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Petroleum Development Oman L.L.C.
PR-1243B
Emergency Procedures part III: Volume 12
Medical Emergency Response Manual
Part II: Site Specific MER Procedures
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I Document Authorization
II Revision History
Chapter No.
Section No.
Description Date Initials Reference Indicator
All All First Version of the Procedure NA MCO11N March 2007 III Scheduled Local Review & Update of Site Specific MER Manual for
Site Name
Date of Review & Update
Medic Signature
Site Manager Signature
Notes
IV Distribution List
CUSTODIAN COPY CUSTODIAN COPY CECC - MAF 01 LEBC’s (All Areas): MCC 02 Fahud (ONO/1F) 24 MCO/1 03 Lekhwair (ONO/1L) 25 MCO/2 04 Qarn Alam (ONO/1Q) 26 MCO/3 05 Yibal (ONO/1Y) 27 MCO/4 06 Marmul (OSO/1M) 28 MCO/11N 07 Bahja (OSO/1B) 29 MCO/22S 08 Nimr (OSO/1N) 30 Sahara PAC Clinic Fahud 09 LEBC - MAF 31 Sahara PAC Clinic, Nimr 10 MAF Coast (OIS/1) 32 Renaissance PAC Clinic, Fahud 11 Air Ops (TSL) 33 Renaissance PAC Clinic, Nimr 12 TSL/3 34 PAC Clinic, Qarn Alam 13 OIS/2 35 OIS 14 MCN 15 MCN/1 16 MCN: Fahud 17 Lekhwair 18 Qarn Alam 19 Yibal 20 Marmul 21 Nimr 22 Bahja 23 All contractor clinics
V Glossary of Terms, Definitions,and Abbreviations. ACLS Advanced Cardiac Life Support AED Automatic External Defibrillators ALARP As Low As Reasonably Practicable ATLS Advanced Trauma Life Support BLS Basic Life Support BU Base Unit CCR Central Control Room DD Deputy Director DFA Designated First Aider ECG Electrocardiogram ETO Emergency Telephone Operator FA First Aid KPI Key Performance Indicator LEBC Local Emergency Base Controller LECC Local Emergency Control Centre MAF Mina Al-Fahal MCC Chief Medical Officer MER Medical Emergency Response MCI Multiple Casualty Incident
CONTENTS I Document Authorization …………………….……………………………………..…….……3 II Revision History ………………………………………………..……………….……..….……3 III Scheduled Local Review & Update of Site Specific MER Information…………..…….3 IV Distribution List …………………………………………………………………………….…...4 V Glossary of Terms, Definitions, and Abbreviations ………………………………………5
1 INTRODUCTION................................................................................................................. 7 1.1 Overview ............................................................................................................................. 7 1.2 Objective ............................................................................................................................. 7 1.3 Scope .................................................................................................................................. 8 1.4 Site Characteristics…………………………..…………………………………………………....9 1.5 Related Business Control Documents ………………………………………………………….9
2 PDO MER PROCEDURE ..................................................................................................10 2.1 Overview ………………………………………………………………...…………………………10 2.2 First Response and Call-Out Procedure ……………………………………………………………11 2.3 Tier 2-3 Medevac Procedure ……………………………………………………………………….11 2.4 Tier 4 Medevac Procedure …………………………………………………………………………12 2.5 Site Specific Medical Infrastructure ……………………………………………………………….13 2.6 Site Specific General Infrastructure ……………………………………………………………….14
3 SITE SPECIFIC MER ORGANIZATION AND RESOURCES.......................................... 15 3.1 Site Specific MER Organization ........................................................................................ 15 3.2 Site Specific MER Manual Responsibilities ...................................................................... 16 3.3 Site Specific MER Equipment ........................................................................................... 17
4 MER PROCEDURES........................................................................................................ 18 4.1 Information Prompt List ..................................................................................................... 18 4.2 MER Contact Information.................................................................................................. 18 4.3 First Response and Call Out Procedure ........................................................................... 19 4.4 Tier 2 –3 Medevac Procedure........................................................................................... 20 4.5 Tier 4 Medevac (Tier 3 to Tier 4 Hospital) Procedure....................................................... 22 4.6 Multiple Casualty Incidents (MCI) Procedure.................................................................... 23
5 IMPLEMENTATION AND PERFORMANCE MONITORING ........................................... 24 5.1 Inspection and Maintenance Program .............................................................................. 24 5.2 MER Exercises.................................................................................................................. 24 5.3 MER Skills Maintenance ................................................................................................... 24 5.4 KPIs................................................................................................................................... 24 5.5 Audits ................................................................................................................................ 24 5.6 Management Review........................................................................................... 24
ATTACHMENTS .............................................................................................................................. 25 • Attachment 1 Site MER Response • Attachment 2 Medical Personnel • Attachment 3 MER Responsibilities • Attachment 4 Medical Equipment • Attachment 5 Medevac Resources and Contact Information • Attachment 6 Initial Call - Information Prompt List • Attachment 7 Multiple Casualty Incidents (MCI) - Responsibilities • Attachment 8 Multiple Casualty Incidents (MCI) - Triage Protocol • Attachment 9 Hazards and Effects Management
1 Introduction
1.1 Overview This Site Specific Medical Emergency Response (MER) Manual outlines the facilities and equipment available at Site Name and defines the organization and procedures for responding to a medical emergency. It must be read along with PDO Medical emergency Response Manual PR-1243. This MER Manual provides a framework for the management of medical emergencies and describes the appropriate response. The Site Specific MER Manual is part of the overall Emergency Response Plan, but provides specific information for medical emergencies. Where appropriate, reference is made to the Emergency Response Plan. An updated copy of this Site Specific MER Manual should be always readily available at: 1. Medical Clinic & Site Ambulance 2. LEBC/ LECC Room/ Site Manager 3. Site CCR/ ETO/ Radio Room 4. Copy to Regional PDO Clinic (MAF/ North/ South)
o Nothing in this document is intended to prevent the Incident Commander from using their judgment or expertise to initiate necessary action to secure the safety of the facility and its
occupants during a medical emergency situation.
1.2 Objective The objective of the MER Manual is to help ensure an effective response to medical emergencies by:
• Documenting the organization roles and responsibilities of personnel managing the medical emergency.
• Defining interfaces between the different response teams.
• Providing clear concise instructions and guidance on what action to take in response to a medical emergency.
• Detailing communication requirements.
• Providing templates to facilitate the medical emergency response.
• Specifying equipment / facilities / resources that are available during the medical emergency.
1.3 Scope This MER Manual covers Site Name and associated operations that comprise:
•
• An overview of the site and associated facilities is presented in Figure 1
Figure 1 Overview of Facilities
An overview of the MER response for the site is provided in Attachment 1.
1.4 Site Characteristics
The details of the site are presented in Table 1. Table 1 Site Characteristics
Site Category Nature of Site
Activities Performed at Site
Population at Site
Hours of Operations
Specific High Risks
1.5 Related Business Control Documents
Code of Practice
Ambulance Code of Practice
Procedures Medical Emergency Response Manual Part I PR-1243 E R Document: Part III Contingency Plan : Vol.
2 : Well Engineering PR-1287
E R. Document(s) part III, Contingency Plan Vol. 3 : Production Operations
PR-1066
E R Document: Part III Contingency Plan Vol. 14 : Government Gas System
PR-1246
E R Document: Part III Contingency Plan : Mina Al-Fahal Offices
PR-1329
E R Document: Part III Contingency Plan : Vol. 9 : Air Operations
PR-1269
2 PDO MER PROCEDURE:
2.1 Overview
2.2 First Response and Call Out Procedure The ‘First Response personnel at the emergency location shall:
• Take immediate action in case of a medical emergency; call 5555 • Contact the nearest Designated First Aider (DFA); • Advise the Site Manager and the Site Medical Professional of the emergency (often through a site
control center (CCR) or radio room). • Provide information about:
o Location of the emergency; o Number of casualties and condition of these casualties (vital life support) o Situation on Site; o Identity of caller.
On the receiving side (Site Manager, site control centre, radio room) shall:
• Ensuring all essential information is captured, perform confirmation of emergency location; • Inform and alert relevant MER personnel e.g (Site Manager, Site Medical Professional, where
applicable nearest DFA) through telephones and or paging system, radio etc • Maintaining communication with the emergency site; • Imposing radio silence and discipline; • Accurate note taking throughout the emergency.
2.3 Tier 2-3 Medevac Procedure
• The Site Medical Professional shall communicate with the personnel at the emergency location, advise the Site Manager and go to the emergency location immediately if warranted;
• If significant transport is needed to mobilize more Medical Professionals to the casualty (e.g. helicopter flight, long overland trip in ambulance), this shall require approval of the Site doctor, site manager or MCC.
• The Site Medical Professional shall advise the Site Manager of the need and conditions (urgency, ambulance or common vehicle) for transport of the casualty to the Site Clinic, Extended Site Clinic or Tier 3 Hospital (Medevac);
• If warranted, the Site Medical Professional shall consult with Remote Medical Support (MCC) and continue to do so during the emergency;
• The Site Medical officer or deputy shall take the final decision on the need for Medevac and the way it shall be executed;
• If an aircraft is needed for the Medevac, the Pilot or the Vessel Master shall advise the Site Manager on their ability to transport the casualty and they shall have the right to refuse or delay the transport if in their opinion the prevailing conditions entail unacceptable risk;
• If it is decided to proceed with the Medevac: 1) The Site Medical Professional in liaison with site manager shall:
o Be in command and issue the corresponding instructions and nominate o communicators, observers and record keepers for the duration of the emergency; o Send a Tier 2 MER Professional to the casualty who shall accompany the casualty o during the Medevac; o Impose radio silence and discipline as appropriate; o Mobilise the MER assistants (stretcher bearers etc. as appropriate) to the o emergency location; o Call Out the aircraft or ambulance. o Advise the Tier 3 Hospital of the imminent arrival of a casualty. o Inform PDO Emergency Duty Coordinator; o Inform the relevant authorities directly involved in the MER; o May delegate tasks to subordinates.
2) The Site Medical Professional shall:
o Coordinate the medical actions of his team (DFAs, MER assistants, other Tier 2 MER Professionals);
o Provide relevant medical information about the casualty to the service providers, such as ambulance service and Tier 3 Hospital;
o Advise the MCC or Company Health Adviser
3) The Emergency Duty Coordinator, DD shall: o Advise the PDO Company management; o Inform relevant authorities; o Maintain contact with the PDO press if warranted; o Contact Next of Kin of the casualty(s)
4) The Company Medical Officer on site shall:
o Contact the Tier 3 Hospital; o Advise Emergency Duty Coordinator.
The Tier 2-3 Medevac Procedure shall contain up to date and complete list of emergency communication information (telephone numbers, radio frequencies, contact persons). 2.4 Tier 4 Medevac Procedure If appropriate specialist medical care (Tier 4) is required and available in country of operation, the decision to transfer the client to Tier 4 hospital is at the discretion of the treating doctor at Tier 3 hospital. Transport out of Oman will require the approval of PDO MCC/health adviser and PDO management. Requirements for local government authorisation prior to transport out of country shall also be considered.
2.5 Site MER Infrastructure The infrastructure that is available to provide support in the event of a medical emergency is presented in Table 2.1 Table 2.1 Infrastructure of Surrounding Area & their Contacts
Facility Type Facility Name Distance Contacts
Tier 3 Hospital
Tier 4 Hospital
Level 1 call
Level 2 call
Nearby Clinics
Level 3 call
Airstrips Areas to avoid during MER
Adjacent Facilities (including 3rd party) that can provide support
N.B. Medical Facilities Levels of Call in case of MCI on instructions from Site Medic/ Site Manager: Level 1 call: Number or Nature of casualties requires summing help from some of the nearby clinics Level 2 call: Number or Nature of casualties requires summing help from all clinics within the area Level 3 call: Number or Nature of casualties requires summing help from clinics outside the area
2.6 Site Specific General Infrastructure A diagrammatical representation of the infrastructure of the surrounding area is given in Figure 2.1. Figure 2.1 Overview of infrastructure of surrounding area
3 Site Specific MER Organization and Resources 3.1 MER Organization An overview of the MER organization at the site is presented in Figure 3.1 Figure 3.1 MER Organization
First Responder
Remote Medical Support Dedicated Site
First Aiders
Site MedicClinic
Company Health Advisor/ PDO Doctor
On-Scene Commander
A list of the designated first aiders, medical professionals and remote medical support provider(s) together with contact information is provided in Attachment 2.
3.2 Site Specific MER Manual Responsibilities
he responsibilities for management and maintenance of MER Site Specific manual are:
ite Manager, The most senior responsible position on the Site (e.g. Senior Site Supervisor)
e.
pany requirements
ation.
oles and responsibilities for key personnel during MER, in the form of checklists, are provided in
T S• Ensuring this MER Manual is distributed and understood by the workforc
• Ensuring process is in place to maintain MER Manual.
• Ensuring MER exercises are performed in line with com
• Liaising with Site Medical Professional
• Maintaining MER Manual and contact inform
• Verifying medical equipment is maintained. RAttachment 3.
3.3 MER Equipment
n overview of the site MER equipment is presented in Table 3.3 below ATable 3.1 MER Equipment
Medical Facilities on Site
Location of Site Control Center
Communication Facilities
MER Equipment
First Aid Boxes ee Attachment 4) (s
Automatic External Defibrillators ee Attachment 4)
(s
Medevac Transport
or details and contact information see Attachment 5
F
4 MER Procedures Checklists ER procedures have been developed to provide guidance on tasks to be performed during a medical emergency. These are provided in the form of flow charts providing an overview of the process and required action to respond to the following MER events: Tier 0 - 1 First Response and Call Out Procedure Tier 2 – 3 Medevac Procedure Tier 4 Medevac Procedure - Transfer to Specialist Hospital Multiple Casualty Incidents (MCI)
•
o Nothing in this document is intended to prevent the Incident Commander from using their judgment or expertise to initiate necessary action to secure the safety of the
facility and its occupants during a medical emergency situation.
4.1 Information Prompt List
It is important when providing initial details of the medical emergency to provide as much information as possible. To assist with this an emergency response prompt list has been developed and is provided in Attachment 6.
4.2 MER Contact Information
The contact details for personnel that would provide support in the event of a medical emergency is provided in Attachment 2 – Medical Personnel.
4.3 First Response and Call Out Procedure
Notify Site Control Center of Potential Medical Emergency and recommended response
Contact Designated First Aider (DFA)
Tier 2 activation required?
Yes
No
Initiate Tier 2-3 Medevac Procedure
CHECK?MEDICAL EMERGENCY RESPONSE
First Response and Call Out
First Responder identifies injured party and makes initial assessment
Make Area Safe
Stabilize Injured Party until Designated First Aider
arrives on site
Designated First Aider arrives on site and assesses injured party
≤ 4 minutes
Treat injured party at site
4.3 Tier 2 –3 Medevac Procedure
4.4 Tier 4 Medevac (Tier 3 to Tier 4 Hospital) Procedure
Note: this procedure is not site controlled, but managed by the Medical Professionals.
4.5 Multiple Casualty Incidents (MCI) Procedure
* Responsibilities associated with Multiple Casualty Incidents (MCIs) are outlined in Attachment 7. * Triage Protocol for MCI is outlined in Attachment 8.
5 Implementation and Performance Monitoring
5.1 Inspection and Maintenance Program
To ensure medical equipment is adequately maintained and will function as required during a medical emergency an inspection and maintenance program is in place. The MER equipment forms part of the routine inspection program and scheduled according to the table provided in ATTACHMENT 4.
5.2 MER Exercises
A series of MER exercises shall be performed to test the effectiveness of the MER. The requirements for holding drills and exercises is identified in PDO MER Manual PR-1243 (Appendix 2). MER exercises are managed through the emergency response plan, which details the schedule and type of exercises to be performed.
5.3 MER Skills Maintenance
To ensure the competency of MER personnel is maintained, there is a requirement for personnel to meet the initial competency requirements and to undergo refresher training. The qualification criteria and training requirements are defined in the PDO MER Manual section 3.2.3. Skills maintenance is managed through the competency assurance program.
5.4 KPIs
Key Performance Indicators (KPIs) shall be developed, maintained and regularly reviewed to monitor the implementation and effectiveness of Medical Emergency Response. KPIs developed shall be specific and measurable and be monitored and reviewed as part of the HSSE monitoring and reporting process.
5.5 Audits
Medical Emergency Response shall be subjected to periodic audits to assess compliance against the requirement of the MER Standard. MER should be included in the Terms of Reference of local and independent HSE Management System audits.
5.6 Management Review
The effectiveness of Medical Emergency Response shall be periodically assessed by management. This Site Specific Manual should be reviewed and updated locally by medic in charge and sit manager on an annual basis or if any changes to the Site specific contents is required. Regional PDO doctor (MAF, North, South) should be informed upon completion of the review and updated if any changes have taken place.
ATTACHMENTS
Attachment 1 Site Initial MER Response*
* Site Initial MER Response should be kept in a prominent, accessible place at the site. All Site employees should be aware of its’ location.
Medical Emergency Response
Site: Site Manager :
Emergency Action Contact • Raise Alarm
• Make Area Safe (if possible)
• Stabilize injured party
• Remain with injured party until medical assistance arrives
CCCall 5555 aalll 5l 5555555Provide details:
• # injured
• Injury
• Location
• Cause of injury (if known)
Non Emergencies Contact
For all other injuries and illnesses • Site medic : ……………………………
• Use first aid kit, if necessary
On Site Medical Emergency Response Equipment & their Location • First Aid Kits
• Automatic External Defibrillator (AED)
* Please indicate down the DFA responsible for regular inspection and maintenance of Site FA Kits and AED
On Site Medical Emergency Responders (DFA) Shift Name Certification Location Contacts
A
B
Attachment 2 Medical Personnel
Designated First Aiders Shift A (Please indicate personnel responsible for scheduled inspection of FA Kit & AED) # Name Location Latest Certification Contacts
Designated First Aiders Shift B (Please indicate personnel responsible for scheduled inspection of FA Kit & AED) # Name Location Latest Certification Contacts
On Site Medical Professionals
Emergency Certification # Name BLS ACLS ATLS Rig
Medic
Location Other
Contacts
Remote Medical Support Providers # Name Location Contacts
Attachment 3 MER Responsibilities
First Responder
Assess Scene and communicate with site ETO/CCR/Telephone Operator
Make Area Safe for patient and responders
• If unable to make area safe – move casualty to safe location (if safe to do so) Provide Care – remember Do’s and Don’ts
Handover to DFA – communicate information on injuries, action taken and cause of injury (if known)
Designated First Aider
Assess Scene and condition of casualty
Provide Care - provide initial first aid care and stabilize patient
Call Out - alert Tier 2 MER professional of medical emergency
Provide Care -remain with patient and await arrival of Tier 2 MER professional
Tier 2 Professional (on site)
Assess Scene and condition of casualty
Provide Care - provide care to stabilize / treat patient
Consult Medical Support Provider – obtain advice (as required) on diagnosis / treatment
Communicate Medevac requirement – notify Incident Commander of required Medevac response
Accompany Patient to Tier 3 hospital (if medevac required)
Remote Medical Support
Provide Advice - readily available to provide advice to the site Tier 2 Professional
Facilitate Response - provide assistance with response (as required)
Incident Commander
Coordinate Response
Verify Tier 2 Professional notified
Verify Medevac organized
Verify Hospital notified
Ensure Shell Health Provider notified
Attachment 4 Medical Equipment
Medical Equipment on Site – First Aid Boxes # Location Size Medical
Inspection Date 1 2 3 Medical Equipment on Site – Automatic External Defibrillators # Location Make & Model Medical
Inspection Date 1 2 3 Frequency for Scheduled Clinic MER Equipment Inspection* # Medical Equipment Frequency Notes
1 Defibrillators Twice/ week or After Use 2 Oxygen Cylinders Once/week or After Use 3 Emergency Bags Once/2 weeks or After Use 4 Emergency Drugs Once/week or After Use 5 Crash Box/ Trolley Once/week or After Use 6 ECG Once/week or After Use 7 Communication Modes Once/week 8 Ambulance Daily by Ambulance Driver
Once/week by Medic
9 Other MER Equipment as per MER Manual PR-1243 Appendix 4
Once/2 weeks or After Use
* A signed Check-list should be kept attached to these items
Attachment 5 Medevac Resources and Contact Information
Medevac Personnel (Ambulance Drivers) Details and Contact Information Name
Location Contacts Mobilization Time /
Restrictions Equipment
Attachment 6 Initial Caller/Telephone Operator – Action Check List
Initial Caller/Telephone Operator – Assessment Prompt List Description
Location of incident
Number of casualties
Nature of Injuries / Illness
Time of Incident
Cause of Incident
Name of Casualty
Age of Casualty
Sex of Casualty
Status
Area secure
Personnel dealing with incident
Number of personnel involved
Contained or escalating
Current response activity
Response Requirements
Immediate response needs
Longer term response needs
Contact Information
Name of Informant
Position / Responsibility
Contact Numbers
Attachment 7 Multiple Casualty Incidents (MCI) - Responsibilities
On-Scene Commander
Assess Scene
Assign MER Team - to coordinate:
• Rescue
• Medical supplies
• Triage
• Communications
• Treatment
• Transportation
Verify Primary Search complete
Coordinate and Monitor MER
Site Medical Professional
Coordinate medical supplies and manpower
Verify number and type of casualties
Coordinate Triage and treatment of casualties
Coordinate patient evacuation
Communicate with remote site medical support, public health authorities, incident commander (as appropriate)
Rescue Team Leader
Coordinate and conduct primary search
Notify casualty numbers – notify Site Medical Professional and Incident Commander once primary search completed, transfer of casualties to triage area
Logistics
Identify Transportation area – select area which allows easy access from ambulance staging and treatment area
Coordinate patient transportation - in priority order as determined by Triage and Treatment Officers
Request additional ambulances and air operations resources
Coordinate helicopter / ambulance operations
Acquire and distribute medical equipment and supplies
Maintain records on where casualties were dispatched
Communications
Establish and maintain communication with appropriate company and local authorities as per the emergency response plan
Remote Site Medical Support
Provide advice and support to the onsite medical professional
Arranging mobilization of additional medical resources to site (as required by the incident)
Coordinating medical response with local and company health authorities
Attachment 8 Multiple Casualty Incidents (MCI) – Triage Protocol
Triage – Mass Casualties and Multiple Injuries Triage is the sorting or prioritising of MER action based on need for treatment and the available resources to provide it. In simple terms it aims to ‘do the most for the most gain’. In cases of multiple causality incidents it also refers to sorting of those who should be treated first because their problems require priority attention or which patients need to be transferred to a higher care centre first. Triage can be performed quickly using START Protocol (Simple Triage And Rapid Treatment):
Guidance of Stages of Triage Stage 1 – RED - Immediate aggressive resuscitation. Conditions that are a threat to life or limb with imminent risk of deterioration (e.g. tension pneumothorax or conditions of deep coma, respiratory rate of <10, or >29). Stage 2 - YELLOW – Urgent emergency attention required. These are conditions that could potentially progress to a serious problem requiring emergency intervention, e.g. previously stable vital signs but clinical suspicion of ectopic pregnancy, proximal long fractures. Stage 3 - GREEN – Emergency action is delayed or non urgent till concurrent stages 1-2 above are stable or transferred. Conditions where level of seriousness could benefit from reassurance and intervention can be delayed for 1-2 hours. Usually relate to mere distress, e.g. sprained ankle. Stage 4 - BLACK – The casualty is dead or in a terminal state and beyond resuscitation. It should always be kept in mind that this staging may not be static, the three main natural steps of resuscitation should be followed – assess & triage, treat and re-evaluate.
Attachment 9 Hazards and Effects Management
Hazards And Effects Management
This section outlines the risk assessments that have been performed to demonstrate that the risks associated with medical emergency response have been reduced to As Low As Reasonably Practicable (ALARP).
Classification of Site Category
• Classification of Site Category.
Waivers / Deviations
• Waiver for not having a Site Clinic.
Non Routine Activities
• List of Non-routine Activities and associated risk assessments or references to these studies.
Tier Response Times Cannot Reasonably Be Achieved
• List of ‘Sites and workgroups where Tier response times cannot reasonably achieved’ and associated risk assessments or references to these studies.
Site Medical Review
• Reference to Site Medical Review.
Site Specific Risk Assessments
• Reference to Site-specific risk assessments (e.g. Health Risk Assessment, Impact Assessment).
ALARP Demonstration
• Risk assessment (or references to the study) to demonstrate that chosen alternative solution for smaller Sites not having a Site Clinic ensures risks are ALARP.
