Published on Oil News Kenya 20th August 2016 – full article here
With the oil & gas and commodity prices low, companies are forced to operate leaner and reduce both capital and operational costs. All aspects of the operation are scrutinized and cost vs. benefit interrogated. This does not come without certain risks, some of which can be to on-site healthcare in a more pressurized environment.
From a workforce health perspective, companies may be forced to look for more cost effective, logistically easier solutions to satisfy their duty of care for employees and workers. This includes making use of local healthcare faculties and medical professionals, becoming more reliant on evacuation plans and having access to evacuation or medical assistance on a “call when needed” basis.
The potential risks with these approaches are that
a) Not all healthcare professionals are created equally,
b) Where time is a critical factor, “call when needed” is likely to be too late and,
c) An evacuation or emergency plan is nothing more than a list of things to do and numbers to call – it does not treat a patient.
Experience has shown that some decision makers are not aware of the limitations or differences between training and experience of various healthcare professionals. A lack of understanding of these two factors can lull clients into a false sense of security – feeling comfortable in the belief that having any level of healthcare professional on a remote site or a medical facility close by is adequate.
When we say that not all healthcare professionals are created equally, we think of the horses for courses concept. For example, a doctor (either national or “western trained” general practitioner) may be perceived to be best suited to a remote site, however, general practitioners do not spend as much time on actual emergency medicine and do not have the focused training and experience that, say, a Paramedic would have. Generally speaking, a doctor may spend 5 or 6 years studying general medicine, but a paramedic would spend 3 or 4 years studying emergency medical care and rescue, almost exclusively. (This obviously excludes doctors who have specialized in or have a keen interest in emergency medicine)
When we look deeper into the healthcare training capabilities within Africa, the unfortunate truth is that there is no formalized Advanced Life Support (ALS) paramedic training in most of Africa outside of South Africa – with the possible exception of a developing EMT (Emergency Medical Technician) training program and some short courses in cardiac care in Kenya.
The title “Paramedic” refers to ALS providers, all other levels are Basic or Intermediate Providers – not Paramedics. The term EMT refers to a basic life support provider, and the term Paramedic refers to Advanced Life Support. Nevertheless, many EMT-Basic and EMT-Intermediate consider themselves to be Paramedics.
With the greatest respect to our colleagues, national healthcare practitioners – doctors, clinical officers, nurses and “Paramedics” are generally not specifically trained, experienced or equipped to diagnose and treat significant medical and trauma emergencies. It’s not their fault, or for us to question their willingness or belief that they are trained. It is however, a reality. Some do travel abroad for specialized training, but many have neither the funds or ability to do so.
A short course in Advanced Cardiac life Support or Advanced Trauma Life Support may provide insight into emergency care; but without an existing experience base or knowledge of the equipment, these courses are largely ineffective.
Many decision makers don’t know the difference, a doctor is a doctor and a paramedic is a paramedic.
We place emphasis on the word “experience”. This is critical because on a remote site, thankfully medical emergencies or significant injuries are infrequent. Despite the infrequency of these events, the implications thereof are dramatic to both the patient, the operation, insurers and funders. However, when one does happen, the healthcare practitioner should be able to rely on solid training and experience, having performed enough advanced life support procedures for it to become second nature.
Technological advancements in the oil & gas, mining and exploration environments have allowed organizations to drill faster, extract better and refine more cost effectively.
The same holds true for general and emergency medicine; where technology and up to date, evidence based medicine can improve outcomes, save lives and reduce long term disability as a result of a medical emergency or injury. For example:
- A simple medication such as Aspirin could have a significant effect on the long term outcome of a heart attack,
- High flow, high concentrations of oxygen can be detrimental in certain circumstances,
- Some of the medications traditionally used for a cardiac arrest have no benefit, waste time or can even be detrimental to a successful outcome,
- Knowing when to administer a certain medication is as important and life-saving as the medication itself,
- Spine boards / backboards, neck braces and extrication devices have been shown to do more harm than good and are only used in specific circumstances.
Sending a patient off-site for primary healthcare diagnosis and treatment can be appropriate, provided that the facility is suitably equipped, staffed and resourced. This is especially relevant in a medical emergency.
When deciding on the most appropriate healthcare resource for a remote site, key points to bear in mind are:
- Risk vs. Cost vs. Benefit,
- Medical qualifications and experience levels of the healthcare practitioner,
- Availability of, training and experience of the selected healthcare practitioner on emergency equipment,
- Availability of local healthcare resources, clinics, hospitals and emergency services,
- The time it would take to activate an emergency plan, air ambulance or drive to a medical facility,
- Capability of a local resource, clinic or hospital which, for example, may have an operating theater, however, the presence and availability of a surgeon and anesthetist should be confirmed.
- The significant risk with this approach is that true emergencies are time-critical in nature – they do not allow for delays in treatment and outcomes deteriorate by the second rather than by the hour.