Oil companies focus on health care for remote operations

Helsinki, with its modern facilities and high level of medical care, is often the destination of medical evacuations from Russia. Shown here at Helsinki prior to departure in a Euro-Flite Ltd. medivac jet, are a paramedic, flight captain, and physician (Fig. 1).

Oil companies are taking a hard look at the effects of employee health on overall corporate standing. Of special interest is the health of workers stationed in remote locations, such as offshore production platforms, where access to health care is limited.¹

A healthy work force not only saves money, but also increases productivity. Health issues were a major focus at the Society of Petroleum Engineers (SPE) Inc.'s third international conference on health, safety, and environment in oil and gas exploration and production, held June 9-12 in New Orleans.

A round-up of some of the important papers presented at this meeting explains:

• Difficulties associated with work in remote environments

• Guidelines for health facilities in remote locations

• Programs instituted by oil companies to improve worker health.

An extreme environment

The dangerous environment in which remote work often is performed can increase the frequency of accidents and illnesses. Mark Shrimpton, a socioeconomic consultant with Community Resource Services Ltd., St. John's, Newf., outlined the difficulties associated with remote work.²

"Particularly in the case of offshore petroleum operations, the difficulties of operating in such an environment may also mean that the workers' accommodations are in close proximity to a hazardous workplace," he said.

Remote work also involves a hazardous commute to and from the site. And the use of extended shifts and rotations can be fatiguing.

The standards for medical facilities in offshore petroleum operations have improved with time, says Shrimpton. It is now normal practice for operators to screen employees before offshore work. Typically, all workers are trained in safety and first aid, and medical and fire-fighting personnel receive specialized training.

Medical facilities on large, modern installations may comprise a physician, sick bay, and operating room, says Shrimpton. On smaller rigs and installations, a first aid center and staff medic are more common.

"The medical facilities and personnel offshore may be supported by the use of remote medicine, whereby diagnosis and treatment are assisted by doctors and equipment located onshore, with telephone and satellite links communicating voice, images, and readings from diagnostic equipment," said Shrimpton.

Remote care guidelines

Esso Production Malaysia Inc., Kuala Lumpur., developed a set of guidelines for medical services at remote sites. Exxon's Dr. A.H. Samad summarized these specifications at the meeting.³

"For any given remote location," said Dr. Samad, "the company physician responsible for the operation can use the guidelines to generate risk-based, operation-specific recommendations for local management to ensure that health and safety needs are met."

The guidelines are designed to facilitate the selection of third-party providers by ensuring, at the start-up of an operation, that vendors' bids cover a comparable set of services. They also serve as a yardstick for evaluating established operations.

Esso Production Malaysia divides medical personnel into three categories: company physicians advising remote operations, health care providers (HCPs), and external consulting physicians. HCPs include such classifications as licensed physicians, nurse practitioners, physician's assistants, and paramedics.

The guidelines delineate the necessary qualifications, critical skills, duties, and responsibilities of the HCP.

A first responder, for example, must be qualified in six areas to work in a remote location: extrication and rescue, spinal immobilization, patient assessment, bandaging and splinting, cardiopulmonary resuscitation, and basic airway management.

An emergency medical technician (EMT) paramedic, however, must have additional skills involving: cardiac arrest treatment, electrocardiogram (ECG) interpretation, medication therapy, advanced airway management, intravenous therapy, and pneumatic antishock garments.

Exxon's guidelines also provide general specifications for facilities, supplies, and equipment necessary for remote operations.

"The typical remote site clinical facility should include a sick bay with designated areas for consultation, physical examination, simple and basic laboratory tests, storage of supplies, in-patient beds, toilet, and shower," said Dr. Samad.

The available medications should include: cardiac medications, antibiotics, antiemetics, analgesics, anti-inflammatories, muscle relaxants, antihistamines, decongestants, steroids, bronchodilators, analeptics, topicals, ophthalmologicals, otorhinolaryngologicals, and intravenous solutions.

Exxon also has developed guidelines for transportation, medical evacuation, and facility organization and management.³

Equipment, facilities

D.G. Dawson, Unocal International, presented a paper detailing standards for medical support facilities developed by the Oil Industry International Exploration & Production Forum (E&P Forum), London.⁴ The forum developed the standards for health professionals to use in evaluating existing medical support facilities in proposed areas of operation.

The E&P Forum is an association of oil companies and petroleum industry organizations. The Forum represents its members' interests in dealings with governments and other bodies concerned with regulating exploration and production.

Table 1 [67517 bytes] shows details of the E&P Forum's guidelines for equipment, facilities, staffing, and procedures.^{5 6}

On-site care

In contrast to setting standards for existing health care facilities at a remote site, one company decided to establish its own on-site care and monitor the facility's activities in order to assess the value of the operation.

When a joint venture between Conoco Inc. and a Russian company installed a production facility in northern Russia, Conoco established medical clinics on site because of the risks and lack of available health care in the area. Clinics were located at the production site in Ardalin, Russia, north of the Arctic Circle, and at the joint venture headquarters in Arkhangelsk.

The clinics were staffed by trained medics with experience on offshore platforms. Physicians experienced in remote medicine supported the medics 24 hr/day by phone.

The medics kept daily logs of patient care and compiled monthly statistics. Dr. W. Howe, Conoco (U.K.) Ltd., presented results of a 12-month statistical analysis of the medical data.⁷

About one third of the clinic visits were for minor coughs, sore throats, and colds. As much as 78% of the work force may have experienced these symptoms.

Other common complaints included:

• Musculoskeletal conditions (13% of total complaints)

• Skin problems (9%)

• Stomach/bowel upsets (7%).

A significant number of lacerations and eye conditions were reported, as were 11 cases of sexually transmitted diseases. Although temperatures during the winter were -20 to -30° C., only nine cold-related injuries were documented.

There were 40 medical evacuations, the most common cause of which was "general illness occurring at work" (Fig. 1). Other reasons for evacuation were:

• Suspected heart attack (4 cases)

• Duodenal ulcer (4)

• Renal colic (4)

• Appendicitis (4)

• Dental problems (3)

• Epileptic attack due to alcohol withdrawal (3).

According to Dr. Howe, "The number of contacts justifies the provision of expert professional resources. The added value is in being able to differentiate the serious from the minor illnesses, and ensure appropriate treatment and disposal.

"The prevention of up to 10 unnecessary evacuations would save about U.S.$500,000-750,000. The approximate annual cost for providing the service was $500,000.

A comprehensive system

In another presentation at the meeting, Dr. J.G. Simpson, Marathon Oil Co., presented an overview of Marathon's comprehensive health management (CHM) system.⁸

Companies in the petroleum industry need to focus special attention on health management "...because of their inherently high health risks, complicated in some instances by health care which is below global standards in many of the locations in which they operate," says Dr. Simpson.

Table 2 [103427 bytes] shows an outline of Marathon's CHM system.

The system includes a questionnaire given to a company health care representative. "The questionnaire, supported by the CHM system, generates initial health and health care strategies for any size company operating anywhere in the world," said Dr. Simpson.

A remote care system

In a plenary session, Ian Strecker, executive vice-president of technology and quality, health, safety and environment for Schlumberger Ltd., Montrouge, France, described his company's approach to employee health.⁹

Schlumberger employs 120 medics on its drilling rigs (2 per rig on a rotating basis) and medical officers on its offshore seismic vessels. A staff doctor visits these remote locations regularly.

"[The] medics are professionals certified to administer routine and emergency medical treatment, ranging from general hygiene to infirmary services," said Strecker. "Each undergoes intensive 5-day first aid and 7-day hospital training courses, specifically tailored to Schlumberger's needs."

The medics are recertified every 3 years.

"For our land seismic crews," said Strecker, "we go a step further and provide a medical doctor, care facilities, and, in certain instances, additional support staff."

Schlumberger employees also test drinking water in remote locations using portable test kits. The kits measure four key parameters that determine water safety.

"These test kits are now used routinely...to minimize the occurrence of waterborne infections, including hepatitis A, cholera, and typhoid," said Strecker.

To target its employees working outside their home countries, who are often at greater risk of disease and injury, Schlumberger has instituted a program called Med-Track. Med-Track includes: thorough reviews of medical histories, pre-employment physicals, and re-examination frequency based on duty.

"The employee is given a detailed assessment of the test results and alerted to any precautionary measures, including vaccinations and recommended lifestyle alterations, which could assist in promoting better health," said Strecker.

The program also involves what the company calls a "health passport." This document provides information such as blood type, allergies, and inoculation history.

Schlumberger also publishes brochures on common health issues. The brochures, written by Dr. Alexander Barbey, international health coordinator for the company, are available on Schlumberger's web site at http://www. slb.com.

Offshore visits

Chevron Nigeria Ltd.'s offshore operations comprise five offshore living platforms and two livings platforms located in swamp land. The platforms house a total of about 260 residents.

Dr. P.A. Ajayi described Chevron's efforts to reduce the cost of employee health care in the area.¹⁰

As part of an improvement program begun in June 1992, Chevron added six staff physicians (all specialists) and a number of nurses with diversified special training. Existing medical facilities, including a clinic at the Escravos tank farm, were expanded.

At Escravos, Chevron added:

• Observation and stabilization rooms

• An X-ray machine

• An operating theater

• Modern diagnostic, resuscitation, and monitoring equipment.

Before the program began, ill or injured offshore workers had to be evacuated to the Escravos clinic. Now, a trained nurse visits each platform once or twice per week, and a staff physician visits at regular intervals.

Dr. Ajayi summarized the nurse's duties:

• Treatment of simple medical problems and administration of first aid

• Referral or evacuation of seriously ill or injured employees

• Health inspection and water sampling

• Health education and counseling

• Organization of disaster drills

• Handling of medical emergencies under the supervision of a staff physician.

"The net effect is a reduction in the frequency with which employees are flown out of their work locations to the base clinic in Escravos," said Dr. Ajayi. "There is also a reduction in lost work time and cost."

In addition, the frequency of visits by offshore workers to the Escravos clinic has decreased.

Other medical programs implemented by Chevron Nigeria include:

• Annual medical screening of employees

• Periodic hearing tests

• Regular first aid training for area employees

• Substance abuse awareness and training, including postaccident and reasonable cause testing

• Pest control.

Chevron plans to implement a first-responders training program soon.

Recommendations

Shrimpton recommends that companies operating at remote sites ensure that all workers are aware of the safety and health ramifications of remote work, and the appropriate responses to them.

"Particular care should be taken to provide appropriate counseling programs for workers and their families, preferably in the form of an employee assistance program," said Shrimpton.

"Lastly, special care should be taken with emergency planning, including the on site and external provision of equipment, personnel, and training."

References

1. Aalund, L.R., "Oil Companies Focus on Emergency Care for Expats in Russia," OGJ, Apr. 29, pp. 33-48.

2. Shrimpton, Mark, and Storey, Keith, "Health and Safety Issues Related to Remote Operations," SPE 35772, Third International Conference on Health, Safety, & Environment, June 9-12, New Orleans.

3. Samad, A.H., and Lindemann, K.C., "Medical Service Guidelines for Remote Sites, SPE 35769, Third International Conference on Health, Safety, & Environment, June 9-12, New Orleans.

4. Dawson, D.G., Barbey, A., Burke, N., Dahl-Hansen, E., Gilbert, M.J., Howe, W., Keech, J., McCready, D., Rodier, J., and Thomas, I., "Standards for Local Medical Support, E&P Forum Report No. 6.44/222," SPE 35771, Third International Conference on Health, Safety, & Environment, June 9-12, New Orleans.

5. Report No. 6.30/190, "Guidelines for Remote Land-Base Geophysical Operations," E&P Forum, London.

6. Report No. 6.44/222, "Standards for Local Medical Support," E&P Forum, London.

7. Wilder, R.J., Howe, W., and James, C., "A 12 Month Analysis of the Medical Workload of the Health Care Services Provided to a Russian/U.S. Joint Venture in Northern Russia," SPE 35802, Third International Conference on Health, Safety, & Environment, June 9-12, New Orleans.

8. Simpson, J.G., "A Paradigm Shift in the Management of Health Service for Organizations-Implications for Oil and Gas Exploration and Production Companies," SPE 35773, Third International Conference on Health, Safety, & Environment, June 9-12, New Orleans.

9. Strecker, Ian, "A Company Approach to the Health of the Individual," Third International Conference on Health, Safety, & Environment, June 9-12, New Orleans.

10. Ajayi, P.A., "Offshore Medical Services-A System of Health Care Delivery to Remote Areas," SPE 35805, Third International Conference on Health, Safety, & Environment, June 9-12, New Orleans.

Copyright 1996 Oil & Gas Journal. All Rights Reserved.