clinical health surveillance of employees hiredlocally or from outside the region;G immunizations;G evaluation of health aspects of catering, livingaccommodation, waste disposal and watertesting;G support for evaluation and management ofoccupational health risks;G arrangements for first-aid and training;G conforming to local occupational healthlegislation;G briefing new arrivals on local health risks;G fitness for task, rehabilitation and return to workassessments9; andG support for human resources employmentpolicies and procedures.In some locations it may be sufficient to appoint alocal doctor as an occupational health practitionerfor the workforce, whilst in other locations it maybe necessary to bring in expatriate medical staff toprovide occupational health support.Clinical health surveillance should be theresponsibility of a doctor who has knowledge ofpreventative health care, ideally in the relevantoccupational health setting. A nurse workingdirectly under the supervision of such a doctor cancarry out some of the procedures.Legislation regarding immunizations and theiradministration varies from country to country.Usually, a nurse may give immunizations providedthat she is acting under the written direction of adoctor who has assessed the nurses competenceto immunize and deal competently with anyadverse reactions.Evaluation of the health and hygiene aspects ofcatering, living accommodation, waste disposaland water testing should only be done by a doctor,nurse or other health professional who hassufficient knowledge and experience to perform thetask in a competent manner.Support for the evaluation and management ofoccupational health risks should only be performedby a health professional that has sufficientknowledge and experience to perform the task in acompetent manner.11MANAGING HEALTH FOR FIELD OPERATIONS IN OIL AND GAS ACTIVITIESAn occupationalhealth-care facilitymay be established toprovide a range ofservices including, forexample, fitness towork assessments,health surveillance ofthe workforce,briefing new arrivalson site, first-aidtraining, vaccinations,and more.9 OGP-IPIECA, 2011. Fitness to work: Guidance for company and contractor health, HSE and HR professionals.
First-aid training should only be given by a healthprofessional competent and certified to give suchtraining.Pharmaceutical and inventorymanagementPharmaceutical and inventory management is, inprinciple, no different at field locations than atmedical facilities in more accessible locations,though logistics and cold chain management maybe more challenging.A cold chain10 is a temperature-controlled supplychain, which aims at maintaining the product at agiven temperature range, thus extending andassuring the shelf life of pharmaceutical drugs.One common temperature range for a cold chainin the pharmaceutical industry is from 2° to 8°C,but the specific temperature (and time attemperature) tolerances depend on the actual drugor vaccine being transported. Remoteness, hotclimate and customs delays pose well-known risksin relation to keeping the cold chain unbroken.Some common ways to achieve an unbroken coldchain include the use of refrigerator trucks,specialized packaging and temperature dataloggers, as well as carrying out a thoroughanalysis, including taking measurements andmaintaining documentation.At some geographical locations, the type andavailability of controlled drugs, as well as thedefinition of what constitutes a ‘controlled drug’,may vary. However, whilst this is ‘business asusual’ for most companies, local legislationrelating to controlled drugs must be respected toensure that the correct procedures are in place forthe receipt, storage, record keeping and disposalof such drugs.Companies operating in remote locations havetypically learnt to ‘inspect not expect’, and such anapproach applies also to the need forpharmaceuticals and related inventory.It is important to ensure that labelling, instructionleaflets and procedures relating to pharmaceuticalsmatch the language competence of the staffhandling the medication. All pharmaceuticals onsite should be stored securely with regular periodicchecks of stock. It may be better to have a goodstandard inventory which is well known to staffthan to add on a number of more advanced drugswith which staff are unfamiliar.Medical field services are often supplied bymedical service providers or seismic contractorcompanies. Where this is the case, the operatorcompany must include pharmaceutical-relatedissues in their risk assessment and follow-up.Medical equipment managementand maintenanceMedical equipment management includes thebusiness processes (e.g. procurement, installationand commissioning, training, maintenance andrepair, record keeping, inventory management,decontamination and disposal) used in theinteraction and oversight of the medical equipmentinvolved in the diagnosis, treatment and monitoringof patients. It is a recognized profession within themedical logistics domain.IPIECA • OGP12Management ofpharmaceuticalinventory mayprove challengingin some locationsfor a number ofreasons, includingclimate, culture andlocal legislation.10 Adapted from Wikipedia: http://en.wikipedia.org/wiki/Cold_chain
A systematic approach to the management ofmedical equipment should be taken to minimizethe risks associated with its use. This shouldinclude the purchasing, deployment, maintenance,repair and disposal of medical equipment. It isessential that whenever an item of medicalequipment is used, it is:G suitable for (and only used for) its intendedpurpose;G used in accordance with manufacturers’instructions;G properly understood by the professional user,i.e. staff should be appropriately trained andcompetent;G maintained in a safe and reliable condition;G recorded on a database;G selected and acquired in accordance with thecompany’s recommendations; andG disposed of appropriately at the end of its usefullife.A complete description of the requirements of acomprehensive medical equipment managementsystem is beyond the scope of this guidelinedocument. See MHRA 200611 for more informationon this subject.The health and welfare of the localworkforceGlobalization has had an impact on the health,safety, well-being and culture of populationsworldwide, as have new technologies, workplaceorganization, work practices, mobility anddemographic trends. All of this has beenassociated with new types of diseases and healthconcerns among the working population and theirfamilies, together with an increased awareness ofhealth issues.A workforce may consist of a combination of local,national and international staff, and short- andlong-term contractors and rotators. Their terms ofcontract will be equally diverse but, as a guideline,the health-care provisions should follow theprinciples set out in this document.Management has a duty of care and must besensitive to the diversity and individualrequirements of its workforce and their dependants.Elements that should be considered bymanagement and, in particular, by health-carepersonnel include:G occupation;G literacy, education and training;G culture;G language;G religion;G tradition;G superstition;G gender;G family;G dietary habits;G sanitation;G hygiene standards;13MANAGING HEALTH FOR FIELD OPERATIONS IN OIL AND GAS ACTIVITIESThe workforce mayconsist of acombination oflocal, national andinternational staff;managementshould be sensitiveto the diversity andrequirements of itsworkforce and theirdependants.11 MHRA, 2006. Managing medical devices: guidance for health-care and social services organisations. Medicines and Health-care products Regulatory Agency, report number DB2006(05), November 2006. Available from the MHRA website at:www.mhra.gov.uk/Publications/Safetyguidance/DeviceBulletins/CON2025142
The importance offamiliarity withcultural norms ofthe workforcecannot beoveremphasized.G public health;G endemic conditions;G medical and health briefs;G alternative and traditional medicine;G local law and political climate; andG safety culture (fatalism and education).The importance of familiarity with cultural norms ofthe workforce cannot be overemphasized.Medical aspects of health care in alocal environmentThere should be close cooperation between:G national health-care workers;G company health representatives;G local health-care authorities; andG relevant stakeholders.Health-care personnel should take into account thediversity of the population they serve. In somecountries, distance and access to certain specialitiesshould be taken into account, as should racial,cultural and religious aspects, for example:G all individuals being treated with equal respect;G women’s needs to be treated by female health-care personnel;G fasting periods required by religious practices;G requirement for the provision of interpreters;G the impact of religion and culture on healtheducation programmes; andG the complementary benefits of traditional andwestern medical practices.CommunicationEffective communication is essential for anyoperation and, in particular, for the management ofhealth-related problems.Communication can be performed by:G telephone (fixed phone, mobile, satellite);G radio;G fax;G computers (e-mail, Internet);G video transmission; andG telemedicine (see below).Communication is necessary to enable the healthprofessional in the field to contact company healthprofessionals, approved specialists, relevantauthorities, medical evacuation companies andmanagers. It enables health professionals to obtainadvice, provide appropriate medical care, obtainnecessary medication and material, and accessmedical websites and online medical journals toupdate their knowledge, organize medicalevacuations and keep management informed ofrelevant medical decisions.TelemedicineTelemedicine can be defined as the use oftelecommunication technologies to deliver medicalinformation and services to locations at a distancefrom the care giver or educator.Telemedicine may be as simple as two healthprofessionals discussing a case over the telephone,or as complex as using satellite technology andvideoconferencing equipment to conduct a real-time consultation between medical specialists in twoIPIECA • OGP14
different countries. It can be used to provide medicalconsultations (routine or emergency), advice andassistance in diagnosis and treatment by providinga second opinion with a specialist. It can be usedto coordinate and interpret diagnostic proceduresand to transmit laboratory and radiological results(electrocardiogram, medical imaging, etc.).Telemedicine can also help the isolated healthprofessional by providing on-site education.Telemedicine can be broken into three maincategories:G store-and-forward;G remote monitoring; andG interactive services.Store-and-forward telemedicine: involvesacquiring medical data (like medical images,biosignals etc.) and then transmitting these data toanother health-care professional at a convenienttime for assessment offline. It does not require thepresence of both parties at the same time. Thestore-and-forward process requires the clinician torely on a history report and audio/videoinformation in lieu of a physical examination.Remote monitoring: also known as self-monitoringor self-testing, enables medical professionals tomonitor a patient remotely using varioustechnological devices. This method is used primarilyfor managing chronic diseases or specificconditions, such as heart disease, diabetes mellitusor asthma. This service can provide healthoutcomes comparable to traditional in-personpatient encounters, supply greater satisfaction topatients, and may be cost-effective.Interactive telemedicine services: provide real-timeinteractions between patient and provider, andinclude telephone conversations, onlinecommunication and home visits. Many activities,such as history review, physical examination,psychiatric evaluations and ophthalmologyassessments, can be conducted comparably tothose done in traditional face-to-face visits. Inaddition, ‘clinician-interactive’ telemedicine servicesmay be less costly than in-person clinical visits.Ideally, telemedicine requires a computer, a digitalcamera, diverse adapted diagnostic equipment,acceptable communication systems (sufficientbandwidth) and an agreement with specializedhealth-care providers. However, a basic telephonecall or e-mail with a scanned or digital picture orX-ray attached can suffice in many cases.A number of problems remain to be solvedconcerning telemedicine, including privacy,confidentiality and security, as well as medico-legalresponsibility and payment.15MANAGING HEALTH FOR FIELD OPERATIONS IN OIL AND GAS ACTIVITIESWell-establishedcommunicationsystems areessential for theeffectivemanagement ofhealth-relatedissues andemergencies.
The purpose of a fitness for task assessment is toensure proper placement of prospective employeesin job positions that will match their capabilitieswithout risk to themselves or co-workers.The employee’s health status should be compatiblewith their job position and confirmed by fitness fortask assessments as required12.The fitness for task assessment is to be conductedby an appropriately qualified health-careprofessional, who will determine the extent of theassessment, dependent on the essential/requiredjob position functions and country legalrequirements. Typical components include acomprehensive health history, routine blood workand urinalysis, audiometric and pulmonary functiontests, and visual acuity testing. More specificmedical examinations may be required for specificworkplace exposures. Other tests such as functionalcapacity evaluation or trade testing may berequired for particular job groups.The fitness for task assessment should:G use appropriate methods to detect relevanthealth issues that could impact future workcapabilities;G cover both physical and mental health;G maintain employee confidentiality;G comply with local regulatory agencies andindustry standards;G reduce employer liability and be cost-effective;G have reasonable accommodation whereappropriate/required;G assess the employee’s compatibility with thedemands of the job without risk to the employeeor co-workers; andG ensure proper placement of prospectiveemployees in jobs that will match theircapabilities.The frequency and content of a fitness for taskassessment will be dependent on:G the type of job tasks and inherent health risks;G the type, amount, duration and frequency ofworkplace exposure; andG local regulatory legislation and industrystandards.Other factors that may influence the frequency andcontent of an assessment include the employee’sage, past medical history and current health status.Health surveillance is the specific examination ofcertain aspects of health which may be affected byidentified workplace health hazards. While thisprocess may include some similar testing to routinefitness for task assessments, the purpose is different.The health surveillance process monitors thepotential effect of the job on the individual, notsuitability for task. Health surveillance is also anongoing process, although periodicity may bedifferent from a fitness for task assessment. It maybe conducted in conjunction with fitness for taskassessments where convenient and appropriate.Where pre-placement health assessments areconsidered necessary, they should be conductedafter an offer of employment is made. They shouldbe designed to verify the suitability of newemployees for their job positions in accordancewith their physical and mental capacities and thephysical, psychosocial and environmental demandsof the job, and should accommodate individualswith medical conditions or disabilities wherepossible. The assessments aim to ensure that thenew employee does not have any health-relatedcondition that may be aggravated by the job dutiesor that may affect the health and safety of co-workers. Pre-placement assessments also providebaseline data against which future evaluative datacan be measured.IPIECA • OGP16Fitness for task assessment and health surveillance12 OGP-IPIECA, 2007. Health performance indicators: A guide for the oil and gas industry. OGP report number 393.
Industrial development projects can give rise tohealth impacts, both positive and negative, and theoil and gas industry is no different. A health impactassessment (HIA) is a combination of procedures,methods and tools by which a project may bejudged according to its potential effects on thehealth of a population and the distribution of thoseeffects within that population. This applies ‘outsidethe fence’, i.e. to the local community populationand other stakeholders who may be impacted byactivities at the company’s field operational site.The intent of an HIA is to predict potential positiveand negative community health impacts from aproject and to facilitate either avoidance orreduction of the negative impacts on human health.HIA is complementary to environmental and socialimpact assessment and, in many cases, can becarried out at the same time using shared coreinformation. The jointly published OGP-IPIECAGuide to health impact assessments13 containsin-depth information and practical tools forapplication ‘on the ground’.17MANAGING HEALTH FOR FIELD OPERATIONS IN OIL AND GAS ACTIVITIESHealth impact assessmentReporting of health information will normally berequired or requested from an operation byseveral different organizations. There will likely bea legal requirement for reporting, either by hostor home country legislation which must becomplied with. Internal reporting to both local andcorporate management is normally a routinerequirement. Industry representative bodies mayalso request information.Legislative reportingLegislative reporting is normally non-negotiable.The information requested, and the form ofpresentation, will be governed by the relevanthealth and safety laws applicable to the operation.There is wide variation between countries as to thenature and amount of this information but, ingeneral, this will normally relate to occupationalillness and infectious disease. This information maynot be anonymous and could require theidentification of individual employees, in whichcase circulation of reporting documents should berestricted, ideally to the health department only,where possible.Internal reportingAll companies should require internal reporting ofhealth information. Occupational and work-relatedillness should be treated with the same importanceas an accident or incident, using much of the sameprocess as that utilized for investigating the cause,and for improvement, of controls. Occupationalillness is poorly reported industry wide, andspecific efforts should be made to ensure thatinstances are identified. The long latent period forthe development of occupational illness means thatmany cases are reported a considerable periodafter the onset of exposure, possibly after theindividual has changed jobs or locations. Goodhealth record keeping is therefore essential.Records of all cases of occupational illness shouldbe maintained, although only new cases arenormally reported.Anonymous reporting of grouped health data willidentify areas where targeted intervention mayproduce cost-effective health improvements. Thesecan be related to key performance indicators whichare important to quantify effectiveness of healthprogrammes, justify health expenditure and planHealth reporting and record management13 OGP-IPIECA, 2005. A guide to health impact assessments in the oil and gas industry.
health provision. For guidance on the identificationof appropriate health performance indicators seeOGP-IPIECA 200714.Company corporate functions will normally requireanonymous reporting of health data in order tomap illness trends at a global level to allow strategicplanning of health services. This information may bedifferent from that required locally.Industry reportingIndustry representative bodies may request healthinformation that relates to initiatives that they areinvolved in. These may be ongoing projects (e.g.HSE statistics) which can be useful tools for industrybenchmarking, or may be a targeted piece ofresearch. Participation in this type of reporting isessentially optional but may be a requirement ofmembership of the body.Record managementGood health records are essential not only forreporting but for the protection of patient, healthprofessional and company. Companies shoulddevelop standards for health record managementwhich comply with appropriate legislation, corporatestandards and international best practice.Health records are defined as any informationpertaining to the medical or occupationalassessment, care, treatment, surveillance or otherintervention related to the health of the individual.Health records must be kept for each employee andshould detail each medical contact, intervention orcommunication. They should be identifiable asbelonging to a specific individual and must beaccurate, contemporaneous and legible. They maybe physical or electronic records.Records must be kept secure and accessible only tohealth department staff who must have signed aconfidentiality agreement. Identifiable health datamay be shared with other health professionals ifeither implied or expressed consent is obtainedfrom the individual.In order to service the various requirements forhealth reporting, relevant data sufficient forreporting requirements should be maintained in thehealth records. To ensure uniformity, a health codingsystem such as ICD 915 will enable standardizationacross different areas of the business.IPIECA • OGP18Occupational illnessis often poorlyreported, butshould be given thesame importanceas reporting anaccident or incidentoccurring at thework site.14 OGP-IPIECA, 2007. Health performance indicators: a guide for the oil and gas industry. OGP report number 393.15 ICD 9: International Classification of Diseases, 9th Edition: a widely used classification system employed to codify diseasesand medical conditions.
19MANAGING HEALTH FOR FIELD OPERATIONS IN OIL AND GAS ACTIVITIESPublic health interface and promotion of good healthCorporate social responsibilityEntering into sustainable partnerships withgovernments and host communities in order tofacilitate improvements in health may form part of acompany’s corporate social responsibilityprogramme. Such effective partnerships withstakeholders, based on consultation and respect forhost culture, can take many forms but does notnecessarily involve building expensive facilities orinfrastructure. Increasingly, corporate socialresponsibility health projects are related topreventive health care and may build on existinggovernment or community health programmesinvolving local capacity building (see OGP 200016).Good social responsibility programmes willnecessitate professional risk assessment, extensivedialogue and management of expectations and agood understanding of local context. Ultimately,corporate social responsibility may be seen asmitigation of social risk, as well as forming thebasis of the industry’s licence to operate. To mostcompanies it is just the right way of doing business.The International Standard ISO 26000:2010,‘Guidance on Social Responsibility’, providesglobally relevant guidance for organizations of alltypes based on international consensus amongexpert representatives of the main stakeholdergroups. The ISO 26000:2010 Standard onlycontains voluntary guidance on social responsibilityand is therefore not used as a certification standard.Food and water safety standardsFood and water safety presents unique challengesin field operations in extremely remote settings, butneeds to be actively managed even in urbanareas. During construction phases, groups ofworkers live in temporary, mobile camps wherekitchen facilities are continuously built anddismantled and there is significant risk to workersof both morbidity and mortality from microbial,chemical and physical contamination of the foodand water supply. In addition, there is substantialcompany reputational risk associated withinsufficient food and water safety planning. Food-and water-related illnesses could, potentially,cause an operation to be shut down.For guidance on how to organize a food and watersafety management programme see OGP-IPIECA200917. Requirements and standards for food andwater safety need to be included in tenders from allsuppliers of goods and services pertaining to foodIntegrating healthprojects into acompany’s corporatesocial responsibilityprogramme cancomplement existinggovernment orcommunity healthprogrammes andsupport localcapacity building.16 OGP, 2000. Strategic health management: principles and guidance for the oil and gas industry. OGP report number 6.88/307,June 2000.17 OGP-IPIECA 2009. A guide to food and water safety for the oil and gas industry. OGP report number 397.
and water. The standards should benefit allpersonnel on site, including all contractors.Sewage and sanitationSanitationDisease-causing organisms, including viruses,bacteria and eggs or larvae of parasites may all bepresent in human faeces. These microorganismsmay enter the body through faecally-contaminatedfood, water, and eating and cooking utensils, andby contact with other contaminated objects.Diarrhoea, cholera and typhoid are spread in thisway and are major causes of sickness and death.Some fly species and cockroaches are attracted to,or breed, in faeces. High fly densities will increasethe risk of transmission of trachoma and Shigelladysentery. Intestinal worm infections (hookworm,whipworm and others) are transmitted throughcontact with soil that has been contaminated withfaeces, and may spread rapidly where opendefecation occurs and people walk barefoot.Facilities for disposing of excreta must be designedand built to avoid contamination of water sourcesthat will be used for drinking-water. Any successfulmeasure for managing human excreta includes theprinciples of separation, containment and destruction.Whatever form of toilet is designed and built, it mustfulfil these three functions to minimize health risks.To ensure a sustainable solution, it is important totake into account local custom as well as theavailability of water. Some field operations may needto have several solutions in the same camp, e.g.simple screened cubicles with concrete slabs andpour-flush toilets, as well as Western-style waterclosets. Hand washing facilities should always includehot and cold water, liquid soap, disposable towelsand foot-pedal operated or other non-touch, liddeddisposal units. Stickers or other information on theimportance of hand washing should be available.Communal facilities should be of a sufficient numberand be regularly cleaned by staff who areadequately trained and equipped. Clean latrineshelp to encourage proper use of the facilities; dirtylatrines inevitably lead to carelessness andunsanitary defecation practices in and around them.Routine inspection by supervisors is necessary toensure that cleaning standards are maintained.Latrines should be sited no more than 50 metresfrom users’ living quarters, to encourage their use,but sufficiently far away (at least 6 metres) toreduce problems from odours and pests.SullageWastewater from kitchens, bathrooms andlaundries is called sullage. It can containdisease-causing organisms, particularly from soiledclothing, but its main health hazardoccurs when it collects in poorly drained placesand causes pools of organically pollutedwater that may serve as breeding places for Culexmosquitoes. This genus of mosquitoestransmits some viruses as well as the parasiticdisease lymphatic filariasis. Mosquitoes thattransmit malaria do not breed in polluted water.Solid wasteRats, dogs, cats, birds and other animals, whichmay be carriers (reservoirs) of disease-causingorganisms, are attracted to discarded food,Toilet facilities shouldbe appropriatelylocated andmaintained at ahigh level ofcleanliness; sewagedisposal measuresshould be carefullydesigned and builtto avoidcontamination ofdrinking watersources.IPIECA • OGP20
21MANAGING HEALTH FOR FIELD OPERATIONS IN OIL AND GAS ACTIVITIESAttention should begiven to thetreatment anddisposal of solidwaste, especiallymedical waste fromfield site clinics, toprevent or minimizethe potential risks ofinfection.clothing, medical dressings and other componentsof solid waste. Small rainwater collections in solidwaste such as discarded car tyres or oil drumsmay serve as the breeding places for Aedesmosquitoes, vectors of the dengue virus.Medical waste from field site clinics may present aspecial challenge and could typically contain thefollowing categories of waste: infectious waste;pathological waste; sharps (i.e. syringes, blades,glass, etc.); pharmaceutical waste; chemical waste;waste with high heavy metal content; andpressurized containers. The safe and appropriatedisposal of medical waste is critical to preventingor minimizing the risk of transmittingmicroorganisms and potential infections.Storage, collection, treatment anddisposal of sullage and solid wasteManagement of health risks related to storage,collection, treatment and disposal of sullage andsolid waste will depend on the source, quantityand nature of wastewater and solid waste as wellas soil, topography, climate and other factors thatmay determine which options are possible.Legislation controlling the handling, collection anddisposal of medical waste is extensive and varies bycountry. Sharp items, such as hypodermic needlesand syringes, cannulas and surgical blades, shouldbe disposed of in dedicated, sealed after-usecontainers. Contaminated consumables such asbandages, gauzes, plasters, cotton tampons, surgicaldressings and gloves, must be stored separately fromnon-medical waste and shall be disposed ofseparately as per local laws and regulations, orincinerated. It should be compulsory for all personnelhandling medical waste to use appropriate PPE, suchas gloves (disposable and one-time use); face mask(covering the mouth and nose); protection glasses(for eye protection); and long-sleeve coveralls.A complete description of the treatment anddisposal of sullage and solid waste is beyond thescope of this document.For further information on the topics in this section,see the references below:G Water supply and sanitation assessment andprogramme design18,19,20,21G Solid waste management22G Surface water and waste water drainage20,23G Management of medical waste.24,2518 WHO, 2003. Environmental health in emergencies and disasters: a practical guide. Eds. Wisner, B. and Adams, J.World Health Organization. ISBN 92-4-154541-0. 272 pages, English only. Order No. 11500487.www.who.int/water_sanitation_health/emergencies/emergencies2002/en/index.html19 The Sphere Project, 2000. Humanitarian charter and minimum standards in disaster response. Chapter 2: Minimum standardsin water supply, sanitation and hygiene promotion. www.sphereproject.org/content/view/38/5/lang,english20 Davis, J. and Lambert, R., 2002. Engineering in emergencies: A practical guide for relief workers. Second Edition. RedR/ITPublications, London. 718pp ISBN: 1-85339-521-8.21 Harvey, P., Baghri, S. and Reed, R. (2002) Emergency sanitation: Assessment and programme design. WEDC, LoughboroughUniversity, UK.22 UNCHS, 1989. Solid waste management in low income housing projects: the scope for community participation. UNCHS,Nairobi, Kenya23 WHO, 1991. Surface water drainage for low-income communities. ISBN 92-4-154416-3. World Health Organization, Geneva.24 Reed, R. and Dean, P. T., 1994. Recommended methods for the disposal of sanitary wastes from temporary field medicalfacilities. In: Disasters, Vol.18(4), pp.355-67, December 1994.25 WHO, 1999. Safe management of wastes from health-care activities. Eds. Prüss, A., Giroult, E. and Rushbrook, P.World Health Organization, Geneva.
Clinical governanceThe systematic approach to maintaining andimproving the quality of patient care within ahealth system.Emergency medical technician (EMT)A term used in some countries to denote a health-care provider of emergency medical services.First responderA term used to refer to the first person to arrive atan emergency scene.First-aidersAn individual who is a non-expert, but a trainedperson able to provide the initial care for an illnessor injury, usually to a sick or injured person, untildefinitive medical treatment can be accessed.Health management systemA process that applies a disciplined and systematicapproach to managing health in company activities.Health-care systemA complex of facilities, organizations and trainedpersonnel engaged in providing health care withina geographical area.Medical emergency response plan (MERP)A site-specific emergency response plan for dealingwith injury or illness to a worker.Occupational diseaseAny illness associated with a particular occupationor industry.Occupational health hazardAny source of potential damage to, or harm oradverse health effects on a person, resulting fromconditions at work.Occupational health serviceA service established in or near a place ofemployment for the purposes of:(a) protecting the workers against any healthhazard which may arise out of their work orthe conditions in which it is carried out;(b) contributing towards the workers’ physical andmental adjustment, in particular by theadaptation of the work to the workers and theirassignment to jobs for which they are suited;and(c) contributing to the establishment andmaintenance of the highest possible degree ofphysical and mental well-being of the workers.Strategic health managementSystematic, cooperative planning throughout theproject life cycle to maintain the health of theworkforce and promote lasting improvements in thehealth of the host community.IPIECA • OGP22Glossary
23MANAGING HEALTH FOR FIELD OPERATIONS IN OIL AND GAS ACTIVITIESAnnex 1: Health audit for managersThe template in Table 2 (below) provides an exampleof a self-audit that managers can perform in order toassess their health provision (this can be adapted tomeet different companies’ needs). It is based ondata from OGP Report No. 423, HSE management:guidelines for working together in a contractenvironment, published in June 2010.The questions in the table are examples of theinformation that can be collected and assessed. Thescoring system is 0, I, 2 where ‘0’ is no provision,‘1’ is partial compliance and ‘2’ is full compliance.The information obtained can be used to measurehealth performance and improvement, to set targetsand prioritize action points for local management.Table 2 Questionnaire for contractor HSE capability assessment0 1 2 Comments1. Leadership and commitment2. Policy and strategic objectives3. Organization, responsibilities and resourcesAre health issues regularly addressed at leadership/management meetings?Are sufficient resources allocated to health in the location?Is the improvement of health an overall corporatestrategy/value?Is a positive health culture promoted at all levels?Are all senior managers setting a personal example toothers?Location: ....................................................................... Assessment conducted by: ..........................................................Position: ......................................................................... Date of assessment: ....................................................................Remarks: .....................................................................................................................................................................................Is there a written HSE policy that makes reference to theimportance of health that is dated and signed by thechief executive?Are policy statements issued to cover specific aspects(e.g. alcohol, substance abuse, smoking, AIDS)?Are health objectives clearly defined at location level?Are all employees aware of the company’s healthpolicies and objectives?Have all employees had first-aid training?Have all employees had hygiene training?Have all employees had health training?Do all employees undergo pre-placement/periodic healthassessment?Are vaccination requirements clearly defined at thelocation level?Are first-aid requirements clearly defined at the location level?continued …
IPIECA • OGP24Table 2 Questionnaire for contractor HSE capability assessment (continued)0 1 2 Comments3. Organization, responsibilities and resources (continued)Does the location have the adequate number of HCP(s)?Has the location’s HCP been recertified/retrained as percompany standards?Does the location’s health-care professional have a jobdescription matching his/her responsibilities?Does the organization chart clearly show the positionsof HCP and their line of reporting?Is the location’s HCP familiar with the standards of thecompany health assessments?Is the location manager kept informed by the HCP ofmajor health risks?Does the HCP participate actively in HSE meetings?Does the HCP understand the main hazards and risks ofthe operation?Has the HCP taken action to reduce the risk?Is the HCP familiar with the medical emergency responseplan (MERP) and has he/she participated in its preparation?Does the HCP have a confidential medical file for eachemployee?Applicable only if there is a company health-care professional (HCP):Is the facility inspected/audited on a regular basis?Does the facility meet company standards?Does the facility have equipment and medication as percompany requirements?Is the necessary emergency equipment available as percompany recommendations?Is medication kept in a dry and safe area?Are controlled/dangerous drugs kept locked away?Are medication expiry dates respected?Are records maintained and securely stored in aconfidential manner?Are records maintained for equipment?Are records maintained for medication?Is medical waste disposed of correctly?Applicable only if there is a company medical facility:
25MANAGING HEALTH FOR FIELD OPERATIONS IN OIL AND GAS ACTIVITIESTable 2 Questionnaire for contractor HSE capability assessment (continued)0 1 2 Comments3. Organization, responsibilities and resources (continued)4. Contractor and supplier management5. Risk managementIs the vehicle in good working condition?Is a trained ambulance driver available 24 hours a day?Is the ambulance equipped according to company requirements?Do drivers have a periodic health assessment as per companypolicy?Applicable only if there is a company ambulance:Has the local hospital been audited as per companyrequirements?Does it meet cleanliness and hygiene standards?Is there a well-equipped emergency room?Does the emergency room function 24 hours a day?Is there an intensive-care unit?Is there a doctor on call 24 hours a day?Does the hospital have its own ambulance?Is the hospital’s telephone number known?Is there an interpreter?Are contractors aware of the company’s healthrequirements and standards?Do contractor’s employees all have a health assessment?Do drivers have a periodic health assessment as percompany policy?Does the catering staff have appropriate healthassessment/hygiene training?Does the contractor have a medical emergency responseplan (MERP)?Does the contractor have medical evacuation coverage?Has a health risk assessment (HRA) been developed atthe location?Is there an occupational health programme in place,based on the HRA, that: identifies health hazards;assesses the health risks; provides for the control of healthhazards; identifies PPE and prophylactic requirements;provides emergency cover; and applies to all work sites?Applicable only if there is a local hospital (secondary care facility):continued …
IPIECA • OGP26Table 2 Questionnaire for contractor HSE capability assessment (continued)0 1 2 Comments5. Risk management (continued)6. Planning and proceduresIs there a welfare programme in place that meets theneeds of isolated work sites (if applicable)?Are personnel checked for medical fitness for task by arecognized and approved medical facility?Is an ongoing system of health surveillance based onjob-specific health risks in place?Are all employees up to date with the requiredvaccinations?Do accommodation and catering facilities meet acceptablestandards of hygiene and are they fit for purpose?Does food storage, handling and preparation meetacceptable industry standards?Are the health and hygiene training standards known?Is the local MERP known?Is the international MERP known?Are living quarters designed and maintained accordingto acceptable standards?Do employees know where to get country info onepidemics/MERP/resources, etc.?Is health addressed regularly in HSE meetings?Is the MERP in place for all identified medicalemergency situations, and are the responsibilities of allinvolved parties clearly identified?Is an appropriately manned response centre set up tocoordinate the MERP?Are all personnel made aware of the MERP and theirindividual roles and responsibilities?Of particular importance in emergency situations is thatinstructions are available and understood in thelanguage of the individuals—is this requirement met?Is the MERP covered in employee HSE orientation?Are lines of communication clearly identified and testedwith: third-party emergency services; local hospitals;helicopter services; and Medevac facilities?Are third-party emergency services aware of their rolesin the MERP?Medical emergency response plan (MERP):
27MANAGING HEALTH FOR FIELD OPERATIONS IN OIL AND GAS ACTIVITIESTable 2 Questionnaire for contractor HSE capability assessment (continued)0 1 2 Comments6. Planning and procedures (continued)7. Implementation and monitoring8. Health management audit9. Management reviewTOTAL SCORE:Are MERPs, both local and international, tested andpractised regularly?Has the health plan been developed in compliance withcompany medical standards?Have written procedures been developed which coverdifferent health hazards encountered on location?Are written procedures available to all employees,including subcontractors, in their own language?Are all health procedures controlled documents?Are health performance indicators (HPIs) identified to measurehealth performance?Is progress against identified HPIs measured regularly?Does the HCP provide a regular activity report/report healthproblems?Are kitchens, refrigerators, dining rooms and catering staffregularly inspected by the HCP, and do they comply withstandards?Are living quarters cleaned and maintained frequently, andinspected regularly by the HCP?Is water testing performed and documented?Are Medevac drills conducted regularly and reviewed, and arethe lessons learned implemented?Is there a health management audit procedure complying withthe health plan, identifying responsibilities, frequency, methodand follow up.Are audits planned and line management kept informed?Have medical resources been audited within the past 12 months?Has corrective action been taken concerning all the points listedin the last audit?Does management undertake a documented review of healthperformance at a prescribed frequency, and do they take intoaccount health incidents and audit findings?Are the improvements identified documented andincorporated into an improvement plan?
General requirements fortransportationG All methods of transportation should beapproved for use according to defined companystandards and audited on a regular basis.G The vehicle (ground vehicle, boat or aircraft)must be compliant with local law, meet local andcompany safety regulations, and undergoregular maintenance.G The vehicle must be ergonomically suitable forstretcher recovery work, allowing ease of accessfor the stretcher as well as the patient escort andequipment.G Secure storage space for the required equipmentand material should be provided.G A suitable and approved power supply formedical equipment within the vehicle should beprovided.G Adequate interior and exterior lighting andclimate control should be available.G The vehicle operator should be made aware ofpatient injury or illness, advise on adverse travelconditions and agree to undertake the transport.G The patient escort must be able to communicatewith the vehicle operator, either directly or via aheadset link.G An adequate level of communication betweenthe patient and the patient escort should bemaintained throughout the evacuation.G The patient escort and/or the vehicle operator mustbe able to communicate with external support.G The patient escort must have sufficient space toprovide care and resuscitation.General requirements for medicalequipmentAll medical supplies and equipment dedicated foruse within the vehicle should be readily accessible,inventoried and checked. Note that all electricalmedical equipment should have a self-containedpower supply.The following should be available:G oxygen provided via a variable flowmeter andappropriate masks:• rebreatheable bag masks are necessary if100% oxygen is required;• normally, a minimum of 3 litres of oxygen isrequired per patient per minute, however incase of trauma, 10–15 litres are required perminute;G suction equipment;G a mechanism for adequate delivery of intra-venous fluids;G splints (vacuum and traction);G spinal immobilization equipment and vacuummattress;G stretchers (which should meet company safetyregulations, be securely fastened and shouldhave a patient restraining harness that can beeasily released);G automated external defibrillator (AED) ordefibrillator/monitor;G PPE and methods for safe disposal of clinicalwaste;G emergency material and medication as definedin the Level 3 first-aid kit (see Annex 3).Medical evacuation by ground transportGround vehicle standards formedical transportRecommendations in addition to the generalrequirements listed above:G Vehicles should be suitable for stretcher recoverywork, doors should open fully to allow free andunrestricted access, and all seats should be fittedwith seat belts. Harnesses should be provided tomake patients secure.G The stretcher should be securely fastened to avehicle anchor point and preferably havelocking wheels. It should be possible to load thevehicle with the patients head towards the front.G Seating for the patient escort should beavailable at the patient’s head.IPIECA • OGP28Annex 2: Guidelines for medical evacuation by ground,air and water
29MANAGING HEALTH FOR FIELD OPERATIONS IN OIL AND GAS ACTIVITIESG The vehicle should be staffed with a minimum oftwo people—a driver and a patient escort.G The driver should hold a current driving licenceappropriate for the class and size of the vehiclewith a valid appropriate medical assessment.G The patient escort should be a doctor, nurse,paramedic or first-aider as defined by companyprocedures.Medical evacuation by air transportMedical evacuation by air is a complex and costlyprocess that may require prior company approval.Feasibility of evacuation by air depends upon:G access to an appropriate medical facility thathas agreed to receive the patient;G an appropriate landing zone and transport tothe medical facility;G clinical condition of the patient;G weather conditions;G availability and type of aircraft;G landing and flyover clearances; andG visa and travel documents clearance.In general, family members will not be allowed totravel with the patient. Medical evacuation by air isnormally contraindicated in the followingcircumstances:G cardiovascular instability;G non-drained gaseous effusion (pneumothorax,intestinal occlusion); orG recent surgical procedures.Medical evacuation by air normally requires apatient escort. Standards for patient escorts includethe following:G Depending on the complexity and severity of themedical case and the journey time, more thanone patient escort may be required.G Should a doctor, nurse or paramedic berequired, they should have received training in,and be familiar with, the aviation environmentand impact on patient physiology in flight.G In some cases a family member, friend orcolleague may be sufficient. This should bedetermined by the company-approved healthprofessional in association with the carrier.G The patient escort must carry sufficientmedications to provide for the anticipated needsof the patient during the flight, includingadditional quantities in case of unexpecteddelays.G The patient escort must ensure that all medicalequipment has been approved for use on theaircraft concerned. In addition, an approvedand dedicated power supply for medicalequipment should be available.G The patient escort should travel in seatingadjacent to the patient.Consideration should be given to connecting flights,transit time and the requirement of commercialcarriers.Commercial aircraftBoth scheduled and chartered commercial aircraftcan be utilized for seated and stretcher patienttransport. Commercial flights are the first choice forstable patients needing to be flown long distances.For stretcher patients an airline-approved stretcheris necessary; note that this can limit the availabilityof commercial aircraft for rapid patient movement.Medical evacuation by commercial aircraft isusually contraindicated in the followingcircumstances:G contagious diseases;G agitation;G nauseating odours;G incontinence;G ongoing intensive medical care.In such cases, special authorization by the airlineand/or pilot is required.
Medical evacuation by scheduled commercialaircraft imposes additional requirements:G The airline must consent to carry the patient byapproving a medical clearance form.G The medical clearance form is to be completedand submitted to the airline as soon as the needfor medical evacuation by this means isdetermined (at least 48 hours of advance noticemay be required).G If necessary, oxygen should be requested fromthe airline (up to 180 litres of oxygen is requiredper person per hour).G Suction equipment should be available.G Conveniently placed hangers or hooks should beavailable to support the provision of intravenousfluids in flight.Light fixed-wing aircraft andhelicoptersIn certain circumstances it may be necessary to uselight fixed-wing aircraft or helicopters. Considerationshould be given to:G pressurization of the aircraft;G stretcher accessibility;G pilot awareness concerning the extent of theinjury or illness, and agreement to undertake thetransport;G airline and/or pilot clearance of the equipment;G in-flight communication between the pilot andthe patient escort.Air ambulancesAir ambulances may be used to transport patientswho:G are seriously ill/injured or have unstableconditions;G would not be accepted by a commercial flight;G have urgent conditions in locations wherecommercial flights are not available.Aircraft standardsIn certain types of aircraft (e.g. helicopters),consideration should be given to problemsassociated with:G noise (hearing protection, communicationbetween patient escort and patient);G vibration;G temperature (in helicopters space blankets arehighly recommended);G air sickness;G psychological distress due to travel conditions;G use of certain medical equipment (e.g. defibrillator).Medical evacuation by water transportAll watercraft which may be used for evacuationneed to be able to accommodate a stretcher case ina safe, comfortable and secure manner.Watercraft standards for medicaltransportAdditional recommendations include the following:G The craft must be ergonomically suitable forstretcher recovery work and should be equippedwith an appropriate sheltering area or cabin toprotect the patient lying on the stretcher as wellas the medical escort and equipment.G It must be equipped with appropriate life jacketsfor all on board including the patient, and becompliant with local water transport safetyregulations.G The position of the stretcher should allow the patientto be aligned along the long axis of the watercraft.G Special precautions should be taken when usingelectrical equipment (e.g. automatic externaldefibrillator) in a wet environment to avoidelectrocution of any personnel.G The craft should have a power supply forpowering medical equipment.G It should carry a vacuum mattress for spinalcases and other cases needing immobilization.These stretchers must be securely fixed to thewatercraft.IPIECA • OGP30
31MANAGING HEALTH FOR FIELD OPERATIONS IN OIL AND GAS ACTIVITIESAnnex 3: Guidelines for health-care professionals:knowledge, skills and medical kitsFor the purpose of this document, health-carepersonnel have been divided into five categories:G Level 1 health-care providers: basic first-aider.G Level 2 health-care providers: advanced first-aider and emergency medical technicians (EMTs).G Level 3 health-care professionals: nurse andparamedic.G Level 4 health-care professionals: medicaldoctors and nurses.G Level 5 health-care professionals: medicalspecialists.Level 1 health-care providers:basic first-aiderKnowledge and skillsG Scene assessment and prevention of secondaryaccident (including self protection)G Contents and use of Level 1 first-aid kitG Priorities (‘ABC’—Airway, Breathing andCirculation)G Emergency call-out proceduresG Relevant safety data sheetsG Prevention of blood-borne pathogens and otherassociated hazardsG Basic hygieneG Use and application of the recovery positionG Cardio-pulmonary resuscitation (CPR), possiblyincluding use of an AEDG Basic control of external bleedingG Application of simple dressingsG Application of simple splintsG Eye washing of foreign bodies and chemicalsplashesG Initial treatment of thermal or chemical injuriesG Ability to provide clear details of injury/illness.Level 1 first-aid kitG Contents listG Cardiopulmonary resuscitation cardG Individually wrapped sterile adhesive dressingsG Sterile eye padsG Surgical tapeG Triangular bandagesG Safety pinsG Medium and large sterile unmedicated dressingsG Alcohol-free cleaning wipesG Surgical glovesG ScissorsG Pocket maskG Burns packet (e.g. Water-Jel™ or equivalent)G Bag for clinical waste.Access to an AED and eye wash facility isrecommended.Level 2 health-care providers:advanced first-aiderEmergency medical technicians (EMTs) used insome countries may come under Level 2.Knowledge and skills(in addition to Level 1)G Contents and use of Level 2 first-aid kitG Management of bleedingG Management of simple woundsG Management of an unconscious personG Treatment for shock, hypothermia, heat injury,immersion, burnsG Various types of dressingsG Immobilization of injured partsG Transportation of an injured or ill personG Communication and delegation in an emergencyG Specific workplace risksG Simple record keeping.Level 2 first-aid kit(in addition to Level 1)G Guidance leafletG Butterfly closuresG Crepe bandagesG Splints (inflatable or vacuum)
G Thermometer (digital)G ForcepsG Pocket lightG Saline solutionG Burn blanket (space blanket)G Tourniquet.Other abilitiesIn certain circumstances first aiders may need todrive or operate radio equipment in order to fulfiltheir first-aid responsibilities.Recertification and maintenance ofskillsFirst-aid and resuscitation skills decline rapidlywithout practice. Recertification should take placeat least every three years. In the interim, skillsshould be maintained through participation indrills. Records should be kept of each individualstraining.SupervisionAll first-aiders need supervision by competentcompany approved health professional.Level 3 health-care professionals:nurse and paramedicLevel 3 health-care professionals are individualswith specialized training in emergency care; theyare accredited by various professionalorganizations around the world, and are usuallyemployed in field operations to manage medicalemergencies with remote support from a Level 4health professional.Knowledge and skills(in addition to Level 2)G Contents and the use of Level 3 medical kitG Emergency response planG Food hygieneG Administration of identified drugs and medicinesunder qualified supervision.Level 3—medical kitContent to include Level 2 first-aid kit plus thefollowing items that the Level 3 individual iscompetent to use or certified to administer:G Suture setG SphygmomanometerG StethoscopeG Oro-pharyngeal airwayG Laryngeal maskG Pulse oximeterG Bag, mask and valve set (Ambu bag)G Oxygen, tubing, manometerG Foot operated suction unit with cathetersG Laryngoscope with blades, bulbs and batteriesG Endotracheal tubesG Intravenous giving setsG Intravenous cannulaeG Intravenous fluidsG Intramuscular injection needles and syringesG Medication as approved by the supervisinghealth professional (with manufacturersprescribing information)G Rehydration sachetsG Patient identity tagsG Injury and treatment summary charts and reportformsG Large torch with batteriesG Container for contaminated needles and sharpsG ThermometerG GlucometerG SplintsG Nasopharyngeal airwaysG PPEG Spinal immobilization equipmentG AED +/– 12 lead capabilityIPIECA • OGP32
33MANAGING HEALTH FOR FIELD OPERATIONS IN OIL AND GAS ACTIVITIESG Nebulizer capabilityG Capnography device.Level 4 health-care professionals:medical doctors and nursesThe primary health-care unit on site should bestaffed by registered and licensed healthprofessionals. These could be doctors, nurses,physician assistants or other trained personnel withexperience in primary and emergency medicalcare. They would be expected to provide advancedemergency medical care to resuscitate a patient andto participate in the MERP in case the patient is tobe transferred to the secondary or tertiary HCU.Knowledge and skills(in addition to Level 3)Advanced life support (ALS)G Cardiac monitoringG Cardiac defibrillationG Transcutaneous pacingG Intravenous cannulation (IV)G Intraosseous (IO) access and intraosseous infusionG Surgical cricothyrotomyG Needle cricothyrotomyG Needle decompression of tension pneumothoraxG Advanced medication administration throughparenteral and enteral routes, includingintravenous (IV), intraosseus (IO), per os (PO, bymouth), per rectum (PR), endotracheal (ET),sublingual (SL, under the tongue), topical andtransdermalG Following algorithms as set forth by AHA26,advanced cardiac life support (ACLS)G Following algorithms as set forth by Pre-HospitalTrauma Life Support (PHTLS), Basic Trauma LifeSupport (BTLS) or International Trauma LifeSupport (ITLS).Advanced trauma life support (ATLS)G Spinal immobilization and correct application ofemergency cervical collarG Use of long back board and head immobilizer(if available)G Care of unconscious head injuryG Evaluation of level of consciousness usingGlasgow Coma ScaleG Patient log rolling techniquesG Stop bleedingG Identify signs of shockG Immobilization of limbs in a possible fractureG Eye irrigationG Patient decontamination.Interpretation and diagnosis of all potentialserious and life-threatening conditionsThese shall include the following:G Cardiac chest painG Difficulty in breathingG AnaphylaxisG AsthmaG HyperglycemiaG HypoglycemiaG Altered level of consciousnessG Head injuryG Neurological deficitsG HypertensionG HypotensionG Heat stroke and heat-related illnessG Food poisoningG DehydrationG Altered mental statusG Signs of infection (viral, bacterial and fungal)G Signs of infestationG Suicidal tendenciesG DepressionG FatigueG Acute weight lossG Eye injuries/disordersG Sight deficiencyG Hearing deficiency.26 American Heart Association
Level 5 health-care professionals:medical specialistsThe identified secondary and tertiary HCU shouldbe staffed by medical specialists. These are medicalpersonnel who have undertaken postgraduatemedical training and obtained further medicalqualifications, and whose competence has beencertified by a diploma granted by an appropriatespecialist medical college. They would be expectedto assess, diagnose and treat specialized andcomplex medical conditions.Knowledge and skills of secondaryHCU medical specialists(in addition to Level 4)G Management of inpatient medical and surgicalcases requiring investigation and/or treatmentG Capable of damage limitation surgeryG Ability to provide emergency resuscitation andstabilization of patients prior to referral to atertiary HCU if necessaryG Participation in MERP in case the patient is to betransferred to the tertiary HCU.Knowledge and skills of tertiaryHCU medical specialists(in addition to Level 4)The tertiary HCU is able to handle criticalconditions that exceed the capacity of the localsecondary health-care facility. Such conditionsinclude, but are not limited to the following:G Major traumaG NeurosurgeryG Severe burnsG Cardiac surgeryG High-risk pregnancyG Complex tropical diseasesG Organ failure and transplantG OncologyG Major psychosesG Substance abuse treatment.IPIECA • OGP34
35MANAGING HEALTH FOR FIELD OPERATIONS IN OIL AND GAS ACTIVITIESAnnex 4: Local medical facility audit templateLogisticsThe checklist in Table 3 below summarizes the basics of what should be found in primary, secondary andtertiary health-care units.Table 3 Basic requirements of primary, secondary and tertiary health-care unitsAdministrationSecondaryhealth-careunitBasic Patient confidentiality G G GHealth records G G GControl of prescription drugs including CDs G G GStandard operating procedures G G GMedevac procedures G G GAdvanced Appointment system G G GDischarge agreement with company G GAgreed company access to monitor patient care G GG G GAccessibility G G GSecurity G G GCommunication G G GSupply of quality drugs and medicines G G GPreservation of cold chain G G GProgramme of preventative maintenance G G GTelemedicine G G GClinical waste disposal G G GBasic Competence (training, skills, experience) G G GParamedic G G GNurse G G GDoctor—general practitioner G G GAdvanced General surgeon G GCardiologist G GObstetrician—gynecologist G GPaediatrician G GAnaesthetist G GDentist G GTertiaryhealth-careunitPrimaryhealth-careunitHealth professionalscontinued …
IPIECA • OGP36Table 3 Basic requirements of primary, secondary and tertiary health-care units (continued)… Health professionals (continued)Secondaryhealth-careunitAdvanced Pharmacist G G(contd.)Health technician G GOphthalmologist G GSurgical specialists GMedical specialists GCleanliness G G GPrivacy G G GComfort (TV, phone) G GFurniture (desks, chairs, etc.) G G GBeds and examining tables G G GLighting G G GRefrigeration G G GHeating/air conditioning G G GBack-up power supply G G GHand washing facilities for staff G G GToilets G G GWaste disposal G G GRunning water G G GEnvironmental protection G G GAmbulance G G GCatering G GPotable water G G GPotable water testing GLaundry service G G GSterilization/sterile supplies G G GOperating theatre G GRecovery room G GEmergency room G GIsolation room G GMortuary G GTertiaryhealth-careunitPrimaryhealth-careunitPremises
37MANAGING HEALTH FOR FIELD OPERATIONS IN OIL AND GAS ACTIVITIESTable 3 Basic requirements of primary, secondary and tertiary health-care units (continued)… Premises (continued)Secondaryhealth-careunitHelicopter landing access G G GCD cabinet G G GThermometer G G GSphygmomanometer G G GStethoscope G G GFoetal stethoscope G GOtoscope G G GReflex hammer G G GOphthalmoscope G G GEye chart G G GUrine dip stick G G GScales G G GHeight measurement G G GElectrocardiogram G G GSpirometer G GPeak flow meter G G GAudiometer G GRadiology G GUltrasound G GCT scan G GMRI G GInvasive diagnostic procedures G GLaboratory G GGlucometer G G GDrug and alcohol testing G12-lead ECG G G GPoint-of-care testing, e.g. pregnancy,cardiac markers, malaria G G GTertiaryhealth-careunitPrimaryhealth-careunitDiagnostic equipmentcontinued …