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appendixto:aframeworkforremoteandisolatedhealthprofessionalpractice|revisedAugust2018 1
remoteandisolatedmininghealthservicesappendixto:aframeworkforremoteandisolatedprofessionalpractice
version2|revisedAugust2018
improvingremote health
2 CRANAplusremoteandisolatedmininghealthservices
RemoteandIsolatedMiningHealthServiceRevisedAugust2018
Appendixto:AFrameworkforRemoteandIsolatedProfessionalPracticeReviewedAugust2018
Authors:GeriMalone,JudyWhiteheadandChrisBelshaw
appendixto:aframeworkforremoteandisolatedhealthprofessionalpractice|revisedAugust2018 3
Contents
Introduction 4
Contextofremoteandisolatedminingsector 4
Aframeworkforremoteandisolatedmininghealthservices 6
Theprofessionalrole 6
Thehealthfacility 9
Relevantlinks 10
References 10
4 CRANAplusremoteandisolatedmininghealthservices
introduction
The‘AFrameworkforRemoteandIsolatedPractice’1describestheremotehealthworkforcebeinglocatedindiverselocationsandhealthsettings.TheminingindustryinAustraliahasbeenactiveintheremotesectoroveralongperiodoftime.IncreasingdemandsandcomplexitieshaverequiredtheMiningIndustrytoprovideabetterlevelofhealthservicetotheiremployeeswhilst,atwork,inremotelocations.
MiningcommunitiesacrossremoteAustraliaarediverseinnatureresultinginthehealthservicesevolvingwithgreatvariation.Therearesomewell-establishedhealthservicesinoperationformanyyears,forexample,MoombaOperationunderSANTOSintheCooperBasin.
Thisdocumentwillprovideaframeworkfortheestablishmentofhealthservicesinconsiderationoftheprofessionalneedsofhealthemployeesandbestpracticestandardsfortheminingcompany.
Forthepurposeofthisdocument,the‘miningcommunity’contextisreferredto,asbeingremotelylocated,non-permanentminingsites,withaFly-In,FlyOut(FIFO)orDriveIn,DriveOut(DIDO)workforce.Itisimportanttonoteremoteandisolatedconjuresgeographicalremoteness.However,healthprofessionalsworkingintheminingindustrymaybeisolatedintheirprofessionalpractice,astheindustryfocusismining,nothealth.
contextofremoteandisolatedminingsector
TheWorkforce
Theworkforceremainspredominantlymale,withtheassociatedco-morbidities,isolatedfromfamily,networks,andsocialsupports.Inspiteofthis,thereareanincreasingnumberofwomenintheminingworkforce,influencingthetypeofhealthservicesoffered,thuschangingthe‘traditional’typesofservicefromamalefocustobeinclusiveofbothgenders.
Theworkforceprofilehaschangedovertheyearsfrombeingyoung,activewhenjobswerephysical,tobeingolder,moresedentaryroles,withasignificantchangeintheexpectationsoftheworkforcebytheemployers.
LegislativechangessuchasenforcedDrugandAlcoholTestingProgram(DAMP)andconditionsofworkandrequirementsrelatedtoworkhealthandsafetyhaveimpactedandinfluencedtheemploymentexpectationswithintheminingindustry.
Theworkforceremainslocationdependent,andwhilstitisstillpredominantlymale,variancesdoexist,rangingfromyoungsingles,toyoungtomiddleagedwithpartnersandfamilieslocatedelsewhere.
ItisrecognisedtheMiningindustryworkforceismulti-cultural,andgenerallytheworkershaveahigh-incomestatus,withassociatedhighdisposableincome,whichimpactsonspendingpatternsandlifestyles,whilstonleave(rest).
appendixto:aframeworkforremoteandisolatedhealthprofessionalpractice|revisedAugust2018 5
Locations
Miningsitescanbelocated‘off-shore’or‘on-shore’sharingsomeofthesimilaritiesinregardtogeographicalisolation.Somearegeographicallyisolated;othersmaybelocatedclosertoregionalorruraltownships.
Theestablishingminingcompanydeterminestherangeoffacilitiesandservicesavailableinisolatedcommunities.Thesevariationsinfacilitiesrangefromsemi-permanent‘demountable’tomobile‘set-ups’withvariancesexistinginaccommodationstandards,andothercampfacilitiessuchassporting/recreation,cateringandtheavailabilityofalcoholonsite.Iftheminingsiteislocatedintheregionalorruralareasclosertotownships,otherservicesmaybemorereadilyaccessible.TheworkforceisFly-In,FlyOut(FIFO)orDriveIn,DriveOut(DIDO)andthelengthoftimeonsite,isvariable.
HealthServices
HealthServicesvarybroadly,basedontheroleofthecompany,thesizeofthesite,legislationandcontractualarrangementsalongwiththeminingcompany’sethos.
Thehealthservicesrangefromfirstaidservicestoamorecomprehensivehealthservicethatprovidesforgeneralhealthconsultations,alongwithemergencycare,workplaceaccidentmanagement,andworkplacehealthandsafetyservices,suchas,audiometry.
Staffingvariesfromsafetyofficers,firstaiders,advancedfirstaiders,toParamedics,Nurses,Doctors,whichisdependentonthelevelofservicerequired.Thehealthfacilityvariesfrom:acaravan;ademountable;afirstaidroom;toadesignatedhealthcenter(stand-alonefacility).
Criticallookatthechallengesforhealthprofessionals
Healthprofessionalsemployedinanon-healthindustryi.e.Miningareisolatedintheirpractice,astherearenoacknowledgedbenchmarksfortheestablishmentofhealthfacilitiesandservices.Thislimitationimpactsuponhealthcarestandardsandservicedelivery.
Healthprofessionals‘employed’toworkinfacilitiesoftenhavenohealthgovernancepolicytoassistinguidingandshapingtheirday-to-daypractice.Theminingindustrypersonnelmayhavelimitedlevelofunderstandingoftherequirementsforprofessionalpracticeofhealthprofessionals,employinghealthstafftofulfilla‘legislative’requirement.
Traditionallytheroleofhealthserviceprofessionalswastorespondtoworkplace‘accidents’andoccupationalhealthandsafetyrequirements.However,thereareacknowledgedbenefitsofprovidingacomprehensiveprimaryhealthcareservice,totheemployees,whilsttheyareawayfromhomebase.
Theprovisionofprimaryhealthcareservicehasbenefitsforboththeworkforce,andthecompany.Fortheworkforce,itprovidesamorecomprehensivelevelofcareonsite.Forthecompany,itreducestheimpactontherequirementforemployeestoleavethefieldfor(non-workrelated)healthconditions,astheycanbemanagedsafelyandcompetently,byhavingtheappropriatelevelofhealthstaff.
Acriticalchallengeforhealthprofessionalsinestablishingamininghealthserviceistopreventitfallingshortofthehealthcarestandardsthatare‘acceptable’tothehealthprofessional’sroleandresponsibilities.Failuretodothismayresultinconflictsbetweenthehealthprofessionalandtheemployeroversuchissuesascomprisingprofessionalconfidentialityandworkingoutsideoftheirscopeofpractice.Thisplacesthehealthprofessionalatprofessionalrisk.
6 CRANAplusremoteandisolatedmininghealthservices
aframeworkforremoteandisolatedmininghealthservices
TheremoteandisolatedmininghealthservicesframeworkalignswiththeAFrameworkforRemoteandIsolatedProfessionalPractice(RevisedAug2014)2withtheaimtoprovideguidanceintheinitiation,developmentandtheon-goingserviceprovisionofaremotemininghealthservice.
There are three key components of this framework:
● TheProfessionalRole
● TheHealthFacilityGuide
● RelevantLegislative
CRANAplus’‘AClinicalGovernanceGuideforremoteandisolatedhealthservicesinAustralia’3providesguidanceforestablishinganurse–ledhealthservicesasitisbasedontheNationalSafetyandQualityHealthServiceStandard#1:GovernanceforSafetyandQualityinHealthServiceOrganisations.
theprofessionalrole
Itiswellrecognisedthatremotehealthprofessionalsareguidedby‘health‘asbeingawhole-of-lifeconcept,encompassingphysical,spiritualandemotionalwell-beingofindividuals,family,communityandtheenvironment.
Remotehealthprofessionalsworkwithintheirscopeofpractice,arespecialistpractitionerswhoprovideand/orcoordinateadiverserangeofhealthcareservicesforadiversityofpopulationgroups4.
ScopeofPractice
CRANAplus supports the following definition of Scope of Practice:
Aprofession’sscopeofpracticeisthefullspectrumofroles,functions,responsibilities,activitiesanddecision-makingcapacitywhichindividualswithintheprofessionareeducated,competentandauthorisedtoperform.
Thescopeofprofessionalpracticeissetbylegislation–professionalstandardssuchascompetencystandards,codesofethics,conductandpracticeandpublicneed,demandandexpectation.Itmaythereforebebroaderthanthatofanyindividualwithintheprofession.
appendixto:aframeworkforremoteandisolatedhealthprofessionalpractice|revisedAugust2018 7
The actual scope of an individual’s practice is influenced by the:
● contextinwhichtheypractice
● consumers’healthneeds
● levelofcompetence
● education,qualificationsandexperienceoftheindividualserviceprovider’spolicy,qualityandriskmanagementframework
● organisationalculture5
CollaborativePractice
Whilsthealthprofessionalspractisinginaremotesettingmayfeelisolatedassolehealthprofessionals;collaborativepracticeisanessentialrequirement.Thismaytakemanyformswitharangeofotherindividualprofessionalsandorganisations.Inessence,nohealthprofessionalshouldworkinisolation.TheadvancesinTelehealthhavegreatlyassistedwiththecollaborationbetweenmultidisciplinaryteammembers.
Types of collaborative practices:
● Miningcompanyassignedmedicalpractitioner,healthserviceproviders;e.g.RoyalFlyingDoctorService(RFDS)orequivalent,workplacehealthspecialists
● Professionalnetworksaroundspecificareaofpracticei.e.CardiacNetworks,Dermatology.
● Miningstaff:SafetyOfficers,FirstAiders,SiteManagers,HumanResourcepersonnel,RehabilitationOfficersandCorporateOfficers.
PreparationforPractice–Education,QualificationsandExperience
The‘AFrameworkforRemoteandIsolatedProfessionalPractice’documentprovidesinformationaboutcareerpathways,coursesandexperiencesrequiredtoworkinremoteandisolatedcommunities.Inaddition,asanemployeeintheminingsectortheremaybevariouspathwaystogainingtherequirededucationandtrainingtoequiptherole,througheitherpost-graduateeducationand/orcontinuingprofessionaldevelopmentactivities.
These include:
● SpecificWorkplaceandHealthandSafetycourses
● Audiometry
● DrugandAlcoholtestingcourse
● Safetyauditcourses
● Disastermanagement
8 CRANAplusremoteandisolatedmininghealthservices
As a Health Professional, you need to consider the following questions, but limited not to, in preparation of your role:
● Whataretheconditionsofemployment?
● Whatistheemployers’expectationsofyourrole?
● Howwellistheroleandresponsibilitiesdescribed?
● Whataretheprofessionalandorganisationalreportingprocesses?
● Arethereclinicalgovernancestructuresandprocessesinplaceifso,aretheyclear?
● WhatGuidelinesareinplace?e.g.CARPAandPrimaryClinicalCareManual(PCCM)
● Isthereajobdescriptionavailable?
● Doyouhaveaclearunderstandingofyourprofessionalscopeofpractice?
ForfurtherinformationvisittheCRANAplus’website,‘PathwaytoRemotePractice’whichunpacksthepreparatorystageintofoursimplesteps:https://crana.org.au/uploads/pdfs/CRANAplus_RemotePractice_V1_1_webrescmp_Jan15-1_1.pdf
Your Role may contain some of the following elements:
● Emergencycare
• OccupationalandGeneralCare
● PrimaryHealthCareacrossthelifespan
• Chronicdisease,mentalhealth,men’sandwomen’shealth
● WorkplaceHealthandSafety
• DrugandAlcoholscreening
• Audiometryscreening(NoiseStandards)
• ConfinedSpaces
• Workingatheights
• Roperescue
• Undergroundmining
• Breathingapparatus
• Returntoworkrequirements
appendixto:aframeworkforremoteandisolatedhealthprofessionalpractice|revisedAugust2018 9
ContinuousProfessionalDevelopment
Itiswellrecognisedthattomaintaincompetenceintheworkplacehealthprofessionalsneedtoembracea‘lifelonglearning’approachtoenhancetheirknowledge,skills,attitudesandbehaviourstomeettheirobligationstoprovideethical,safe,andcompetentcare.Theongoingandmaintenanceorexpertisewillbeshapedbytheirscopeofpractice.
The knowledge and expertise expected will require depth and breadth of experience and may include areas such as:
● Emergencycare
● MentalHealth
● PrimaryHealthCare
● ChronicDisease
● WorkplaceHealthandSafetycourse/topics
thehealthfacility
Thefacilitywillvaryandisdependentupontheservicesrequired.InthecontextofthisdocumentdescribesafacilitybasedonaRegisteredNurselevelofpractice,deliveringaprimaryhealthcarealongwithemergencyandworkplacehealthandsafetyservices.
The standard requirements:
● Building–facility-basedontheNationalFirstAidintheWorkplace–CodeofPractice(2018)6
● Additionalconsiderationswillvaryaccordingto‘on-site’servicessuchas:
• Consultingrooms,forvisitingdoctor,alliedhealthprofessionalsorothers
• Drugstorage
• Equipment
● Resourcese.g.Ambulancevehicle(refertoAppendixlistasperRemoteHealthAtlas)
● Drugs/Licenses:jurisdictionalbased,requiresconsultationandplanning
● Supportingresources/personnel
10 CRANAplusremoteandisolatedmininghealthservices
relevantlinks
National Registration with links to the National Boards https://www.ahpra.gov.au/
National Law with links to each State and Territory National law https://www.ahpra.gov.au/About-AHPRA/What-We-Do/Legislation.aspx
State and Territory legislations DrugsandPoisonsorControlledSubstancesActsandotherLegislationsimpactingonpractice,areunderthejurisdictionofeachStateandTerritory.Thesedocumentsarefrequentlyupdated,youwillneedtosearchundertherelevantStateorTerritoryparliamentaryand/orDepartmentofHealthwebsites.
SafeWork Australia with links to each State & Territory https://www.safeworkaustralia.gov.au/
Australian Commission on Safety and Quality in Health Care http://nationalstandards.safetyandquality.gov.au/
Fact sheets on NSQHS Standards http://nationalstandards.safetyandquality.gov.au/resources
NOPSEMA – National Offshore Petroleum Safety and Environmental Management Authority https://www.nopsema.gov.au/
references
1. MaloneG,CliffeC:AFrameworkforRemotePractice:CRANAplusJune2012.
2. CRANAplus:AFrameworkforRemoteanIsolatedProfessionalPractice:RevisedAugust2018.https://crana.org.au/resources/practice/remote-practice/
3. CRANAplus:AClinicalGuydeforRemoteandIsolatedHealthServicesinAustralia;September2013.https://crana.org.au/resources/practice/standards/
4. CRANAplus:AFrameworkforRemoteanIsolatedProfessionalPractice:RevisedAugust2018:p6.
5. NursingandMidwiferyBoardofAustralia:National Framework for the development of decision-making tools for nursing and midwifery practice,September2007–rebranded.http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Frameworks.aspx
6. SafeWorkAustralia:FirstAidintheWorkplace–CodeofPractice:May2018.http://www.safeworkaustralia.gov.au/system/files/documents/1805/code_of_practice_-_first_aid_in_the_workplace_0.pdf
12 CRANAplusremoteandisolatedmininghealthservices
Cairns office
Street address: Lot 2, Wallamurra Towers, 189–191 Abbott Street, Cairns, QLD 4870
Mailing address: PO Box 7410, Cairns, QLD 4870
Phone: (07) 4047 6400 Fax: (07) 4041 2661
Alice Springs office
Street address: c/- Centre for Remote Health, cnr Simpson and Skinner Streets, Alice Springs, NT 0870
Mailing address: PMB 203, Alice Springs, NT 0871
Phone: (08) 8955 5675
Adelaide office
Mailing address: PO Box 127, Prospect, SA 5082
Phone: (08) 8408 8200 Fax: (08) 8408 8222
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