Increased Burden of Infectious Disease in Offshore Oil & Gas Locations

The search for oil and gas has taken us to increasingly distant locations and further into the offshore environment. Year on year, some of the world’s most profitable businesses are placing more emphasis on adopting crisis emergency services in Nigeria, signalling they are recognising the problems of insufficient capacity and the drastic need to change.

Because of poor road infrastructure, long distances between tertiary centres and the low doctor to patient ratio, air ambulance transport for the oil and gas sector is vital part of any corporate infectious disease preventative plan.

The prevalence of infectious diseases is higher in Africa than other countries and can be directly and indirectly spread from person to another. Therefore specific strategies and precautions must be developed by companies to avoid workers being exposed.

Below is a list of some infectious diseases found in Nigeria and other parts of Africa:

Disease	Vaccination/Prevention/Mitigation	Transmission
Elephantitis	The best way to prevent lymphatic filariasis is to avoid mosquito bites. The mosquitoes that carry the microscopic worms usually bite between the hours of dusk and dawn.If you live in an area with lymphatic filariasis *Sleep in an air-conditioned room or sleep under a mosquito net especially,between dusk and dawn *Wear long sleeves and trousers and use mosquito repellent on exposed,skin	Elephanitis also known as Lymphatic filariasis, considered globally as a neglected tropical disease, is a parasitic disease caused by microscopic, thread-like worms. Lymphatic filariasis is spread from person to person by mosquitoes.
Lassa Fever	Primary transmission of the Lassa virus from its host to humans can be prevented by avoiding contact with Mastomys rodents, especially in the geographic regions where outbreaks occur. Putting food away in rodent-proof containers and keeping the home clean help to discourage rodents from entering homes.	The Lassa virus is transmitted to humans via contact with food or household items contaminated with rodent urine or faeces.
Malaria	Antimalarial drugs are recommended unless they are contraindicated.Antimalarial drugs are recommended to those who intend to an extended Stay in Nigeria, and those who study abroad.Chemoprophylaxis is recommended to be taken for the entire duration of long-term travel.	It is transmitted through bites of an infected mosquito (female Anopheles).
Typhoid	It is also recommended to most travellers, especially those who are staying with infected friends or relatives, visiting smaller cities, villages, or rural areas where risk factors increase through the direct contact with food or water; or prone to adventurous eating.	It is also transmitted through the Fecal-oral route.

Specific recommendations have been put together by our remote site, oil and gas emergency response expert team to circumvent infectious diseases in a corporate working environment.

1. Prepare a policy document and make sure to include strategies that ensure safe working environment, prophylaxis and vaccination.

2. Education on total hygiene, particularly hand washing, healthy lifestyle. For example, wearing long sleeves clothing in the evening.

3. Designing appropriate signage in toilets, restrooms, kitchens and canteens.

4. Training programmes that help recognize symptoms of possible infectious disease.

5. Provision of facilities and resources with equipment, and preparation of an adequately equipped clinic at workplace which should be provided with PPE, first aid boxes and alcohol hand gel.

6. Specific infectious disease training for healthcare staff. Many infectious diseases such as Lassa

Fever are under-diagnosed. High index of suspicion is required to ensure that diagnosed is made early and appropriate management undertaken.

We are starting to see employers adopting specific strategies, taking precautions, recognising and addressing the need for additional assistance and onsite medical equipment for unique circumstantial changing first aid needs.  For more information on how the Flying Doctors can assist you with infectious disease planning, medical evacuation and oil and gas first aid training in Nigeria and Africa wide. 

Please contact sales@flyingdoctorsnigeria.com

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

Flying Doctors Host Workshop for Industry Safety Leaders

On the 14th of May, 2015, the FDN (De Flight Medics Ltd) team hosted a workshop for 60 company doctors, HSE professionals and safety leaders to discuss 'Emergency Medicine For Industry in Africa'


We have realized that there are very specific and unique challenges faced by industry in Africa, particularly in remote areas. These will be addressed in our white paper due for publication in the next few days. We will focus on the work of flying doctors and medevac medics in Africa.

Why is work in Africa different?

There are many factors that make working in industry in Africa unique due to it's remoteness and topographical challenges, some of these are listed below.

1. Emergency Services:  Many of the public emergency services such as fire fighting service, police, coast guard and ambulances may not work as effectively in Africa as they do in developed countries. Therefore many companies must make private provisions for these normally public services

2. Infectious Disease: The prevalence of infectious disease is higher in Africa than in many other countries. Therefore specific protocols must be developed by companies to mitigate against the effect of infectious diseases.

3. Medical Services: Many countries in Africa have weak healthcare infrastructure. In an emergency the distances that need to be traveled to reach definitive care are often far longer than in the West. Therefore, companies must think more carefully about how geography influences their emergency care plans.

There were three main topics addressed over the course of the workshop namely:  

1. A safer environment for the energy sector - The Proactive approach
2. Challenges of managing health in the Offshore/Remote site location in the Oil and Gas Industry - Recent Developments in Nigeria. 
3. Emergency Transport in Nigeria -Any hope for Nigeria.

Over the next few hours some of Nigeria's most prominent safety leaders debated these issues in small groups and then presented their results. The results of these discussions will be released over the next few days in our white paper titled 'Emergency Medicine for Industry in Africa'. It became very apparent that the Flying Doctors are a much needed and appreciated service.


Dr Olutomiwa Ogunbona

Aeromedical Evacuation: A Personal Outlook

Aeromedical Evacation often shortened to Medevac is the timely, efficient movement and en route care provided by highly trained medical personnel to ill, wounded patients, neonates and infants from an area with inadequate medical facility to one with better equipped facility.[1]

The United States Army is arguably the first set of people to use this lifesaving technique in Burma towards the end of the World War II using the Sikorsky R-4B helicopter. The British also used it in Sinai Peninsula when a Royal Aircraft Factory BE2 flew out a soldier in the Imperial Camel Corp who had been shot in the ankle.[2]

In modern times, aeromedical evacuation has gone way beyond just evacuation in times of war and conflict to evacuation from construction sites, remote sites, oil rigs, drills, mining sites to even neonatal and infant transport for better medical specialist care.[3]

In Nigeria, aeromedical evacuation is very new. Initially it was exclusive to  expatriates in the Oil and Gas sector to repatriate them to their home countries for better medical care and attention. However, today such services are available and accessible commercially. I was privileged to be on one in my home country.

The patient to be evacuated, Mr I.I, a 45 year old Nigerian male with a background history of hypertension and type II diabetes mellitus not regular on medications who had presented with a recent history of right sided hemispheric stroke possibly ischaemic and was stabilized in a hospital in his country home. His vitals as at the time of contacting the aeromedical evacuation team was a blood pressure of 150/90 mmHg, temperature of 37.1 C, Pulse of 90/minute regular, synchronous with no radio-radial or radio-femoral delays, respiratory rate of 18cycles/min and an SpO2 of 96-100%. The patient was conscious, alert oriented in time. place and person with a Glasgow Coma Score of 15/15. He was to be airlifted from Port Harcourt to Lagos for specialist care.

The first thing that caught my attention was the high level of commitment of the flight physicians on call. It was an early morning evacuation but the response time was 23 minutes. The team comprised an anaesthetist[4], a senior flight physician[5], myself, the paramedics, the pilot, co-pilot and the cabin crew. The anaesthetist was given a clear role as the lead physician.

He read out the medical history of the patient to be evacuated, possible aetiology, various modes by which such patients could present, the complications, risks of flying such patients at various altitudes, safety precautions to be taken and look-out signs on such patients. He stated that all such details have been explained to the relatives of the patients and they have signed a consent form with the legal team before we proceeded with this evacuation.

Simultaneously, I could see the flight engineers on the aircraft. I later found out that they were checking all the medical equipments were fully functional, the batteries fully charged and that the Air Transport Stretchers were comfortable for a non-ambulant patien

Just as we boarded, the lead physician took a few minutes off to repeat a summary of the patient to the pilot, co-pilot and cabin crew. Then we were cleared for take-off.  Aboard, we took turns to refresh one another on various topics in Advanced Cardiac Life Support. It was a 45 minutes flight.

On ground at the Port Harcourt Airport, the patients was at the tarmac with a land ambulance, had an anaesthetist, 2 physicians and a few paramedics. The lead physician again lead us to the patient, introduced us one after the other to the team on ground, I was asked to do a Pre-flight assessment of the patient. This included documenting the vital signs of the patient, performing and documenting general physical examination as well as systemic examination. Then the lead physician who was discussing with the on ground physicians and relatives came over to do a run through of yet another general physical examination but picked out only the affected systems for examinations. He then explained to the patient the risk associated with flying him, possible complications that could arise and the steps that have been taken but to forestall and control. 

He was then loaded into the air ambulance using a vacuum stretcher. He had his face mask connected, Intravenous fluid was set at 15drops/minute. One of paramedics were assigned to monitor the vitals of the patient every 10 minutes.

On ground at the Lagos airport, the receiving hospital had sent a land ambulance with paramedics to transport the patient over. The lead physician again briefed them on the clinical state of the patient after doing his Post-flight assessment.

We were then ushered to the airport lounge for a debrief and brunch.

Dr Olutomiwa Ogunbona is a staff of Flying Doctors Nigeria. www.flyingdoctorsnigeria.com/

The author takes full responsibility for the article. All correspondence should be directed at the author via email at tommyogunbona@gmail.com while drtommyflyingdoctors@gmail.com should be put in copy.

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[1] en.wikipedia.org/wiki/Medical_evacuation

[2] en.wikipedia.org/wiki/Medical_evacuation

[3] Emergency Pre-hospital Care. Dr Ola Orekunrin

[4] Dr Wale Raji

[5] Dr Ola Orekunrin, Founder Flying Doctors Nigeria

Medical Practice at a Flying Doctor's Remote Site Clinic

Leading the team of medical personnel under the auspices of Flying Doctors Nigeria, our primary medical service is to respond quickly to any medical emergencies that may ensue from oil and gas exploration process. We also run a clinic where ailments like malaria, Respiratory Tract Infections e. t. c and some Chronic Medical conditions are attended to, to forestall complications. 
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Exploration and Production as parts of upstream sector of oil and gas are the major activities embarked on in this field.

The oil and gas exploration site where we attend to patients is a marginal field still at the early production facility (EPF) phase located about ten minutes from the residential camp.
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As a resident doctor in conjunction with other medical personnel, we do embark on a routine patrol with our well equipped Ambulance from the residential camp where the Clinic is located to the exploration site. 
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Indigenous contractors and also Expatriates from Europe and Asia are the Clients who have been benefiting from our medical coverage. Weekly up to date reports of medical emergencies vis-à-vis clinic attendance are relayed to our head office for expertise feedback.

Since inception of my practice on site, there has not been any overwhelming medical emergency necessitating the need for medical evacuation. However there have been cases of referral to a nearby hospital from the site clinic for further management. 
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The major challenges encountered on the field ranges from intermittent unrest on the part of host community to a complete disconnect from the larger society.
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Remote site medical coverage in oil and gas is a worthwhile experience that will forever linger in my memory.

Dr Wale Amerijoye

Flying Doctors Nigeria.

Every Second; A Night in the Middle East

This is a column that will be featured on our blog every month titled 'EVERY SECOND' and it is going to be a  series of  brief personal accounts by our flying doctors on some of the evacuations we have undertaken.
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This is a personal account by Dr Tolu Taiwo, one of the doctors of Flying Doctors Nigeria team.
           

 

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One of our first international evacuations this year was a really hectic one. We had to transfer a critically ill, elderly patient via air ambulance from Lagos to the Middle-East under strict intensive care. All hands had to be on deck, from the trauma physicians, support staff to the cabin crew, to ensure the patient was successfully taken home alive. Even the equipment were not left out as they worked full time - the monitors, infusion pump, ventilator, oxygen tanks and the rest – while the required drugs and infusions were continuously administered.
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Matters were only made more arduous as we could not fly directly to the destination since we were not allowed to fly over Libya considering it was still a no-fly zone. The implication was that we had to take a longer route and stop over at Khartoum, Sudan, adding more precious hours to the already critical journey.

                                   

But, all’s well that ends well, as we delivered the patient to the family alive. We could heave a sigh of relief with a sense of fulfillment as we rested for the night to fly back to Lagos the following morning. Mission accomplished in the Middle-East!  

At the Speed of Life: The Importance of Rapid Response

                   

 Chances are very good that if you have never had to use the services of an air ambulance or medical transport you might never have heard of it. In a nutshell, an air ambulance is an aircraft that has had its interior specially configured so it can operate as a mobile hospital complete with intensive care unit. 

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Also an air ambulance can be seen as a specially outfitted aircraft that transports injured or sick people in a medical emergency or over distances or terrain impractical for a conventional ground ambulance. 

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Like ground ambulances, air ambulances are equipped with medical equipment vital to monitoring and treating injured or ill patients. Common equipment for air ambulances includes medications, ventilators, ECGs and monitoring units, CPR equipment, and stretchers. A medically staffed and equipped air ambulance provides medical care in flight which is referred to as medical evacuation (MEDEVAC)
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Air ambulance services have established their usefulness in other countries, but their role in Nigeria is developing slowly.
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With the awareness of the importance of air ambulance services, the services will be provided to different types of patients, with different ailments and accidents at different locations. This will bring about the reduction of the mortality rates of the patients in question.

If you ever found yourself in either a remote location or in an area of Nigeria that doesn’t offer the specialized medical emergency care you or your family need, this is when the expertise of an air ambulance comes to the forefront of your mind. 
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Timely response via Air ambulance is very important in Nigeria because we have cities that simply don’t have good roads that are good enough to accommodate a traditional ambulance all the time.
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Also, our bigger cities seem to be overcrowded which brings about traffic. Traffic can cause the death of a patient in a critical condition. Immediately a patient overwhelms the level of medical care at any healthcare centre, such a patient needs timely response to get to the other healthcare centre that suits his condition. The transfer needs to be done at the speed of life. Every second that leads to a minute matters in this process.

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The importance of timely response in Nigeria via Air Ambulance cannot be over emphasized. It cuts the issue of traffic and any form of road transport delay.
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Even though the services of air ambulances are offered 24 hours a day, seven days a week, 365 days a year, it is better to be prepared. Being prepared could be as simple as contacting a potential service provider like “Flying Doctors Nigeria”, speaking with the medical specialist and describing not only your current health issues – if any – but also the location to which you are traveling. Doing this will not only save you precious time in the event of an emergency but it will help you know how long it could take for a provider to reach you in the event of an emergency evacuation. While it is unlikely that you will need a medical evacuation, it’s better to be prepared.

Air Ambulances - Their Importance and Value

Have you ever heard of air ambulances? Well if not then, air ambulances are specialized aircraft where the interior has been configured as a mobile Intensive Care Unit, ICU. They are used when a more traditional means of medical transportation cannot be used to rescue a patient and transport him or her to the nearest hospital and are a new concept that is gaining a lot of importance and popularity.

Helicopters are the main form of this medical transportation, but now private Corporate Jets are also gaining a lot of popularity due to their flexibility, range, reliability, and flight comfort. This type of aircraft is significantly more flexible then other types of aircraft because of their ability to be configured with the latest intensive care unit equipment, these jets are well suited for transporting patients long distances, quickly, comfortable, and safely.

Fixed wing jet aircraft are best for transporting people who have had severe accidents or have fallen ill where they cannot be transported by conventional means either because of time or distance.For instance,An example would be during winter sports athletic competitions where there is a high probably for the competitors to face serious accidents during playing winter games.

Air ambulances are very well equipped with medical items and the quantities of medicine and specialized equipment are tailored for each specific mission. By reducing the amount of excess equipment the airplane carrying we are able to reduce the amount of weight that the aircraft has to carry. An example of this mission tailoring would be not bringing a kidney dialysis machine on a mission to transport someone who has a broken leg. All carry some standard equipment such as ventilators, CPR's, ECG's, monitoring units etc. All this equipment allows the crews to monitor and stabilize the patients till they reach to the hospital.

You do not need to worry about whether or not the crews onboard the aircraft are efficient and are very well trained. The crew knows how to handle a patient to stabilize their condition before they reach to a safe location. The crews are a team who know how to work together as a team and have the medical and flying experience. They have the experience and the training to stop profuse blood flood, any crushes and falling, cardio attack any many more.

The services that are offered by air ambulances are available 24 hours a day and seven days a week which means that whenever you call them you will be able to report to them regarding where you are stuck or have fallen ill. These services are provided for people who are within the local country or somewhere outside which means internationally as well. Once the advocate or the patient is able to contact the medical transportation provider, the flight coordinator will decide how urgent the situation is and what kind of medical treatment is needed for the patient to stabilize them before he or she is admitted to the hospital.

Air ambulances are also called Aero-medical evacuation, Medevac, Airevac, and Medical Flight. There are many different agencies that own or one can say operate aircraft configured as ambulances. Two of the main agencies are the government and those owned by private enterprise agencies.

Written by John Bohn, a professional pilot with Mercy Jets.

Article Source: http://EzineArticles.com