Dealing with Major Incidents in Africa

During the exploration and production of oil and gas resources a range of risks are present, which if not adequately managed, have the potential to result in a major incident. Large hydrocarbon inventories, high pressure, high temperature wells, the presence of Hydrogen sulphide (H2S), deep water operations in harsh environments, sophisticated control systems, are a few of the factors that can contribute to an organisation having to manage a challenging risk profile.

Unfortunately, sometimes incidents do occur that require support from the flying doctors, either in terms of casaulty assistance or medevac services. 
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Overall, while it can be argued that the Exploration and Production industry has been relatively successful in managing major incident risk, a number of high profile incidents that have occurred over the past few years has brought into question whether the industry can improve the process through which such risks are identified and addressed.
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Over the past few decades the industry has focused on reducing the number of fatalities, LTIs, and medical treatment cases. Due to the frequency of these types of incidents, the effectiveness of initiatives aimed at reducing these types of incident can be measured. In the case of major incident risk, the lack of an accepted KPI, and the infrequent nature of major incidents, undermines the application of the traditional management approach which is: 

• identify a problem
• determine and implement a change
• and measure the effectiveness of that change.

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Major incident risks have characteristics which differentiate them from the more frequently occurring occupational risks. These are detailed below:

Occupational Safety Incidents	Major Incidents
Frequent	Infrequent
Personal	Remote
Known	Unthinkable
Relatable	Technical
Behavioural	Systematic
Measurable	Difficult to measure
Inputs linked to outputs	Complex link between input and output
Quick feedback loop	Long timescales

               

These differences bring into question whether, by focusing on reducing more routine occupational safety incidents, sufficient focus has been given to improving the management of major incident risk.
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Major Incident
The term major incident is used to refer to incidents with the potential to result in multiple fatalities, significant environmental damage or significant asset damage which could lead to huge financial loss, low or zero production, or complete facility shutdown.

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Priorities during a major incident are hazard control, casualty retrieval and emergency helicopter transport assistance as shown below.

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For more information on how the Flying Doctors can assist you with major incident planning, training, medevac in Nigeria and the rest of Africa. Please contact sales@flyingdoctorsnigeria.com

The Silent Killer - Debunking the Myths

Have you ever heard a story that sounded somewhat like this? --

"He/ she was quite well, wasn't even sick or anything only for him/her to just slump and that was the end".


Recently, I heard one of such stories about a mother of three, who seemed apparently well, then she just "fainted" and never woke up. It was later revealed she died of complications of poorly managed hypertension. Hypertension has gained notoriety in some circles as ‘’the silent killer”.


Now, this is not to say that every case of sudden death, is as a result of hypertension, but to point out that hypertension is a serious condition and can be deadly if not diagnosed and treated properly.


Blood pressure is measured with an instrument called sphygmomanometer. Blood pressure is typically recorded as two numbers, written as a ratio like this: 120/80mmHg


Let's explore what this means:

Systolic blood pressure -

The top number, which is also the higher of the two numbers, (in most cases) measures the pressure in the arteries (the blood vessels that carry blood from the heart to other parts of the body) when the heart beats (when the heart muscle contracts).

 Diastolic blood pressure -

The bottom number, which is also usually the lower of the two numbers, measures the pressure in the arteries between heartbeats (when the heart muscle is resting between beats and refilling with blood).


Hypertension, also called HIGH BLOOD PRESSURE, is a sustained elevation of systemic arterial blood pressure to a level likely to induce cardiovascular damage or other adverse consequences.  Hypertension has been defined as a systolic blood pressure (the top number) above 140mmHg or a diastolic blood pressure (the bottom number) above 90mmHg.

A single high reading does not necessarily mean that you have high blood pressure. However, it is possible for blood pressure to rise quickly and severely enough to be considered a hypertensive crisis. A hypertensive crisis may be an hypertensive urgency or emergency.

If while monitoring your blood pressure yourself you get a reading of 180 or higher on top or 110 or higher on the bottom, and are having any of these symptoms: chest pain, shortness of breath, back pain, numbness / weakness, change in vision, difficulty speaking) do not wait to see if your pressure comes down on its own. Seek emergency medical assistance immediately..

So, let's separate fact from fiction.

Myth #1 - Hypertension is caused by taking too much salt, so if I control my salt intake I can’t become hypertensive.

Fact - The majority (80-90%) of patients with hypertension have essential hypertension, ( also known as primary hypertension ) which can be ameliorated only by life-long pharmacological therapy.  With essential hypertension, the exact cause of hypertension is unknown.  However, it has been associated with multiple risk factors which include.

•  Fetal factors: Low birth weight is associated with subsequent high blood pressure.
• Obesity:  Fat people have higher blood pressures than thin people. There is a risk, however, of overestimation if the blood pressure is measured with a small cuff.
• Genetic factors:  High blood pressure tends to run in families and children of hypertensive parents tend to have higher blood pressure than age-matched children of people with normal blood pressure..
  
  
• Alcohol intake: Most studies have shown a close relationship between the consumption of alcohol and blood pressure level.

• Sodium intake: A high sodium intake has been suggested to be a major determinant of blood pressure differences between and within populations around the world. Populations with higher sodium intake have higher average blood pressures than those with lower sodium intake.
  
  Studies of the restriction of salt intake have shown a beneficial effect on blood pressure in hypertensives. In some people, sodium can increase blood pressure. But controlling sodium means more than just staying away from table/cooking salt.There is some evidence that a high-potassium diet can protect against the effects of a high sodium intake.

• Insulin resistance: An association between diabetes and hypertension has long been recognized and a syndrome has been described of hyperinsulinaemia (high levels of insulin in the blood), glucose intolerance, reduced levels of HDL cholesterol, hypertriglyceridaemia and central obesity (all of which are related to insulin resistance) in association with hypertension. This association (also called the 'metabolic syndrome') is a major risk factor for cardiovascular disease.Stress: Whilst acute pain or stress can raise blood pressure, the relationship between chronic stress and blood pressure is uncertain.

Myth #2 - Every time I go to the doctor, my blood pressure is high, but that’s just because I’m nervous. I’m sure my blood pressure is OK at home.


Fact - Some people may experience what’s called “white-coat hypertension”, that is, a temporary rise in their blood pressure when they’re at the doctor’s office. Even though there are factors that can affect your blood pressure, you should never ignore several readings that indicate you may have high blood pressure.


Myth #3- If you have high cholesterol, you automatically have high blood pressure.


Fact - High blood cholesterol doesn’t automatically lead to high blood pressure, but many of the same lifestyle habits that may increase blood cholesterol levels also may cause elevated blood pressure. Try and cut down on oils and fried foods intake.

Myth #4 - These days everyone has high blood pressure. It’s just a fact of life, and I don’t need to worry about it.


Fact- These are stressful times, and stress may add to your risk factors for high blood pressure. That’s why it’s so important to have your blood pressure checked. Also, high blood pressure is the No. 1 modifiable(controllable)  risk factor for stroke, and they say, prevention is better than cure.

Stay connected for more myths and facts on hypertension.

Are you an adult? When last did you check your blood pressure? Please get it done today!!!

by Dr Olutomiwa Ogunbona.
Nigerian Flying Doctor