International Standard for Remote and Offshore Medics

Introduction

            There is a great need for workers and other personnel to work in the offshore environment, following the recent technological developments in oil and natural gas exploration.  Workers have to often reside and work in locations away from the land and would be exposed to highly stressful conditions.  To ensure that workers can function in an environment that does not seem hazardous to health, a separate branch of medicine has evolved, named as ‘Offshore Medicine’.  This system of medicine would provide an environment in which the safety and the health of the employees would be ensured and also take care of occupational health issues, provide medical care and also manage conditions or disasters that arise out of the offshore or remote environment.  It is important to note several general problems with the offshore or remote environment:-

The workers or employees would be exposed to several toxic substances and hazardous situations that can be a serious risk to health

The offshore unit would be located at some distance from the land and hence, immediate medical assistance at the spot would be required in order to stabilize the worker and transfer them to a hospital onshore.

It may be difficult to provide medical support at the site due to transfer of medical equipment, drugs and support systems to the offshore site (Norman, 1985).

An academic unit was formed in Aberdeen in 1976 with the sole aim of providing people suffering from difficulties and located in remote areas medical support.  They tried to develop ways and means of providing medical care to people who were located in remote areas and who worked in a potentially dangerous environment.  The Aberdeen project researchers closely began to work with health professionals who were located in oil rigs in an effort to launch a health system to their benefit.  Several other parties including doctors, physicians, oil company helath professionals, military, etc, also began to form a part of such a team (Norman, 1985).  There were several special requirements that people who worked in the oil rigs had:-

Provide immediate medical care in certain extraordinary situations
Provision of medical support following injury or acute illness
Contacting doctors and specialists located at onshore locations and performing required procedures or giving drugs after
Round the clock emergency support (Tyler, 2007)

It is the responsibility of the employer to provide a safe environment for the helath and safety of the employees.  Employers who hire the employees to perform offshore working tasks such as oil extraction, deep sea construction works, diving operations, etc, have to ensure that personnel, drugs, equipment, supplies, support systems, etc, are existent to take care of the health and safety of the workers (Tyler, 2007).  Several countries such as the United Kingdom, United States, Canada and some of the Gulf nations, have legislations put across to ensure the safety and the health of the offshore employees (Norman, 1985).

Problems Faced by the offshore health workers

            In the past, the pattern of injuries and health problems faced by the offshore health workers are comparable but not limited to those suffered by onshore industrial workers.  Most of the injuries are suffered by young men who usually fall from a height.  Older adults are also prone for several injuries if they are exposed to risk factors, especially being unfit to work in strenuous conditions.  Eye injuries are common in drillers, whereas crush injuries to the trunk is common whilst transferring goods.  Offshore sea workers are usually between the ages of 20 to 50 years.  A greater percent of those in oil rigs (54 to 65 %) suffer from acute illnesses, whereas a smaller portion (35 to 45 %) are affected with injuries.  In various groups the highest number of injuries occurs in drillers, followed by construction workers, divers, seamen, crane operators and other groups.  With regards to acute illnesses, the most common ones include respiratory illnesses, followed by gastrointestinal, muscular, CNS, eyes and cardiovascular.  Injurious to the eyes and face are the most common suffered by the offshore workers, followed by injuries to hands, feet, back, shoulders, chest, etc (Norman, 1985).

During different stages of oil exploration and production work, different problems may be encountered by the offshore workers.  For example, during the exploration phase (which is the most hazardous), drillers and divers are at the risk for blast injuries, falls, facing injuries to the hands, eyes and head, etc.  During this phase, there are chances that the medical facilities at the oil rig may be poor and hence the personnel may not get immediate medical attention.  During the development phase, the production equipment and facilities are being setup.  There are chances of having great number of workers at the place, and in case of disasters, the effect could be serious.  A wide variety of medical problems can arise.  In the production stage, the number of disasters and accidents would reduce drastically, as the workforce are aware of the risks and are prepared to face it.  Occasionally, repair work may be required which would carry certain amount of risks.  However, production would usually last for several years and during this stage, the workforce would age and would be at a risk of facing several health problems due to aging.  There are greater chances of acute helath problems during this stage than having serious injuries (Norman, 1985).

            Oil rig workers also face a lot of risks in their working environments that could seriously affect their health.  These include:-

·         Dangerous and hazardous environments

·         Constant risks from facing burn-outs or failure of the platforms

·         Constant to and fro helicopter travel

·         Underwater sea risks especially in deep sea construction workers

·         Living in overcrowded places

·         Poor hygiene and pollution

·         Difficulty in getting a nutritious diet at the offshore location

·         Psychological and physical stress

·         Staying away from loved ones at home

·         Day-to-day stresses including injuries suffered at work

·         Poor leisure facilities

·         Poor healthcare facilities which could easily worsen any helath problem (Tyler, 2007)

Offshore Medics of the UK standards

            Every offshore medic would have to complete a training course for medics that have been approved by the HSE.  Usually the rig medics who have been qualified by the HSE are approved anywhere in the world.  Any person who has to work as a rig medic in the UK Continental Shelf would require to have a valid UKOOA Medical certificate, a certificate ensuring that the individual can survive in the offshore environment, and an HSE offshore medic certificate.  To become a qualified HSE approved offshore medic, the person should either be a qualified registered nurse or a qualified person who has served the army, navy, air force or military and has received training as a medical technician, medical assistant, corporal or others.  A registered nurse is also required to have three years of experience following her/his registration (Rig Medics UK, 2008).

            Organizations that train candidates in becoming rig paramedics are located throughout the United Kingdom which would help train the interested candidates in pursuing a career as an offshore rig medic.  The entire course takes about 4 weeks, which includes two weeks of classes, one week as a general practitioner and one week working in the emergency and accident departments.  Candidates who become qualified rig medics would also have to take up a refresher course lasting for 2 weeks every three years.  The price of the course varies from one organization to another, and varies from thousand to two thousand pounds.  Besides, doing the rig offshore medic course, the candidate should also be doing the offshore survival course which would ensure that he/she can survive in an offshore environment.  This course lasts for 3 days, and every four years, the candidate should attend a refresher course in the same.  The survival certificate course cost around 500 pounds and is also known as Basic Offshore Safety Induction and Emergency Training (BOSIET).  Usually the Medic course approved by the HSE in the UK would be approved by several others in the world and would give the candidate a chance to work throughout the world including Canada, South Africa, South America, Australia, etc.  The training courses organized in Aberdeen were one of the first to be organized anywhere in the world (Rig Medics UK, 2008).

Offshore Medics as per USA Standards

            Medics working in the offshore environment are also known as Offshore Nurses or Offshore paramedics.  They should have done the 2 or 3 years course for becoming a registered nurse or a registered paramedic.  They should hold a registration in the current registration council to practice as a nurse or a paramedic.  They should be holding valid certificates for providing advanced cardiac life support, basic trauma life support, and pre-hospital trauma life support.  They should also be skilled and competent in using computers.  It would be desirable for the paramedic or the nurse to have previous experience in the offshore or the remote environment.  The offshore paramedic should have also recovered training in Basic survival in the offshore environment (BST), training with Hydrogen sulphide gas, previous occupational health experience, and WHMIS experience (AOMS, 2008).

            In the US, the paramedics would usually be working in the Gulf of Mexico area for oil extraction and drilling.  Usually, the paramedics or nurses where just shifted from an ambulance environment to the offshore environment with little training.  However, in the offshore environment a lot needs to be learnt.  The training courses under the US system are not approved as much compared to those by the British HSE system (Pucker, 2008).

            A paramedic working in an oil rig or an offshore environment should be thorough to manage basic treatment for conditions or injuries that affects the eyes, face, ENT, etc.  They should also be well experienced in suturing, managing poisoning with hydrogen sulphide gas, antibiotic administration, wound management, administration of oxygen, catheterization, etc.  They should also be taught how to handle other hazards in the offshore environment.   The US system gives great importance to management of trauma and cardiac care, unlike the British system (Pucker, 2008).

Offshore Medics of the Canadian standards

            The Rig medics as per the Canadian standards would provide first aid and initial health services at the rig location.  The employee should meet the standards in terms of qualifications, previous experience, training, etc, in order to enable them to perform their duties at the rig location.  In Canada, the personnel who can become paramedics offshore include medical practitioners, registered nurses, registered paramedics and those who have military medical assistants’ certificates from the Canadian Army.  Nurses and physicians should have two years of experience in the intensive care or emergency care of any hospital, whereas the paramedic should have three years of experience in providing advanced life support.  The candidate may also have desirable experience in evacuating injured people by helicopters, basic trauma life support, advanced cardiac care, pre-hospital trauma life support, etc, that have been recognized by the appropriate Canadian Boards.  They should also receive mandatory training in basic survival training, hazardous and material systems at the workplace and the management of hydrogen sulphide hazards (Canadian Association of Petroleum Producers, 2008).

            The Canadian System for paramedics offshore is much similar to the US system.  They also provide an opportunity for medical practitioners to work in such an environment if interested.  Having medical practitioners working in such an environment would be an added advantage helping to improve the quality of care.

Offshore Medics as per the Australian System

            The Requirements to practice as an offshore medic under the Australian system is similar to that of the UK.  The individual would have to be registered nurse or medical practitioner, and should be medically fit to work at sea.  The candidate would also have to attend the UKOOA program.  Another requirement is the Basic Offshore Safety Induction and Emergency Training (BOSIET) to help gain an insight at the dangers at sea and equip them with the knowledge and the skills require managing any critical or emergency situation.  They should also have the competency to deal with issues regarding hydrocarbons, including hydrogen sulphide.  Some of the other activities that the candidate should be familiar with including emergency helicopter docking, oxygen administration, use of fire extinguishers, rescuing from fires, etc.  The refresher courses need to be done every 2 to 4 years depending on the need.  The Australian system may be more comprehensive as it considers a broader skill set required by the offshore paramedic.  They are also trained on how to swim and rescue people from fires and drowning (IFAP, 2005).

Developing an international system for training offshore medics

            Currently, an international system for rig medics is not existent.  Having such a system would ensure that certain amount of uniformity is ensured, but at the same time, local issues need to be given consideration.

            The rig medic would report directly to the medical officer of the company.  In all countries, the medic would be performing certain common functions.  For up to 150 to 200 workers located on a rig, a rig medic should be present.  The rig medic needs to possess qualification such as registered nurse, medical practitioner, registered paramedic, or military medical assistant/technician.  The medic or paramedic should be trained in several aspects including basic life support, basic trauma, basic sea survival, basic and advanced cardiac life support, pre-hospitalization.  The UK system although recognized, may not consider these programs, and hence, an international system should be encouraged that would consider a skill set from the medics in these aspects (Norman, 1985).

            Continuing education is also very important for the offshore medics, considering that huge amounts of advancements are made in the field of offshore medicine.  On an international basis, training needs to be organized for at least one day in a year to ensure that their skills are constantly being updated.  Some of the skills that the offshore medic needs to posses includes:-

Examining the patient
Giving immediate first aid
Passing information from the offshore site to the doctor or healthcare professional located on the land
Aware of the various services that are located on the land
Be able to examine and monitor patients with minor conditions
Catheterization of the bladder
Performing endotracheal intubation
Maintain vital functions and stabilizing the patient
Ensure proper grounding and transportation of the patient by the helicopter
Be able to advice patients
Competent in using telemedicine facilities and computers
Able to administer drugs by the injections
Able to use medical equipment required to stabilize the patient
Be aware of basic and advanced life support, trauma care and cardiac care
Toxicology including hydrocarbons and hydrogen sulphide (Cirius Denmark, 2007).
The medic also needs to be competent in the language of the offshore workers to ensure that their problems are understood and treated properly.  It is also important to bring in the positive points of various individual systems and incorporate it in the international system.  For example, the Australian system gives importance to gaining swimming and rescuing skills which are relevant in a offshore environment.  Unnecessary aspects need to be also removed.  Local considerations also need to be given importance.

References

AOMS 2008, External Job Postings, AOMS, viewed 23 January 2009, http://www.aoms.nf.net/extjobs.htm

Bouabene, A. 2002, “Providing emergency medical care to offshore oil and gas platforms in the Gulf of Mexico using telemedicine.” TSOE, Vol. 4912, pp. 11-20. http://adsabs.harvard.edu/abs/2002SPIE.4912…11B

Canadian Association of Petroleum Producers 2008, Atlantic Canada Offshore Petroleum Industry Standard Practice for the Training and Qualifications of Personnel, CPAP, viewed 23 January 2009, http://www.capp.ca/getdoc.aspx?DocID=141676&DT=PDF

Capita Health Solutions 2005, Offshore Medics, Capita Health Solutions, viewed 23 January 2009, http://www.capitahealthsolutions.co.uk/930.htm

Cirius Online Denmark 2007, Offshore Medic, Cirius Online, viewed 23 January 2009, http://www.ciriusonline.dk/Default.aspx?ID=6837

Fredrick, A. Et al 2007, Offshore Medicine: Medical Care of Employees in the Offshore Oil Industry, Springer-Verlag, US, viewed 23 January 2009, http://books.google.com/books?id=c1FRAAAAMAAJ&q=offshore+medics&dq=offshore+medics&pgis=1

IFAP 2008, Basic Offshore Safety Induction and Emergency Training (BOSIET), IFAP, viewed 23 January 2009, http://www.ifap.asn.au/training/emergency/bosiet.html

Norman, J.N. Et al 1985, The Offshore Health Handbook: A Practical Guide to Coping with Injury and Illness, Taylor & Francis, London, viewed 23 January 2009, http://books.google.com/books?id=OeoOAAAAQAAJ

Phucker, P. 2008, Paramedics in the Oilpatch, Phucker, viewed 23 January 2009, http://www.phudpucker.com/oilpatch/ems/oilpatch.htm

Rig Medics UK 2008, What you need to have and what you need to do to become an Offshore Medic in the UK, Rig Medics UK, viewed 23 January 2009, http://www.rig-medics.co.uk/pages/article1.html

Tyler, M. Et al 2007, Tolley’s Workplace Accident Handbook, Butterworth-Heinemann, London, viewed 23 January 2009, http://books.google.co.in/books?id=zzReTHRL6I0C

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