SPE 108580

Development of Globally Accepted Standards for Emergency Medical Response

Systems
Kevin Luppen, BP
Copyright 2007, Society of Petroleum Engineers
This paper was prepared for presentation at the SPE Asia Pacific Health, Safety, Security and
Environment Conference and Exhibition held in Bangkok, Thailand, 1012 September 2007.
This paper was selected for presentation by an SPE Program Committee following review of
information contained in an abstract submitted by the author(s). Contents of the paper, as
presented, have not been reviewed by the Society of Petroleum Engineers and are subject to
correction by the author(s). The material, as presented, does not necessarily reflect any
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Introduction
The search for energy resources in more remote areas of the
world has created significant challenges to provide adequate
and appropriate emergency medical services as inherent high
risks require a timely response. A major incident could lead to
mass casualties and in a location with a poor or inaccessible
health infrastructure chances of survival are seriously
diminished. Business, project and HSE managers are under
significant time and cost pressures, and without guidelines,
may choose an inefficient or inappropriate delivery model.
Without consistent competence and resource expectations in
medical delivery systems across the world, project planning
becomes very difficult and the risks for poor medical
outcomes increase. Guidelines providing a practicable model
assist in achieving compliance with global standards and
assurance that risks are adequately managed.
History
Our previous business model relied on the managers within
the local business units to develop the medical emergency
response system. Lacking standardized guidance the
managers approach was dependent upon their previous
experiences or communications within the HSE network.
Frequently the assumption was to rely upon the local
infrastructure without vetting the competency, availability, or
quality of the medical delivery system. Too often the
assistance of the company health team was accessed late when
concerns or incidents occurred. Increased costs and
reputational concerns became evident when health expertise
was not involved during project planning.
When local company health expertise was utilized conflicts
sometimes arose with the recommendations due to cost
pressures. Validation of the recommendations was not possible
as there were no company standards to use as a benchmark.
Local legislation and cost were commonly used as the final

threshold prior to initiation of the model. This process created

a diverse and inconsistent delivery causing confusion and
frustration in appropriateness and expectations.
Plan
To identify and stratify the health risks a gap analysis tool was
utilized and forwarded to all the businesses. Questions
included:
Numbers of emergency responders, training
frequency and guidelines
Hours to stabilization centres (trauma, cardiac, burn)
Types of transport
Personnel & equipment resource
Emergency response and First Aid plan
Health risk assessment and/or Health impact
assessment completed
The results revealed the emergency medical response system
was a significant risk and several critical items needed to be
addressed. These included:
Assessment of health risks of the project or operation
Process to determine appropriate staffing
Recommended health professional profiles and
minimum competencies
Standard response times
Minimum standards for facilities, equipment, and
medication
Triage and evacuation procedures
Guidance on tertiary referral centres
Medical contract scope
Audit & assurance process
A decision was made to develop a company process to
facilitate planning and enable cost-effective delivery. The
model would cover the life of a project from the planning
stage, through exploration, construction, operations and
demobilization both on and off shore. An initial assumption
that existing models or industry benchmark standards could be
utilized and modified was invalid. Models of current oil & gas
best practices, other industry response systems, military and
regulatory systems were reviewed and revealed minimal
information or the process to be proprietary.
A group of company health professionals established a work
group and began to identify best practices within their region
and to review all regulatory concerns. Managers were

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SPE 108580

contacted and problem areas were discussed. Health

departments within other oil companies were contacted to
share or comment on their systems. Web searches were
conducted and existing (e.g. OGP & UKOOA) industry
guidelines were evaluated. Military medical systems, OSHA
and European standards and tools were also reviewed.
Results
The guidelines evolved into nine sections covering the
following areas:
1. Health risk assessment
The health risk assessment (HRA) is the initial critical process
to identify the hazards affecting personnel. It is also important
to review any existing health impact assessments (HIA). Both
these inside and outside the fence risk assessments will help
identify the type of emergency medical provision required.
2. Decision Matrices
In the past quantifying the appropriate personnel was difficult.
Without a universally accepted guideline selection of
personnel numbers were arbitrary and placed at risk by
economic pressures. A decision matrix was created that
reflected the risk activity, e.g. drilling, personnel numbers and
time to appropriate specialist care, and provided a tool to
highlight required staffing levels for both on/off shore. This
tool was not intended to be prescriptive but to be interpreted
by a health professional in the light of local legislation and
infrastructure.
3. Medical Professionals
A cadre of medical professionals working in a coordinated
way will determine the quality of outcome in an emergency
situation. These positions range from first aiders who deliver
immediate care, through emergency medical technicians,
paramedics, registered nurses, physician assistants to
emergency doctors. Apart from first aiders these professionals
would normally be provided as part of an outsourced contract
and it is essential that the contractors staff meet training and
competence standards. As a reference minimum competencies
should be outlined together with suggested roles and
responsibilities.
4. Response Times
It is generally accepted that first aiders should be mobilized
and with the patient within 4 minutes of an incident, or basic
life support is unlikely to succeed. In some countries the
response time is governed by legislation (e.g. OSHA). If more
advanced care is required, the following are generally
accepted response times:
10 minutes Sometimes called the Platinum 10
minutes. EMT or paramedic in attendance
60 minutes Also known as the golden hour. Arrival
at a stabilisation facility
6 hours To tertiary referral centre
5. Minimum standards for facilities, equipment and
medication
Wherever reasonably practical emergency care should be
accessed through local or national resources and in some cases

these may need to be improved or upgraded. Where this is not

possible the company may need to provide emergency care
internally. There are established industry guidelines for
emergency facilities, equipment and medication. Examples
include UK Offshore Operators Association (UKOOA) for
offshore operations guidelines and International Association
for Oil & Gas Producers (OGP) for onshore. They are
generally accepted around the world by the oil and gas majors
and most of their contractor companies.
6. Triage and evacuation procedures
In many business units triage was not fully understood
especially relating to mass casualty. A triage system must be
in place, practiced regularly and up dated with lessons learned.
This should include an exercise of all the tactical teams within
the emergency response system (e.g. medical, fire, rescue,
spill, HAZMAT). Mass casualty assessments and drills should
include reviews of available structures that could be utilized
for triage or treatment areas. Temporary morgue space is often
not considered and a refrigerated area should be identified.
Surplus equipment or supplies can be stored in mobile trailers
or containers for quick access.
Evacuation procedures will need to take into account resources
available, urgency of the transfer, and the medical condition of
the patient. All patient escorts should have received training
in, and be familiar with the equipment they are expected to
use. All components of the medical evacuation process
(personnel, vehicles, equipment, training, communications,
etc) should be initially vetted and then audited at regular
intervals by the company. In certain circumstances the use of a
specialist medical evacuation organization may be desirable.
In this case a contract with the assistance company or
specialist transport company must be part of the emergency
plan.
7. Guidance on tertiary referral centres
These hospital based centres should be able to manage critical
conditions. They may not be available in some countries, in
which case it is desirable to identify such a facility in another
country. The hospitals and staff should be vetted prior to
utilization. A check list summarising the basic requirements of
a tertiary care facility together with an assessment form help to
provide assurance and standardization.
8. Scope of medical contracts
If contractors are utilized the contract for emergency medical
services should have clearly defined terms and expectations to
ensure that care is satisfactory and conforms to an
international standard and the health needs of the location. The
standard terms to be included in all health service contracts
may require local supplementation and there is an expectation
that the contractor will operate within health legislation of the
country. The contract account manager should either be a
health technical authority or incorporate a health technical
authority in development, oversight and assurance of the
contract. Co-ordination with local company health teams
and/or HSE professionals is essential to ensure contract
requirements are met at a local level.

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SPE 108580

9. Key performance indicators and assurance processes

Key Performance Indicators should be set at the beginning of
an emergency medical service contract and performance
reviewed quarterly at a minimum. All health contractor
processes and procedures should be available for audit
purposes.

The implementation establishes a minimum standard of care

that each business unit can now use as a baseline and enables
the health team to expand and respond to business needs. The
standardized approach provides universal expectation of the
medical emergency response system.

Once the medical emergency response plan is developed it

should be practised regularly. The results should be reviewed
and the plan revised if necessary. The extent of resource
deployment during the drills should be pre-determined by
management
and
company
designated
healthcare
professionals. The plan should be audited (and revised if
necessary) at least annually and following any significant
change in circumstances, e.g. type of operation, location, or
healthcare resources. Following actual medical emergencies a
debriefing should be conducted after each use of the medical
emergency response plan so that the company can make
improvements if necessary.
Summary
Site specific emergency medical plans need to be developed
based on company approved standards utilizing various
medical emergency scenarios aligned with their health risk
assessment. To be effective, the medical emergency response
system should:
Address any risks identified, be reviewed regularly
and assessed against measurable targets.
Identify the company designated health/medical
provider(s), their numbers, competencies, capabilities
and limitations. These could be under the direct
control of the company or a third party. If the latter, a
formal agreement for the level of medical support
should be made with clearly defined terms and
expectations.
Address the minimum standards for facilities,
equipment, and medication
Be a written document covering arrangements for,
and management of, individual and multiple
casualties.
Be integrated into the more general emergency
response plans and under the responsibility of line
management.
Determine the likely evacuation route(s) and means
of transport from the incident location to the places(s)
of medical care. Particular attention is required
regarding transportation limitations, e.g. distances,
mode of transport, and weather limitations.
Requirements for local authority/government
authorisation prior to evacuation out of the country
must also be considered. Include contact information
for all individuals who are covered by the medical
emergency response plan
Include contact details for key personnel.
Be regularly updated, well communicated and
understood, regularly practised and evaluated.
Provide guidance on tertiary referral centres.
Provide an assurance process with key performance
indicators.

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