Nigerian Mining Emergency Services Policies Are Meant To Save Lives, So Why Are They Often Met With Disaster?

In 2015 mining in Nigeria, is still over run with illegals working on a small scale and rarely are emergency services or medical strategies in place that ensure a safer working environment. 

The current situation of dangerous working environments, lack of onsite strategies, low literacy and unlicensed medical practitioners make rescue operations far too dangerous for medical teams, with operations to assist and recover illegal miners abandoned.  The mining sector is in desperate need of advancing and addressing inadequate medical transportation methods. 

With many casualties still reported,  Muhammadu Buhari's government and Dr Nnamdi Ilodiuba (ISPON), Dr Okon Akiba (OKLNG & SOEPHON), Dr Olutomiwa Ogunbona - Flying Doctors Nigeria have ‘one goal in mind’ and already addressing significant issues 

A clamp down on illegal activity, unlicensed medical practitioners and improving key emergency service issues in the sector. 

Their ingenuity is paramount in securing a safer more secure working environment and instilling confidence in the international investment opportunities arising for Nigeria. 

Currently medical emergency transport and services rely mainly on road and air ambulance. With many various methods of medical evacuation proving to be continual problems, such as under developed waterways, railways and roads, air emergency transport is the only viable option in securing exceptional healthcare practices for workers. Flying Doctors Nigeria specializes in air ambulances, medevac, medico-logistics services, and offer an alternative solution to sourcing trained doctors, nurses, paramedics for your onshore or offshore on-site operations.

Having taken to the skies since 2007, the team have this month adopted land rescue in the form of , revolutionising the provision of emergency healthcare to remote locations in Nigeria. The bikes offer a much more capable solution in offering rapid response, where poor roads and remote locations would make reaching medical emergency patients an impossible task.  

motor cycle ambulances

Running high-risk operations in sectors like oil and gas and mining, remote emergency services are imperative. Flying Doctors Nigeria specialise in providing plans for corporate bodies to accommodate the speedy handling of emergencies arising from work-associated incidents. Contacting the team has never been easier to see if were a suitable for your company’s needs. 

Why Flying Doctors in West Africa Mining Industry are vital against the combat of Infectious Diseases

With the past spates of Ebola outbreaks in West Africa behind us, we are starting to see more medical health facilities and major incident emergency services apparent in the region. The WHO (World Health Organization) has declared Nigeria ‘Sanction free of the Ebola virus’ putting an end to international, humanitarian tragedy in the region.  However, vigilance remains high as Nigeria looks to re-build its mining economic base.

At the time of the Ebola outbreaks, servicing the mines in the region had proved to be troublesome and difficult. Ebola was largely confined to remote rural areas.  With road and air being the most feasible options. Flying Doctors, air medical evacuation providing on route care, has been proven as the most divisible option.

Incorporating the services of Air Ambulances has proven more complex. Skills such as life support, incident management and public safety competences to remote working locations are a vital part of any business crisis infrastructure.

Whilst the Ebola Crisis saw expatriates and skilled staff deserting corporations, forcing businesses to put expansion on hold, we are seeing ways in which to instil confidence and turn the situation around by embracing capital investment in health and safety, major incident planning and business crisis infrastructures. Any business who adopts these methods will certainly instil confidence back into the market with the return of workers allowing for mining for growth.

A few major specific recommendations for risks of how infectious disease can be tackled and the provisions which should be in place ready for emergency transport

1. Ensuring emergency communication lines for assistance are in place with back up options 
2. Provision of emergency transport (By land, water and air)
3. Regular consistent first-aid and life support training for in-house staff
4. Preparation of organized plans and simulations scenarios
5. Journey plans should be meticulously implemented to help reduce risk of road traffic accidents
6. Major incident plans should be written up and revised

A year on, some of the world’s most profitable business owners are placing more emphasis on adopting crisis emergency services, supporting local healthcare organisations and major international mining communities - signalling they are recognising the problems of insufficient capacity and the drastic need to change.

In Nigeria, the mining industry faces major challenges which directly and indirectly has a knock on effect to the quality of healthcare and emergency medicine response. The prevalence of infectious diseases is higher in Africa than other continents. Therefore specific strategies and precautions must be developed by companies to avoid workers being exposed to infectious diseases.

We’re starting to see employers adopting specific strategies, taking precautions, recognising and addressing the need for additional assistance and onsite medical equipment for unique circumstances, changing first aid needs.  For more information on how the Flying Doctors can assist you with major incident planning and training in Nigeria and Africa wide. Please contact sales@flyingdoctorsnigeria.com

Top Three Professional Nigerian Leaders Make Oil & Gas Industry Recommendations

According to International statistics, 120 million occupational accidents occur annually at workplaces worldwide. Of these, 210,000 are fatal accidents.

Nigeria's oil and gas industry is the largest on the African continent with many triumphs and also set-backs due to major challenges:

1. Regulatory framework uncertainties
2. Corruption 
3. Poor infrastructure
4. Poor compliance to international operation policies.
5. Inefficient basic first-aid training for workers in high risks and critical operations.
6. Unavailability of the qualified facilities and personnel at the referral hospitals.
7. Issues with health insurance.

Hot topics are to develop, promote and encourage safety knowledge and technical know-how. Educate on how to fully enforce standards and ethics in the practice of safety, and address the challenges of managing health in an offshore or remote site location in the Oil and Gas Industry.

Key Industry Professionals

Dr Nnamdi Ilodiuba - is the current President of the Institute of Safety Professional of Nigeria (ISPON). He specialises and recommends good preventive healthcare practices for health and safety of workers, geared specifically towards the Oil and Gas industry in Nigeria.

Dr Okon Akiba – is the Health & Services manager at OKLNG, and the National Chairman of the Society of Occupational and Environmental Health Physician of Nigeria (SOEPHON). He specialises and recommends on the Challenges of managing health in an offshore or remote site location in the Oil and Gas Industry.

Dr Olutomiwa Ogunbona - is our Flying Doctors Medical and Corporate Services Manager, a specialist in Medical Evacuation and Emergency Transport in Nigeria.

Specific recommendations for Oil and Gas industry in Nigeria, Africa

Accident Preventative Measures: By investigating every incident, we learn about causes and can take action towards mitigating and removing.  Making special provisions for emergency services on site such as fire, police, coast guard and emergency medical services (EMS) and preparation for higher risk incidents of civil unrest and violent crime should all be taken into consideration.

Medical Emergency Response (MER): Utilising and implementing telemedicine solutions such as the Internet and live video link for providing a variety of immediate treatment options for the offshore or remote workforce via allocated advanced first aid responders.

Preventing onsite Infectious Disease: Preparation of policy documents to include strategies that cover a safe working environment, adopt prophylaxis schemes to prevent disease and insuring staff are fully immunized against infectious disease where possible. Continue to emphasise and educate on total hygiene, particularly hand washing and a healthier lifestyle. Keep up with CDC (Centre for Disease Prevention and Control) adopting industry recommendations and staff training programmes that help recognize symptoms of possible infectious disease.

At Flying Doctors, we believe that our mission is to deal with geography hurdles when assisting and responding to remote location emergency situations. We try to overcome geographical difficulties and their negative effects on patient care.

Those services include medical evacuation, health cover, remote sites services, medical waste disposal, healthcare consultancy and occupational health.

We operate medical and medico-logistical services for corporate bodies running high-risk operations like oil and gas, mining, construction, telecoms and manufacturing companies.

Since operations in these sectors often involve expatriates and indigenous employees, we have developed bespoke specific plans with corporate clients unique to individual needs to accommodate the speedy handling of emergencies arising from work-associated incidents.

If you would like to discuss your business needs with our expert panel, then please contact us with a brief outline of how we can assist: management@flyingdoctorsnigeria.com

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.