U

Remote Healthcare
Guide
1st December 2014

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Title : Remote Healthcare Guide
Report number : HE 14.047
Distribution : Shell Health
Author : Halim Mohamed
Approved By : Alistair Fraser
Authorisation : Restricted
Keywords : Health
Health Risk
Remote Locations
Medical Emergency Response
Emergency Response
Date : 01 December 2014

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Contents
Introduction 4
Purpose 4
Who is this for? 4
What situations are covered? 4
Remote Locations 5
Remote Healthcare 5
Risk Assessment 5
Medical Emergency Response Requirements 5
Medical Emergency Response Planning 6
MER Resources 6
MER Drills 6
MERP in Remote Locations 6
MERP in Extreme Remote Locations 7
Sites with Low Exposure (e.g. small numbers of personnel) 7
Competence 7
Designated First Aiders (DFA) (Tier 1) 7
Remote Healthcare Practitioners (RHCP) (Tier 2) 7
Remote Medical Support (Topside) 8
Telemedicine 8
Equipment and Supplies 10
Fitness to Work (FTW) 11
Health Promotion 11
Food and drinking water safety 12
Remote Health Care (RHC) in Contractor Management 12
Summary 12
References 14
Glossary 15
Appendix A: Medical Emergency Response Plan (MERP) Example 16
Appendix B: Medical Emergency Resource (MER) Resource Requirements 17
Appendix C: Medical Emergency Response (MER) Gap Analysis Tool 18
Appendix D: Medical Emergency Response (MER) Risk Assessment Template 20
Appendix E: Examples of MER Risk Mitigation Measures 21
Appendix F: Designated First Aider (DFA) Training Contents 22
Appendix G: Topside Service Delivery and Competency Expectations 23
Appendix H: Telemedicine Solution for Various activities 24
Appendix I: Site Clinic Layout 27
Appendix J: Site Clinic Medical Equipment List 28
Appendix K: Site Clinic Medical Supplies List 31
Appendix L: Medical Equipment and Supplies Equipment for Specific Hazard or Specific Extreme Environment 35
Appendix M: Health Promotion Program Components 36
Appendix N: Sample Contract Clauses 37
Appendix O: Remote Healthcare Components for Various Oil and Gas Activities 38

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 Please check that anything you take from this Guide meets local regulatory or business requirements, and is
appropriate for your location and activity.

Introduction
In order to meet the world’s growing energy demand, operations in remote locations will continue to increase. These are
locations where the medical evacuation of an injured or ill person to a hospital within four hours, cannot be guaranteed
in foreseeable circumstances (e.g. the offshore oil and gas production platform). In addition, the energy industry is
increasingly pursuing operations in extreme remote locations. These are sites where medical evacuation to a hospital can
never be achieved within four hours, even in the best of circumstances. Operating in these locations present a multitude
of health challenges. They include: limited medical expertise, medical supplies, and, communications; and significant
delays to diagnosis and treatment. Whilst these health risks cannot be totally eliminated, they can be kept as low as
reasonably practicable, by implementing a number of control strategies. These strategies work together to prevent health
complications by optimising care during transfer, minimising unnecessary medical evacuations, and facilitate necessary
ones. The implementation of these strategies helps to protect the health of remote location workers’, at a level that is
comparable with their non-remote counterparts.

Purpose
This guide aims to provide non-mandatory good practice examples for implementing section 4 of the Emergency
Response Manual of the HSSE&SP Control Framework (Medical Emergency Response). It provides guidance for Health
Managers, Project Managers and HSSE Professionals to implement risk mitigation measures so as to keep risks to As Low
as Reasonably Practicable (ALARP).

Who is this for?

 Emergency Response Coordinators
 Project Managers
 Project HSSE professionals
 Health Managers
 Health Project Owners

What situations are covered?

Operations where the following mandatory medical Emergency Response requirements cannot reasonably be met:
 first aid treatment, including defibrillation, by a Designated First Aider within four minutes;
 assessment and stabilisation by a medical Emergency professional within one hour;
 admission to and care at the nearest Local Hospital within four hours;

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Remote Locations
Remote locations are those where the medical evacuation of an injured or ill person to a hospital cannot be guaranteed
to be achieved within 4 hours in foreseeable circumstances (e.g. inclement weather). Examples include offshore
production platform, seismic/drilling/production in a remote inland area, marine transportation vessels. Whilst most of
these can be reached within 4 hours by helicopter, this transportation time is not guaranteed in the event of adverse
weather, aircraft availability, or at night. Examples in marine operations include vessels sailing within 4 hours of a
nearest port, or vessels with a helipad sailing within 4 hours of flying time to a hospital.
Several factors affect evacuation time (and thus the “remoteness” of a location). These include geographical distances,
available transportation options, transportation infrastructure, communication, weather, and security (e.g. hostilities).
Extreme Remote Locations are sites where medical evacuation to a hospital can never be achieved within 4 hours, even
in the best of circumstances. Examples include seismic/drilling vessels operating hundreds of nautical miles from shore, or
those operating from bases which are themselves remote (e.g. the Arctic). These sites may be out of most rotary wing
aircraft flying range, and evacuation times may sometimes exceed 24 hours.
Remote locations present many challenges to the health of employees who work in them. In the event of an illness or
injury, an evacuation would take a much longer time than can be expected in an urban setting. During this period, the
patient’s condition may deteriorate leading to disability, or even death. Remote locations are also associated with higher
risks (e.g. hot or cold extremes in deserts or polar regions, or infectious diseases in tropical areas), limited access to
basic necessities (e.g. clean water), and limited supplies (due to logistical challenges of re-supply). Remote locations are
also often associated with limited communication options (e.g. the lack of telephone lines, mobile network, satellite
communications or internet). This means a higher likelihood of harm to health (unless appropriate preventive controls are
put in place). The consequences of a complication or the condition worsening are high, unless mitigations are put in
place.

Remote Healthcare
Remote healthcare (RHC) encompasses the health activities involved with the prevention, diagnosis, and treatment
targeted at those working in remote locations. It builds on the existing controls already in place in our HSSE&SP CF in
such a way that enhances their effectiveness and thus minimises the health risks. These controls include fitness to work,
health risk assessment, medical emergency response, food and drinking water safety, health promotion, competence,
and communications. By augmenting the existing controls, we ensure that health support is available where and when it
is needed, and that risks are as low as reasonably practicable.

Risk Assessment
For remote locations, the following factors have a direct impact on the likelihood and severity of the injury/illness, as well
as the level of healthcare resources needed on site: the nature of work activities performed at the site; the number of
people on site; project duration; transportation options, availability and infrastructure; geography; climate; security;
characteristics of the working population (e.g. age profile, gender mix, migrant status, etc); local health facilities’
capability and location.

Medical Emergency Response Requirements

The Emergency Response Manual of the HSSE & SP Control Framework requires the Emergency Response Coordinator to
provide:
 First aid treatment, including defibrillation, by a Designated First Aider within 4 minutes
 Assessment and stabilisation by a medical Emergency professional within 1 hour
 Admission to and care at the nearest Local Hospital within 4 hours
 Referral to an appropriate Specialist Hospital (casualty specific).
When response times or requirements above cannot be met, perform a Risk Assessment and provide medical Emergency
Response Risk mitigation measures to ensure that the Risks are As Low as Reasonably Practicable (ALARP).

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Medical Emergency Response Planning
Remote locations present challenges in terms of medical emergency response (MER) because of distance and travel time
to secondary or tertiary medical care. In addition, the likelihood of poor weather may delay any attempts for a medical
evacuation. To effectively manage medical emergencies in remote locations, a site-specific medical emergency response
plan (MERP) needs to be developed prior to mobilisation. The MERP needs to take into account the potential for
individual and multiple casualties, describing the response to various medical emergency scenarios based on the health
risk assessment, and utilizing available resources. The MERP should consider specific needs of the work activities and the
general situation of the country in which these activities are carried out, as well as any collaboration with local
authorities. See Appendix A: Medical Emergency Response Plan (MERP) Example
• Design the MERP in a way that will achieve:
o First aid treatment, including defibrillation, by a Designated First Aider within 4 minutes
o Assessment and stabilisation by a medical Emergency professional within 1 hour
o Admission to and care at the nearest Local Hospital within 4 hours
o Referral to an appropriate Specialist Hospital (casualty specific)

MER Resources
Resources required for the successful implementation of a MERP include: competent MER Team members (e.g. First
Aiders, Doctor, Nurse, and Paramedic); effective means of communications; adequate means of transportation (ground,
water, air); local health facilities with adequate medical structures (primary, secondary and tertiary care); equipment and
supplies.

• Identify and allocate adequate resources to meet the Tier Response Times.
See Appendix B: MER Resource Requirements

MER Drills
Typical MER Drill frequencies in Remote Locations are as follows:
Test Frequency
Communication Test all communication systems needed for MER,  At start up, and
Test including ‘external’ ones and backup systems. All listed  Monthly thereafter
telephone numbers shall be tested.
Local Medevac Simulation up to casualty being ready for transport and  At start up, and
Drill aircraft confirmed ready for takeoff, or ambulance ready  Annually thereafter
to depart from main Site to Tier 3 Hospital.
Full Scale Simulation with (dummy) casualty delivered to local Tier  At start up, and
Medevac Drill 3 Hospital.  Once every three years thereafter
Note:
 Can be conducted either standalone or in
conjunction with local Medevac drill
 Can be conducted without the transportation
element (i.e. Local Medevac Drill above, followed
by Hospital Drill starting from helibase/airport
In addition to the frequencies above, repeat test/drills whenever there is a significant change in the Site MERP.

 Conduct regular MER Drills to demonstrate that the tier response times are met.

MERP in Remote Locations

In remote locations, the medical evacuation of an injured or ill person to a hospital cannot be guaranteed to be achieved
within 4 hours in foreseeable circumstances (e.g. inclement weather). In order to mitigate the impact of these possible
delays:

 Perform a MER Risk Assessment.

 Implement MER Risk mitigation measures to ensure that the Risks are As Low as Reasonably Practicable (ALARP).
See Appendix C: MER Gap Analysis Tool
See Appendix D: MER Risk Assessment Template
See Appendix E: Examples of MER Risk Mitigation Measures

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MERP in Extreme Remote Locations
In extreme remote locations, a medical evacuation to a nearest hospital may never be achieved within 4 hours, even in
the best of circumstances. In order to minimise the health impact of this unavoidable delay, the mitigation measures (i.e.
competency, equipment, topside, telemedicine) needs to be further enhanced.

• Perform a MER Risk Assessment as part of project planning.

• Where the response times or requirements cannot reasonably be met perform a risk assessment and provide
measures to ensure that the risks are as low as reasonably practicable (ALARP).
See Appendix C: MER Gap Analysis Tool
See Appendix D: MER Risk Assessment Template
See Appendix E: Examples of MER Risk Mitigation Measures

Sites with Low Exposure (e.g. small numbers of personnel)

Some sites have very small number of personnel on site (e.g. 25 people or less), or it may operate within a very limited
time period (e.g. one month or less). In these circumstances, placing an on-site clinic, a health professional or a
dedicated air transport may sometimes be impractical. This is common in marine operations.
• Where the response times or requirements cannot reasonably be met:
o Perform a MER Risk Assessment.
o Perform a risk assessment and provide measures to ensure that the risks are as low as reasonably practicable
(ALARP).
See Appendix C: MER Gap Analysis Tool
See Appendix D: MER Risk Assessment Template
See Appendix E: Examples of MER Risk Mitigation Measures

Competence
Healthcare in remote locations are delivered by Designated First Aiders (DFA) and Remote Healthcare Practitioners
(RHCP). Their competence is crucial to the site’s health delivery.

Designated First Aiders (DFA) (Tier 1)

Designated first aiders (DFA) are usually the first medical emergency response team (MER) team member providing
support at a scene of an incident. The content of initial DFA training is outlined in Appendix F: Designated First Aider
(DFA) Training Contents. The timeframe for DFA initial training is around 40 hours.
In order to avoid DFA skill decay, maintain DFA skills through skills maintenance training. These are commonly
implemented as a 3-monthly, informal practical sessions at the workplace, facilitated by a senior first aider or a Site
Medical Professional. Each session generally lasts around 2-3 hours. Skills commonly covered during these sessions
include Basic Life Support, defibrillation, immobilisation, patient transfer and communication.

• Verify that the DFA training provider is able to deliver the appropriate training contents
• Maintain DFA Skills through Skills Maintenance Training
See Appendix F: Designated First Aider (DFA) Training Contents

Remote Healthcare Practitioners (RHCP) (Tier 2)

Remote Healthcare Practitioners are usually nurses, paramedics, nurse practitioners, physician’s assistants, and sometimes
physicians. These health professionals are responsible for providing assessment and stabilisation of ill or injured workers.
In addition, they are also responsible for the provision of primary healthcare and preventive care. Refer to Institute of
Remote Healthcare Guidance: Remote Healthcare in Oil and Gas and its associated Maritime Activities.
• Verify that the RHCP meets IRHC guidelines on RHCP competency.

In some settings, the remote healthcare practitioners may also be responsible for non-medical tasks (e.g. as the radio
operator, or helicopter landing officer). Some tasks may interfere with the RHCP’s ability to carry out patient care (e.g.
being a helicopter landing officer for a medevac helicopter during a medevac).
• Where possible, avoid assigning non-medical tasks to RHCP.
• Where health professionals are to be assigned non-medical tasks, conduct a task assessment prior to implementing
the task, in order to demonstrate that the tasks does not interfere or conflict with the RHCP’s ability to carry out and
complete his/her primary medical role.

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Remote Medical Support (Topside)
Remote healthcare practitioners often need to work in isolation without the presence of a medical team supporting
him/her. In order to improve diagnostic accuracy and early treatment, remote medical support is commonly
implemented.
Topside is responsible in providing medical advice to the remote healthcare practitioner, immediately upon request, at
any time, via real time voice or video (telemedicine). The advice includes:
1. Provisional diagnosis
2. Immediate treatment required
3. Whether to pursue an evacuation, or to treat on site
4. Destination hospital (if an evacuation is recommended)
5. Evacuation transportation and route (if an evacuation is recommended)
6. The medical support requirements during transport, e.g. equipment, medical escort etc (if an evacuation is
recommended.
• Implement a system for the site health professional to access real-time specialist medical advice from an emergency
physician located at a distance, via telecommunications (and/or information technologies).

There are several models of providing topside support in the industry. Shell’s Health’s minimum expectations are outlined
in Appendix G: Topside Service Delivery and Competency Expectations.
To enable topside to provide accurate and timely advice to the RHCP, it is important that the topside possess technical
competency in managing medical emergencies, understands the hazards and risks of the site he/she is covering, and
has knowledge of the capabilities available health facilities within the site’s medical emergency response plan.
• Verify that the Topside service delivery and competency meets industry expectations.
See Appendix G: Topside Service Delivery and Competency Expectations

Telemedicine
Telemedicine is the use of telecommunication and information technologies to exchange medical information from one
site to another in order to improve patients’ health status. It has been shown to reduce delays in medical evacuations
(e.g. through faster diagnosis), optimise patient care during Medevac’s, and reduce unnecessary evacuations (e.g.
through accurate specialist assessments). Minimum expectations for telemedicine are as follows:
Remote Extreme Remote
Locations Locations
1. 2-way voice communications (e.g. telephone, radio) Required Required
2. Secure email, with ability to transfer attachments (e.g. photos, scanned Required Required
ECG output, scanned documents, etc).
3. Real-time video Desirable Required
4. Real-time data transmission from: Desirable Required
 5- lead ECG
 Vital signs (blood pressure, pulse, respiration, pulse oximeter)
5. Macro video (e.g. to view skin lesions, foreign bodies in eye, etc) Desirable Desirable
6. Otoscope and ophthalmoscope video Desirable Desirable
7. Digital stethoscope Desirable Desirable
8. Point of care laboratory testing (e.g. cardiac enzymes, renal profile) Not Required Desirable
9. Portable digital ultrasound Not Required Desirable
10. Portable digital x-ray Not Required Desirable

• Implement telemedicine to meet the expectations above.

The following are pertinent issues relating to telemedicine:

The following are pertinent issues relating to telemedicine:

• Where telemedicine is utilised to provide advice directly to the patient (i.e. virtual consultations), there may be
regulatory restrictions and licensing issues across jurisdictions (e.g. national or state boundaries). Such issues do not
arise when telemedicine is limited to supporting the remote healthcare practitioner (i.e. Topside to Tier 2).

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• Although telemedicine can significantly improve the level of healthcare provision by bringing expert advice to the
site, telemedicine is currently not a substitute for having competent, remote healthcare practitioner performing
complex health interventions (e.g. advanced life support).
• The average data transfer rate of a chosen telemedicine system should match (or not exceed) the location’s
bandwidth capability.
• Software must be available to the relevant topside. Topside must be familiar with the software.
• Medical data transfer must be secure (i.e. encrypted).
• Where a medical service provider is used (e.g. to provide medical manpower, topside, equipment and supplies), it
is preferable for the telemedicine equipment to be owned, maintained and operated by the medical service provider
(e.g. InternationalSOS, Frontier Medex, etc).
• At Contractor locations (e.g. seismic vessels, drilling rigs), avoid Shell ownership of telemedicine equipment, due to
the potential legal and financial liabilities.
• As remoteness often also impacts quality and stability of connections, establish a back-up plan with alternative
connections (e.g. satellite phone).
• A satellite connection will always be available, but is low/medium bandwidth and expensive.
• Although most drilling and oil production operations have good data connection, they also have large routine
bandwidth usage (e.g. transmission of geological data, emails, etc.). Investigate the possibility of prioritising
bandwidth for telemedicine during medical emergencies.
There are many types of telemedicine equipment in the market. Some are best suited for specific activities (e.g. offshore
drilling, land based seismic campaign, offshore production platform, etc). Based on experience in Shell’s RHC pilot
locations, suitable telemedicine solutions for various activities are outlined in Appendix H: Telemedicine Solution for
Various activities.

• Implement a telemedicine solution that suits the work activity.

See Appendix H: Telemedicine Solutions For Various Activities.

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Equipment and Supplies

Tier 1: First Aid Box

First aid boxes are maintained and used by Designated First Aiders (DFA). The first aid box requirements for remote
locations do not differ significantly from other Shell workplaces.
First Aid Item
1. Automated external defibrillator (AED)
2. Barrier devices and protection (i.e. pocket mask, rubber gloves, protective goggles, plastic apron, biohazard
waste bag)
3. Vital signs equipment (i.e. automatic blood pressure measurement device, digital thermometer)
4. Bandages (i.e. triangular, elastic, roller).
5. Dressings (i.e. gauze pads, burn dressings, multi-trauma dressings, eye pads, antiseptic wash, adhesive dressings)
6. Foil blanket (adult size)
7. Splints (e.g. SAM splints)
8. Cold pack compress
9. Miscellaneous: adhesive tape, cotton buds, safety pins, pen, paper, scissors
10. Guides: Basic life support (BLS) algorithm card, first aid pocketbook
11. Inventory of box contents

• Verify that First Aid items above are in place.

• Verify that First Aid boxes are place at visible and accessible locations.
• Verify that there are adequate quantities of First Aid boxes and defibrillators to meet 4-minute response time.

Tier 2: Site Clinic

An on-site clinic is often necessary to provide assessment and stabilisation within 1 hour of an injury or illness. In addition
to Medical Emergency Response, the site clinic will also need to function as a centre for primary health care, as well as
an office for preventive health services (e.g. workplace health promotion program, hygiene inspections, fitness to work
assessment, etc.). In addition to the remote healthcare practitioner’s (RHCP) competency, the effectiveness of the site clinic
is highly dependent upon its layout, equipment, supplies, and operating procedures.
In most remote locations, space constraints limit the remote site clinic’s footprint. Where possible utilise space-saving
furniture, fittings and equipment. It is important to specify the site clinic layout very early in the planning stage, so this can
be incorporated into the initial design of the vessel/rig/platform/building. Once built, structural changes to a vessel, rig
or building are often difficult to implement.

• Verify that Site Clinic design and layout supports the Site’s MER Plan

See Appendix I: Site Clinic Layout

Consider the following issues when planning to medically equip and supply the Remote Site Clinic.
 Portability. Remote healthcare practitioners (RHCP) in remote location often need to mobilise quickly to a worksite to
provide stabilisation. A number of selected site clinic equipment need to be portable enough (or a portable
redundant made available) to be carried in a trauma bag by a single person to the incident site.
 Quantity. The quantity of items in stock should be based on the number of workers on site, the duration of operations,
likelihood of injuries/illness, and resupply frequency. This will vary widely from site to site, and hence will not be
included here.
 User-friendliness. The remote healthcare practitioner is often the only health professional onsite, and most cases they
are nurses, medics, nurse practitioners and physician’s assistants. Some emergency equipment are ideal for remote
locations due their user-friendliness (e.g. the laryngeal airway, blind intubation devices, haemostatic dressings, etc).
Extreme Remote Locations require additional medical equipment in order to manage serious illnesses on-site. These
include Portable patient ventilator, Point of Care Testing System (e.g. iStat), and digital ultrasound.
Exact requirements for medical equipment may differ, based on the site’s health risk assessment (HRA). The typical
equipment for locations with specific hazards or specific extreme environment is listed in Appendix L.

 Check that the site clinic equipment and supplies list meets the risk requirement of the location and activities.
See Appendix J: Site Clinic Medical Equipment List
See Appendix K: Site Clinic Medical Supplies List
See Appendix L: Medical Equipment and Supplies Equipment for Specific Hazard or Specific Extreme Environment

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Fitness to Work (FTW)
Illnesses which are easily managed in the urban setting may result in a crisis when it occurs at the remote location (e.g.
an asthmatic attack). Operations may be interrupted (e.g. food poisoning outbreak), and the co-workers’ health may be
placed at risk (e.g. chickenpox).
An ageing working population, and an increasing prevalence of chronic illnesses (e.g. hypertension, diabetes mellitus) in
the industries working population represents a special challenge. An emergency arising from a complication of these
chronic illnesses (e.g. a myocardial infarction) will result in significant delays to treatment, permanent disability or death.
In order to ensure that an individual can indeed complete his assigned tasks safely and without unacceptable risk to
themselves and others, it is important that the fitness to work assessments are designed in such a way that takes into
account the prevailing site-specific risks (e.g. temperature extremes), evacuation delays and available on-site health
support.
A generic, non-risk based medical assessment may not sufficiently identify those who are at risk. In some cases it may
also unnecessarily prevent those who can safely perform work from doing so.

Existing FTW Protocols in use for Remote Locations

Shell’s FTW protocols for remote location work are based on the Oil and Gas UK (OGUK) recommendations1. It
contains robust protocols and health standards, such that it is suitable for use in most remote locations, with minimal or no
modifications.
Seafarers are required to hold a statutory certificate of fitness. This will be issued by a doctor approved by the maritime
authority, normally that of either the seafarer’s home state or the flag state of the vessel they are joining. National
standards are followed by approved doctors and need to be in accord with the requirements of relevant international
conventions.2,3
• Implement Shell FTW Protocols for Remote Location Work (or seafarers’ medical examinations for maritime crews).

However, it should be noted that each remote location is unique, and any FTW assessment protocols adopted needs to
be based on the site’s Health Risk Assessment (HRA).

FTW Protocols for Extreme Remote Locations

In extreme remote locations, delay to hospital treatment may be as long as 36 hours of more. Where the local legislation
does not prohibit, it is a good practice for the Site Medic to review the FTW certificates and medical notes around 2-3
weeks prior to mobilisation. This allows adequate time for the Site Medic to verify the FTW assessments, pursue
additional medical work-up, prepare for any foreseeable medical challenges, and be familiar with their medical needs. It
also allows for the Site Supervisor to find replacements for workers who have been found to be unfit for mobilisation.

• Implement a process for the Site Remote Healthcare Professional to review FTW certificates and medical notes
prior to mobilisation.

Generally the existing FTW protocols and standards in use for remote locations (e.g. OGUK published guidance) would
not be suitable for use in extreme remote locations in its current unmodified form.
There are currently no established FTW protocols for extreme remote locations. However, Health advisors may opt to
enhance the OGUK FTW protocol and standards for use in extreme remote locations. These may include:
• Increasing the frequency of periodic assessments (e.g. bi-annually for all age groups)
• The inclusion of dental assessment/certification in the FTW protocol.
• The inclusion of a simple psychological assessment in the FTW protocol.
• Re-defining the health standards (e.g. those relating to pregnancy, insulin dependent diabetes mellitus, asthma,
cardiovascular disease, and history of significant mental illness).
• For extreme remote locations, consider implementing a FTW protocol based on modified OGUK protocol and
standards.

Health Promotion
Chronic illnesses (e.g. hypertension, diabetes) may be difficult to manage in remote locations. Workplace health
promotion programs (WHPP) can significantly reduce cardiac risks by allowing employees to control blood pressure,

1
Oil & Gas UK (2008). Medical Aspects of Fitness for Offshore Work: Guidance for Examining Physicians. Issue 6, March 2008.
ISBN 1903003374.
2
ILO Maritime Labour Convention 2006, IMO STCW Convention Manila amendments 2012.
3
ILO/IMO Guidelines on seafarer medical examinations 2012

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control blood sugar, achieve optimum weight, quit smoking, improve diet, improve fitness and increase morale. This has
the potential to result in cost savings (including those related to evacuations), increased productivity, and lower turnover.
Program uptake can be high due to the captive population in remote locations.

• Implement a Workplace Health Promotion Program (WHPP) with a focus on

o Cardiovascular risk (i.e. diet, exercise, smoking), and
o Site-specific risks (e.g. malaria, HIV, etc.).
See Appendix M: Health Promotion Program Components

Food and drinking water safety

Currently, food poisoning is the commonest reported occupational illness in remote locations, and the commonest health
reason for operational disruption. To ensure food safety in remote locations:
• Establish and maintain a food safety management system in line with Hazard Analysis and Critical Control Points,
HACCP).
• Ensure that catering contracts (and subcontracts) include requirements for Good Hygiene Practices and Hazard
Analysis Critical Control Point.
• Establish a process for inspections to monitor Good Hygiene Practices and key Hazard Analysis Critical Control
Point controls.
For more information refer to HSSE&SP CF Guidance on Food and Drinking Water Safety.

Remote Health Care (RHC) in Contractor Management

For contracts that involve working in Remote Locations, implement risk mitigation measures above so as to keep risks to
As Low as Reasonably Practicable (ALARP). Where the MER is executed by a Contractor, include the mitigation measures
(in yellow boxes) as contract requirements. See Appendix N: Contract Clauses.

• Step 1: Identify and Assess Contract Health Risks

• Step 2: Define Health Controls
o Define the need for Health KPI
o Determine incentives and consequence management
• Step 3: Assess Contractor’s Capability to Manage Health Risks
o Define the required level of Health monitoring and Health support
o Select Health requirements in Contract clauses, and consequences for non-compliance
• Step 4: Verify Contractor’s Health Controls
o Verify Contractor company and personnel have been informed of the contract Health requirements
o Verify Contractor company manages the Health requirements of the Contract
o Include Pre-Mobilisation Check / Inspection on Health controls. A pre-mobilisation tool/checklist is
available in Appendix D of Contractor Health Management Guide,
• Step 5: Assess Contractor’s Health Performance
o Verify Contractor company and personnel have been informed of the contract Health requirements
o Verify Contractor company manages the Health requirements of the Contract
 Recognise Contractor companies that show good HSSE performance
 Where Health performance does not meet requirements, confirm that the Contractor company
takes action to improve,
 Where Health performance is unacceptable, apply consequence management

For more information, refer to Contractor Health Management Guide, and HSSE&SP CF Guidance on Contractor HSSE
Management.

Summary
Remote locations are defined as locations where the medical evacuation of an injured or ill person to a hospital within
four hours, cannot be guaranteed in foreseeable circumstances. In addition, the energy industry is increasingly pursuing
operations in extreme remote locations. These are sites where medical evacuation to a hospital can never be achieved
within four hours, even in the best of circumstances. Operating in these locations present a multitude of health challenges,
including significant delays to treatment, limited medical expertise, equipment, supplies and communications. Risks can
be kept as low as reasonably practicable, by implementing Remote Healthcare strategies. They include risk assessments,
medical emergency response planning, medical assessments for fitness to work, workplace health promotion

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programmes, food safety management systems, healthcare practitioner competency requirements, remote medical
support, telemedicine, careful selection of equipment and supplies. Together, these strategies work to prevent health
complications, optimise care during transfer, minimise unnecessary medical evacuations, and facilitate necessary ones.
Implementation of these strategies protects the health of remote location workers’, at a level that is comparable with their
non-remote counterparts.
See Appendix O: Remote Healthcare Components for Various Oil and Gas Activities

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References
1. Remote Healthcare for Energy and Associated Maritime Activities. Institute of Remote Healthcare (2013).
http://www.irhc.org.uk/resource/resmgr/IRHC_Guidance_Doc/IRHC_RHC_Guidance_Doc_Oct.pdf
2. Medical Aspects of Fitness for Offshore Work: Guidance for Examining Physicians. Issue 6, March 2008. Oil &
Gas UK (2008).
3. ILO Maritime Labour Convention 2006, IMO STCW Convention Manila amendments 2012. International Labour
Organisation (2012).
4. ILO/IMO Guidelines on Seafarer Medical Examinations. International Labour Organisation & International Maritime
Organisation (2012).
5. Emergency Response Guide. HSSE&SP Control Framework. Shell (2010).
6. Food and Drinking Water Guide. HSSE&SP Control Framework. Shell (2010).
7. Functional Health Specifications: Medical Evaluation of Fitness to Work. Version 3.2. Shell Health (2011).

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Glossary
Bandwidth. The ‘volume’ of data a connection can transfer per second. It is expressed in bits per second or multiples of it
(bit/s, kbit/s, Mbit/s, Gbit/s, etc.). A higher bandwidth means in practise that you get your data faster and of higher
quality. As a rule of thumb visual imaging requires more bandwidth than voice-only and moving images more than stand-
still image. Most telemedicine technologies require a minimum bandwidth to function and availability of a good
bandwidth connection can be a major blocker for telemedicine implementations.
Cisco codec. A piece of hardware enabling the encoding and decoding of sound and images for teleconferencing.
Cisco is the standard brand/technology used in Shell for teleconferencing.
Extreme Remote Locations. Sites where medical evacuation to a hospital can never be achieved within 4 hours, even in
the best of circumstances. Examples include seismic/drilling vessels operating hundreds of nautical miles from shore, or
those operating from bases which are themselves remote (e.g. the Arctic). These sites may be out of most rotary wing
aircraft flying range, and evacuation times may sometimes exceed 24 hours.
GID machine. A Shell standard desktop or laptop computer. Most GID machines are “locked” and enable only to have
standard Shell software installed. Only locked machines receive full IT support from the GID-helpdesk and will receive
software updates automatically. On special request, a machine can be unlocked so that the user can install any software
they want. For an unlocked machine, the user will be responsible for keeping all software up-to-date and helpdesk
support is limited. To prevent the hassle of unlocked machines, it is advised to only use Shell standard software and when
new requirements arise, select a standard software solution together with the Health IT department. The IT department can
get the software ‘scripted’ to standard for use on locked GID machines.
Medevac Plan. A description of how a particular medevac will be implemented. Topside (also known as Remote
Medical Support). Real-time specialist medical advice from emergency medical professionals (usually doctors) given to
the site health professional in remote locations, via telecommunications and/or information technologies.
Medevac. See Medical Evacuation.
Medical Emergency. A medical condition which requires immediate treatment (generally within 24 hours of onset), and
which otherwise puts the person’s health at risk. (Note: Some medical conditions which are normally considered non-
emergencies can be an emergency when they occur in a remote or hostile environments due to the lack of diagnostic or
treatment capabilities).
Medical Evacuation. The evacuation of a sick or injured person from a hostile environment to a place of safety where
the appropriate medical attention can be provided.
Remote Locations. Sites where the Medical Evacuation of an injured or ill person to a hospital cannot be guaranteed to
be achieved within 4 hours in foreseeable circumstances (e.g. inclement weather). Examples include offshore production
platform, seismic/drilling/production in a remote inland area, marine transportation vessels.
Satellite Phone. A telephone that makes connections via satellite. Its connection is available everywhere in the world
except at (extreme) northern latitudes. As satellite phones work independent of local infrastructure they are a very valuable
asset as back-up in emergency situations. It works in open sky or requires a receiver on the roof of the clinic. Connection
bandwidth is usually low to moderate, but enough to allow voice & email. There might be slight delays in the connection,
causing poor video quality when used for teleconferencing. Satellite phone equipment and usage charges are very
expensive.
Tempus Pro. A brand of portable telemedicine device, based on a portable vital signs monitor.
VSee. A brand of teleconference software that integrates both sound & vision and medical equipment.

15
Appendix A: Medical Emergency Response Plan (MERP) Example

Incident occurs

Bystander
 Assess scene and casualty
Tier 0: Immediate

 Make the area safe Notify:

 Observe do’s and don’ts  Incident location
 Notify Site Emergency Coordination Centre (ECC): 999  Number of personnel injured
 Nature of injury/illness
ECC  Safety of incident site
 Incident contained or escalating
Dispatch Designated First Aiders (DFA) via PA system

DFA
 Obtain first aid box (with AED)
 Mobilise to incident site
 Assess casualty
 Provide Basic Life Support (BLS) / First Aid
Tier 1: < 4 minutes

 Treat casualty on-site

Tier 2 activation required?
 Notify ECC: De-escalate

Activate Tier 2
 Notify Site Emergency Coordination Centre (ECC): 999

ECC
Dispatch Tier 2 Site Medic via radio

Site Medic
 Obtain Trauma Bag and Spinal Board
 Mobilise to incident site
 Assess casualty
 Provide Advanced Life Support
 Transfer to Site Clinic
Tier 2: < 1 hour

 Contact Topside: 999-999-999

 Treat casualty on-site

Medevac to Tier 3 required?
 Notify ECC: De-escalate

Notify:
Activate Medevac  Provisional diagnosis and severity
 Notify Site Emergency Coordination Centre (ECC): 999  Treatment given
 Notify Hospital: 888-888-888  Transportation and route
 Contact number of medical escort
 Medical support during transport
Tier 3: < 4 hours

Site Medic
 Confirm casualty arrived at Tier 3 Hospital
 De-escalate
 Monitor progress

16
Appendix B: Medical Emergency Resource (MER) Resource Requirements

Tier by at Time Equipment/Transport Training requirements Skills

(after requirements maintenance
incident) requirements
Tier 0 Bystander Site Immediate - • Call for help • Annually
(Initiation) • Make area safe
• Do’s and don’ts
(usually one hour on
induction, for everyone on
site)
Tier 1 (First Designated Site 4 minutes • First aid box • DFA Training (usually • DFA skills
aid and First Aider • Automated External 40 hours) refresher
Defibrillation) (DFA) Defibrillator (AED) (Usually every
3 months, for 2
hours)
Tier 2 Medical Site 1 hour • Trauma Bag • Professional medical • ALS training
(Medical professional Clinic • Ambulance, and training every 3 years
stabilisation) (Medic ambulance • Remote Healthcare
/Nurse Equipment Practitioner Training4
/Doctor) • Site Clinic • Advanced Life Support
Equipment and (ALS) training
Supplies
Tier 3 Emergency Hospital 4 hours • Ground, sea or air - -
(Hospital physician transportation
admission
and care)

1. 4
Currently, there is no universally accepted “standard” training, or accreditation schemes for RHCP’s. However, the competency
expectations are outlined in Remote Healthcare for Energy and Associated Maritime Activities (Institute of Remote
Healthcare, 2013).
.

17
Appendix C: Medical Emergency Response (MER) Gap Analysis Tool

Response Comments Is there

a gap?
Risk
1. How many people are working at the site at any given time?
2. What is the nature of the work performed at the workplace?
3. How large is the workplace?
4. What are the main hazards at the worksite?
5. Based on incident records from the past 3 years5,
a. How many injuries/illness have occurred?
b. What were the commonest injuries/illness?

Tier 0: First Response by Bystander (Immediate)

6. Do all bystanders (all staff and contractors) know how to:
a. Initiate MER (call for help)?
b. Make the area safe?
c. Observe Do’s and Don’ts (e.g. do not move the injured person, etc).
7. Have the adequacy of Bystander (Tier 0) training been reviewed by Shell
Health?

Tier 1: First Aid and Defibrillation by a Designated First Aider (4 minutes)

8. Is First Aid and Defibrillation by a Designated First Aider (DFA) available within 4
minutes?
9. Are there enough trained DFAs to cover a 4-minute response time for all areas on
site?
10. Have the DFA training been assessed by Shell Health for its adequacy?
11. Does the DFA training meet the DFA training requirements? (See Appendix F:
DFA Training Contents)
12. How are the training documentation recorded and maintained?
13. Are DFA Skills adequately maintained through a skills maintenance program (e.g.
regular refresher training)? See Appendix F: DFA Training Contents
14. How many First Aid Boxes are on site?
15. Where are the First Aid Boxes located?
16. Are the First Aid Boxes
a. Placed at accessible locations?
b. Visible?
c. Adequately protected from the elements?
17. Based on the First Aid Boxes’ quantities and locations, can it be brought by the
DFA to all areas on site within 4 minutes?
18. Is there an identified person (e.g. DFA) responsible for maintaining and checking
each First Aid Box?
19. How many automated external defibrillators (AED) are on location?
20. Where are the defibrillators located?
21. Are the AED’s:
a. Placed at accessible locations?
b. Visible?
c. Adequately protected from the elements?
22. Based on the AED quantities and locations, can the AED’s be taken by the DFA
to all areas on site within 4 minutes?
23. Is there an identified person (e.g. DFA) responsible for maintaining and checking
each AED?

Tier 2: Assessment and stabilisation by a medical Emergency professional (1 hour)

24. Is an assessment and stabilisation by a Medical professional available within
one hour?
25. Has the RHC professional completed training in Advanced Life Support (or
equivalent)?
26. Has the RHC Professional completed RHC training?
27. Is the medical professional’s equipment (e.g. Trauma Bag) adequate in providing
professional assessment and stabilisation?

5
include all First Aid Cases, Medical Treament Cases, Restricted Work Cases, and Lost Workday Cases)

18
28. If an ambulance is used, has it been assessed by Shell Health for its safety?
29. Are the ambulance and its equipment adequate in providing professional
assessment and stabilisation?
30. If a Site Clinic is used, has the Site Clinic been adequately assessed by Shell
Health?
31. Is the Site Clinic equipment adequate in providing professional assessment and
stabilisation?

Tier 3 (Admission to and care at the nearest Local Hospital within 4 hours)
32. Can admission at the nearest Local Hospital within 4 hours be achieved at all
times?
33. Have the local Tier 3 Hospitals been assessed by Shell Health (for their
adequacy to be included in the MER Plan)?
34. Have the patient transportation (e.g. transport helicopter, ambulance) been
assessed (for their adequacy to be included in the MER Plan)?
35. Have the different medevac options (and its impact on tier response times) been
reviewed by Shell Health?

ALARP (Perform a Risk Assessment and provide risk mitigation measures to ensure that
the Risks are ALARP)
36. Has a Risk Assessment been completed?
37. Have each of the risk mitigation measures in Appendix E been considered? See
Appendix E: Examples of MER Risk Mitigation Measures
38. Are the chosen risk mitigation measures adequate (i.e. do they demonstrate that
the risks are kept ALARP)?

19
Appendix D: Medical Emergency Response (MER) Risk Assessment Template
Requirement Met? Gap Reasons for Gap Potential Impact Risk Mitigations ALARP?
(Yes/No) Rating (Yes/No)
First Aid by a DFA within 4 e.g. No (e.g. not (e.g. no training e.g. delayed CPR e.g. 3C - e.,g. No
minutes enaugh DFA facility available) leading to irreversible (yellow)
numbers) injury or death.
Defibrillation by a DFA e.g. No (e.g. Not (e.g. cost) e.g. inability to e.g. 3C - e.g. No
within 4 minutes enough defibrillate results in (yellow)
defibrillators) death
Assessment and stabilisation
by a medical emergency
professional within 1 hour
Admission to and care at the
nearest Local hospital within
4 hours

20
Appendix E: Examples of MER Risk Mitigation Measures
The following are examples of mitigation measures to ensure that MER risks are kept as low as reasonably practicable
(ALARP):
1. Competency
2. Equipment/Supplies
3. Topside support
4. Implement Telemedicine
5. Enhance medical
communication
6. Improved transportation and
shortening evacuation times
7. Exposure
Risk Mitigation Measures (ALARP)
 Enhance RHCP competency (e.g. specify higher requirements for skills and
experience)
 Employ a higher qualified RHCP (e.g. an on-site doctor instead of a nurse).
 Put additional expertise (e.g. an additional doctor on-site).
 Put additional medical equipment and supplies, in order to enhance the Site
Clinic’s ability to manage challenging cases on-site.
 Implement a system for the site health professional to access real-time specialist
medical advice from emergency medical professionals (usually doctors) located
at a distance, via telecommunications and/or information technologies.
 Implement a system to allow the use of IT and telecommunication technologies to
exchange medical information between the remote site and Topside.
 Video observation
 Redundant (i.e. multiple) communication systems
 Use faster transportation (e.g. air instead of ground)
 Put transportation on standby (e.g. standby aircraft)
 Make redundant transportation available
 Use all-weather transportation
 Limit the period of operations (e.g. starting and ending within 4 weeks)
 Limit the number of workers exposed (e.g. <25 people)
 Limit the risk activity (e.g. office work only)
21
Appendix F: Designated First Aider (DFA) Training Contents

The timeframe for DFA training varies, but it is generally accepted that the theory, practical sessions and an exit
assessment will (generally) take around 40 hours. The recommended content and proficiency levels are outlined below.

Module Proficiency 6
Remote Locations Extreme Remote Locations
1. Introduction: Principles of First Aid Working Knowledge Working Knowledge
2. Provision of Basic Life Support (BLS) Working Knowledge Working Knowledge
3. Automated External Defibrillator (AED) Working Knowledge Working Knowledge
4. Vital Signs Working Knowledge Working Knowledge
5. Management of Specific Emergencies Working Knowledge Working Knowledge
6. Dressings, Bandages and Slings Working Knowledge Working Knowledge
7. Patient Transfer Working Knowledge Working Knowledge
8. Workplace First Aid
a. Role and Responsibilities Working Knowledge Working Knowledge
b. Workplace First Aid Kit Working Knowledge Working Knowledge
c. Medical Communication Working Knowledge Working Knowledge
d. Material Safety Data Sheet (MSDS) Working Knowledge Working Knowledge
e. Triage and Multiple Casualty Situations Awareness Awareness
f. Medical Evacuations Awareness Awareness
g. Legal Aspects of First Aid Awareness Awareness

6
Proficiency levels:
 Awareness (A): Able to describe the main elements of the area of expertise and their importance to the business.
 Working Knowledge (WK): Able to correctly use the terminology (vocabulary) of the area of expertise, to interpret and evaluate
information and to hold an informed debate in the area of expertise.
 Skill (S): Able to translate guidelines and standards for the Area of Expertise into practical actions, to carry out consistently the
activities to the required standard and to solve imaginatively common technical/operational problems in the area of expertise.
 Mastery (M): Able to diagnose and resolve significant, complex, unusual problems and to successfully adapt external practices into
the area of expertise for substantial improvements.

22
Appendix G: Topside Service Delivery and Competency Expectations

Topside service delivery expectations

1. A single telephone number that connects the RHCP to a call centre.
2. Available 24 hours, 7 days a week, 365 days a year
3. Immediate response (within 20 seconds) to calls
4. Capability to triage a call
5. Capability to support mass casualties
6. Multiple methods of receiving communications (e.g. SMS, email, telephone, enhanced telemedicine, radio etc)
7. A system to record all contacts and advice
8. Use of a standard communication protocol
9. Ability for the topside physician to access and obtain the following specialist medical advice within 20 minutes:
orthopaedics, cardiology, general surgery.
10. Ability to initiate contact, and request for, national/public emergency resources

Topside competency expectations

To enable topside to provide accurate and timely advice to the RHCP, it is important that the topside possess technical
competency in managing medical emergencies, understands the hazards and risks of the site he/she is covering, and
has knowledge of the capabilities available health facilities within the site’s medical emergency response plan. The
following outlines Shell’s minimum expectations for Topside competency:
1. A registered medical practitioner
2. More than 5 year’s post-registration working experience
3. Possess training and certification in Emergency Medicine
4. More than 5 years’ working experience in Emergency Medicine
5. Possess site-specific knowledge
 Hazards and risks of the workplace being covered
 Site Medical Emergency Response Plan (MERP)
 Capability and characteristics of local health facilities in the MERP

23
Appendix H: Telemedicine Solution for Various activities

1. Mobile Telemedicine Equipment Based on a Vital Signs Monitor

Vital signs monitors with connectivity to topside, a video camera, Bluetooth headset, some clever peripherals, and touch screen.
Example: Tempus IC, Tempus PRO (Website, Video)

User-friendliness 
 Switching the machine on immediately connects you to a Topside that is (e.g. MedAire or ISOS).
 Very portable and hardy.
 Automatically generates minute-by-minute medical record in pdf format into a USB-memory stick.
 Links to any windows-based system (need to install the Tempus software), including our GID machine.
 Some (e.g. Tempus IC) comes with a standard medical kit (colour-coded so that it can be used by the layperson under topside
guidance).
Connectivity: 
• Ethernet, Wi-Fi, Bluetooth, 3G, Edge, GSM, satellite phone, or normal telephone land-line.
• Low minimum bandwidth requirement: 60 kbps. Able to manage periods of zero bandwidth.
• The machine scans whichever connection is best, and then latches to it automatically.
• It switches connections automatically without you knowing.
Parameters: 
Tempus IC:
• Video (one-way, doctor sees patient), Still images, voice (using Bluetooth earpiece)
• Pulse, SpO2, BP, Respiration, Temp (aural), pCO2
• ECG (12-lead diagnostic)
• Blood Glucose
Tempus PRO:
• Ultrasound,
• Video-assisted intubation
Usability in Shell operations:
Best for:
• Locations without Tier 2 (medical professional) support (e.g. Shell Aircraft, STASCO)
• Telemedicine monitoring on the move (e.g. during helicopter transport, field operations).
Currently used in:
• Shell Aircraft International
• Shell ambulance (Nigeria)
• STASCO fleet (selected vessels, from end 2014)
Price:
USD30k – 35k
Advantages:
• Very simple to set up and use. Minimal training required.
• Continuous uninterrupted telemedicine connection - from rescue at the field, to stabilization at the clinic, and during transport to the
hospital.
• Plug and play peripherals (e.g. USB ultrasound probe, 12-lead ECG harness).
• Long battery life (~10 hours).
• Complete medical recording in pdf format.
• Low bandwidth (60Mbps)
Disadvantages:
• Limited use in non-emergency situations (e.g. virtual consultations).

2. Clinic-based Telemedicine Equipment based on Windows PC and Cisco codec

A Windows desktop computer connected with medical equipment, and integration software. Examples: AMD, Viju, Cisco.

24
User-friendliness: 
• Installation takes between 1 to 7 days.
• Starting up system requires several steps (and time) to set up connection, and run peripherals.
Connectivity: 
• Ethernet only.
• High minimum bandwidth requirement: 256 kbps.
Medical Parameters: 
• Video (two-way), still images, voice, desktop sharing.
• Pulse, SpO2, BP, Otoscope, Ophthalmoscope, Stethoscope, Spirometer, 12-lead ECG.
Usability in Shell:
Best for:
• Offshore site clinics manned by Site Medics/Doctors, with space
Currently used in:
o Greenland seismic project
o Orange Basin seismic project
o Offshore production platforms, Gulf of Mexico
Price:
• Around USD 60k-300k.
Advantages:
• Very clear close up images
• Fully customisable and expandable (to include almost any peripheral)
• Can be used for non-emergencies (e.g. virtual doctor consultations in primary health care).
Disadvantages:
• Cost
• High minimum bandwidth requirement: 256 kbps.
• Requires space
• Setup time, complexity and learning curve
• Higher equipment failure rate

25
3. Telemedicine Equipment based on Video Conferencing Software.
Video conferencing software with medical peripherals and software integration. E.g. VSee.

User-friendliness: 
• One click connection to a doctor.
Connectivity: 
• Ethernet/Wi-Fi.
• Minimum 50 kbps.
Medical Parameters: 
• Video (two-way), still images, voice, desktop sharing, annotation.
• Pulse, SpO2, BP, otoscope, ophthalmoscope, stethoscope, spirometer, 12-lead ECG, ultrasound
Usability in Shell:
Best for:
• Social investment projects for communities with limited access to healthcare
• Remote Site Clinics site clinics manned by Site Medics/Doctors
Currently being used in:
• Obio community project, Nigeria.
Price:
USD 20k.
Advantages:
• Very low bandwidth
• Low cost.
Disadvantages:
None

26
Appendix I: Site Clinic Layout
It is generally agreed that remote site clinics and extreme remote site clinics both have identical room and layout
requirements. As a minimum, consider the following room and layout:
1. Easy ingress/egress with stretcher
2. Easy access to ambulance or helipad
3. 24 hours exclusive use and availability
4. Adequate space to hold up two beds/stretchers, working space (e.g. table, chairs), and storage cabinets
5. Ventilation, illumination, temperature control
6. Hand-washing facilities
7. A medical waste disposal system
8. Lockable filing cabinet
9. Material Safety Data Sheet archive and other medical reference materials
10. Communication with Site Manager and Remote Medical Support direct from Site Clinic
11. Medication storage
12. Drug refrigerator
13. Access limited to Tier 2 MER Professionals
14. Potable water (running or in containers)
15. Toilet and shower
16. Accommodation for Tier 2 MER Professional immediately adjacent to the Site Clinic

27
Appendix J: Site Clinic Medical Equipment List
The typical site clinic equipment for Remote Locations is listed below. Please note that hazards and risks and in different
locations differ significantly. Exact requirements should be based on the site’s health risk assessment (HRA). As with other
workplaces, medical devices should only be used by qualified site medical professionals.
Extreme
Remote Site
Equipment Remote Site
Clinic
Clinic

Ventilation, Airway and Respiratory Equipment

1. Oxygen delivery (portable and fixed)
a. Oxygen cylinders (or oxygen concentrator)
b. Variable flow regulator  
c. Manually triggered ventilator
d. Delivery system (tubings, nasal cannulas, non-rebreather mask)
2. Masks
a. Bag valve mask  
b. Pocket mask with one-way valve
3. Airways
a. Oropharyngeal airways
b. Nasopharyngeal airway
 
c. Laryngeal mask airway
d. Supraglottic airway (e.g. King LTD)
e. Blind insertion airway device (e.g. Combitube double lumen airway)
4. Suction apparatus (portable and fixed)  
5. Laryngoscope (or a video assisted laryngoscope device)
a. Handle
b. Macintosh blades  
c. Miller blades
d. Extra batteries and bulbs
6. Endotracheal tubes (including stylettes)  
7. Bougie  
8. Nasogastric tubes  
9. Magill forceps  
10. Percutaneous tracheostomy kit  
11. Decompression needle – 14 gauge  
12. End Tidal CO2 detector (PETCO2 detector)  
13. Asherman chest seal Not Required 
14. Portable patient ventilator Not Required 
15. Nebulizer  
16. Chest drain  
17. Haemostatic Gauze  
18. Chest tube tray Not Required 
19. Thoracocentesis tray Not Required 
20. Pericardiocentesis tray Not Required 

Monitoring, Cardiac and Defibrillation

1. Defibrillator  
2. Vital Signs Monitor (BP, Pulse, Respiration, Temperature, SpO 2)  
3. 12-Lead ECG  

Orthopaedic, Trauma and Burns

1. Immobilisation devices
a. Cervical collars
b. Head immobilisation device
 
c. Upper and lower extremity immobilisation devices (e.g. SAM Splint)
d. Lower extremity (femur) traction devices (e.g. Hare traction splint)
e. Finger splint (various sizes)
2. Patient transfer devices
a. Spine Board (with disposable straps)
b. Kendrick Extrication Device (KED)
 
c. SKED stretcher
d. Folding stretcher
e. Wheeled cot
3. Crutches (adjustable, two sizes)  
a. Bandages
 
b. Elastic (ACE) bandages (various sizes)
c. Slings
d. Triangular bandages with safety pins  
e. Shoulder sling
4. Scissors and cutters
a. Trauma shears, or paramedic scissors
b. Ring cutter  
c. Disposable razors
d. Nail clippers

28
5. Burn pack  
6. Sterile burn blanket  
7. Cold packs  
8. Haemostatic solid dressing  
9. Emergency tourniquet (e.g. CAT)  
10. Surgical cautery pen Not Required 

Gynaecological
1. Vaginal speculums  
2. Stirrups  
3. Pelvic light  

Wound Care
1. Wound disinfectants (e.g. Betadine, hydrogen peroxide)  
2. Wound irrigation kit (includes 60 cc Luer-Lock syringe, splash guard, sterile water or saline, waterproof pad)  
3. Wound closure materials
a. Steri-strips
 
b. Dermabond
c. Benzoin
4. Suturing kit
a. Tray
 
b. Artery forceps,
c. Needle holder)
5. Sutures (Nylon, various sizes)  
6. Suture removal kit  
7. Dressings
a. Non-adherent dressings (various sizes)
b. Band Aids (various)
c. Tape (various)
 
d. Self-adherent wrap (e.g. Coban 3M, various sizes)
e. Occlusive dressings (various sizes)
f. Gauze rolls (sterile, various sizes)
g. Adhesive tape (various sizes, hypoallergenic)
8. Alcohol swabs  
9. Incision and drainage kit  
10. Assorted scalpels, blades, razors, etc.  

Examination and Diagnostics

1. Otoscope (with extra batteries, and speculums)  
2. Ophthalmoscope (with extra batteries) Consider 
3. Glucometer (with lancets and strips)  
4. Snellen eye chart Consider 
5. Stethoscope  
6. Sphygmomanometer (adult regular and large)  
7. Reflex hammer  
8. Urine dip sticks  
9. Tongue depressor (tongue blade)  
10. Binocular magnifier (e.g. Optivisor LX)  
11. Magnifying glass  
12. Thermometer (with low temperature capability)  
13. Peak flow meter  
14. Exam light  

Laboratory
1. Point of Care Testing System (e.g. iStat)
a. Cardiac Markers (e.g. cTnl, CK-MB, BNP)
b. Blood gases (e.g. pH, pCO2, HCO3, BE)
Not Required 
c. Haematology (e.g. Hct, Hgb)
d. Chemistry/Electrolytes (e.g. Urea, Creatinine, Glucose)
e. Coagulation (PT, INR)
2. Urinalysis Not Required 
3. Faecal occult blood kit (Haemoccult) Not Required 
4. Specimen cups  
5. Blood sample tubes  
6. Rapid pregnancy test  
 
Radiology
1. Digital Ultrasound Not Required 
2. Digital Plain X-Ray Not Required Consider

ENT
1. Nasal tamponade device (e.g. Rapid Rhino)  
2. 4% Lidocaine  
3. Atomizer  
4. Ear curette  

29
5. Cotton tip applicator  

Eye
1. Eye magnet with loop  
2. Eye patches (hard and soft)  
3. Fluorescein strips  

Personal Protective Equipment, Disinfection and Disposal

1. Non-sterile latex gloves (various sizes)  
2. Sterile gloves (various sizes)  
3. Fluid Shield Mask  
4. N-95 Mask  
5. Goggles  
6. Disposable Gown (large)  
7. Sharps container  
8. Bio-Hazard Tape  
9. Bio-Hazard Trash Bags  
10. Shoe covers  
11. Body bag  
12. Disinfectant hand wash, commercial anti-microbial (towelette, spray, liquid)  
13. Disinfectant solution for cleaning equipment  

Intravenous Therapy
1. Intraosseous infusion system (e.g. EZ-IO) Not Required 
2. IV catheter  
3. IV fluids
4. Crystalloids (e.g. Normal saline, Lactated Ringers, Hartmann’s, Dextrose)  
5. Colloids (e.g. haemaccel, gelafundin)
6. IV tubing  
7. Tourniquet  
8. Syringes (Luer Lock, various sizes)  
9. Needles (various sizes)  
10. Insulin syringes  
11. Alcohol wipes  
12. Pressure bag  
13. IV pole (or roof hook)  
14. IV arm board  

Dental
1. Dental mirror, dental explorer, periodontal probe, retractors  
2. Excavator, plugger, scaler  
3. Dental forceps, elevators  
4. Topical anaesthesia  
5. Temporary filling material  
6. Cyanoacrylate glue  

Medical and Miscellaneous Supplies

1. Flashlights (2) with extra batteries and bulbs  
2. Blankets  
3. Sheets, linen/paper, pillows  
4. Towels  
5. Disposable emesis bags or basins  
6. Disposable bedpan  
7. Disposable urinal  
8. Urinary indwelling catheter  
9. Hospital bed/stretcher  
10. Casualty care charts/forms/recording books  
11. Magnifying glass  
12. Autoclave or sterilizer  
13. Refrigerator  
14. Trauma Bag  

30
Appendix K: Site Clinic Medical Supplies List
The table below lists medications in a typical remote site clinic. Please note that hazards and risks and in different
locations differ significantly. Exact requirements should be based on the site’s health risk assessment (HRA).
Extreme
Remote Site
Medications Remote Site
Clinic
Clinic

Analgesics
1. Co-Codamol Tablets 8/500 Tablets (or Effervescent Tablets)  
2. Codeine phosphate 30 mg tablets  
3. Diclofenac Emulgel (or similar)  
4. Diclofenac Injection 75mg/3ml  
5. Diclofenac Tablets 50mg  
6. Entonox cylinder size D  
7. Ibuprofen, 400 mg tablets  
8. Lemsip Sachets (or similar cold remedy)  
9. Migraveve Pink and Yellow Tablets (or similar otc migraine treatment)  
10. Paracetamol, 500 mg tablets  
11. Tramadol Inj. 100mg/2ml (alternative to Morphine)  
12. Tramadol Tablets 50mg  
13. Voltarol (Diclofenac Sodium) 50 mg suppositories  
14. Morphine Sulfate Injection 10mg/1ml (note: this is a controlled drug)  

Anaesthetic (Local)
1. Citanest 3% Standard - with Octapressin (2.2ml Cartridge) (for Dental use) Not required 
2. Lidocaine 1% Injection (5ml)  
3. Lidocaine Gel 2% (Instillagel)  
4. Lidocaine (Xylocaine) Pump Spray - 10%  

Antibiotic & Antibacterial

1. Amoxycillin 500mg Capsules  
2. Cefixime Tablets 200mg  
3. Ceftriaxone Injection 1G vial  
4. Ciprofloxacin 500mg Tablets  
5. Clarithromycin, 500 mg tablets  
6. Co-Amoxiclav Injection 1.2G  
7. Co-Amoxiclav Tablets 625mg  
8. Crystapen (Benzylpenicillin sodium) 1.2G injection  
9. Doxycycline 100mg capsules  
10. Flucloxacillin Capsules 500mg  
11. Metronidazole 0.5% IV Infusion - 100ml  
12. Metronidazole suppositories 1g Not required 
13. Metronidazole tab. 400 mg tablets  
14. Trimethroprim 200 mg tablets  

Antimalarials
1. Artemether & Lumefantrine 20/120 (Riamet or Co-Artem) Tablets  
2. Quinine Dihydrochloride Injection 600mg/2ml  

Antidotes
1. Carbomix Powder  
2. Flumazenil Injection 500mcg/5ml  
3. HF Antidote gel (where HF is in use)  
4. Konakion (Phytomenadione - Vitamin K1) 10mg/1ml  
5. Naloxone Mini jet 400mcg/ml  
6. Vodka 40% (if Methanol is on site)  

Antihistamine & Anaphylaxis

1. Adrenaline injection 1:1000 BP 1 ml ampoule  
2. Cetirizine Tablets 10mg  
3. Chlorphenamine 4mg tablets  
4. Chlorphenamine Injection 10mg  
5. Hydrocortisone(Solu-Cortef) Injection 100mg  

Cardiovascular
1. Adenosine Injection - 3mg/ml - 2ml vial - Pack of 6  
2. Adrenaline (Epinephrine) 1:10,000 Prefilled Syringe - 10ml  
3. Amiodarone Hydrochloride Injection 300mg - 10ml pre-filled syringe  
4. Amlodipine Tablets 5mg  
5. Aspirin, 75mg dispersible tablets  
6. Atenolol, 50mg tablets  
7. Atropine Sulphate MiniJet 1mg/10ml  
8. Bendroflumethiazide Tablets 2.5mg  
9. Calcium Chloride 10% Injection 10ml  
10. Dalteparin Graduated Syringe 10,000IU/1ml Solution for Injection  
11. Digoxin Injection 0.5mg/2ml ampoule  
12. Digoxin Tablets 250mcg  
13. Furosemide 10 mg in 1 ml inj, 2 ml ampoule  
14. Furosemide 40 mg tablets  
15. Glyceryl trinitrate patches (Transiderm) 5mg  
16. Glyceryl Trinitrate spray 400 mcg per actuation (200 diose)  
17. Isosorbide Dinitrate Tablets 10mg  
18. Lidocaine MiniJet 1% -10ml  

31
19. Magnesium Sulphate 50% MiniJet - 4ml  
20. Ramipril Capsules 5mg  
21. Tenecteplase 10,000 units Injection  

Ear Nose & Throat

1. Cerumol Ear Drops  
2. Otosporin (Antibiotic) Ear Drops  
3. Beclometasone (50mcg/dose) Nasal Spray (Aqueous) 200 dose pack  
4. Karvol Capsules  
5. Naseptin Nasal Cream  
6. Pseudoephedrine Tablets 60mg  
7. Xylometazoline Nasal Spray 0.1%  
8. Bonjela  
9. Cavit  
10. Corsodyl (Chlorhexidine) Mouthwash  
11. Hydrocortisone Muco-adhesive Buccal Tablets 2.5mg  
12. Miconazole Oral Gel  
13. Oil of Cloves  
14. Strepsils Lozenges  

Endocrine
1. Glucogen Hypokit 1mg Injection  
2. Glucogel (Dextrose 40%) Gel  
3. Glucose Minijet 50%w/v (50ml)  
4. Hydocortistab Injection 25mg/1ml vial Not required 
5. Humulin S Insulin 100IU/ml 10ml vial  
6. Prednisolone EC 5 mg tablets  

Gastrointestinal system
1. Anusol Ointment  
2. Anusol Suppositories  
3. Buccastem (Prochlorperazine maleate) 3 mg tablets  
4. Cinnarizine Tablets 15mg - Pack of 100  
5. Gaviscon Liquid  
6. Glycerin (Glycerol) Suppositories 4g  
7. Hyoscine butylbromide (Buscopan) Tablets 10mg  
8. Hyoscine N-Butylbromide Injection 20mg/1ml ampoule  
9. Kwells (Hyoscine hydrobromide, 0.3 mg) tablets  
10. Lactulose Syrup  
11. Loperamide Capsules 2mg  
12. Maalox Oral Suspension  
13. Maalox Plus Tablets  
14. Mebendazole (Vermox) 100 mg tablets  
15. Mebeverine Tablets 135mg  
16. Metoclopramide Injection 10mg/2ml  
17. Metoclopramide Tablets10mg  
18. Movicol sachets Not required 
19. Omeprazole Capsules 20mg  
20. Prochlorperazine(Stemetil) Injection 12.5% 1ml  
21. Proctosedyl Ointment Not required 
22. Proctosedyl Suppositories Not required 
23. Senokot Tablets  
24. Sodium Chloride + Dextrose Rehydration Salts (Multi Flavour) -  
25. Sodium Citrate (Microlax) Enema (rectal) Not required 

Immunisations
1. Hepatitis B Vaccine Syringe Pack  
2. Rabies Vaccine (Rabipur) 1ml  
3. Ads Diphtheria [low dose], Tetanus and Poliomyelitis (Inactivated) Vaccine  
4. Tetanus Immunoglobulin Injection 250 Unut  
5. Injections (Miscellaneous)  
6. Heparin sodium 10 units/ml - Ampoules - 5ml  
7. Sodium Chloride Injection 09% Ampoules – 10ml  
8. Water for Injections BP 5ml  

IV Fluids
1. Gelofusine  
2. Glucose 5% infusion  
3. Hartmanns Solution  
4. Mannitol IV Infusion 20%  
5. Sodium Chloride 0.9% infusion  

Nervous system
1. Chlorpromazine HCl 25 mg tablets  
2. Diazemuls (Diazepam) Injection 10mg/2ml  
3. Diazepam rectal tubes, 10 mg in 2.5 ml  
4. Diazepam Tablets 5mg  
5. Haloperidol Injection 5mg/1ml ampoule - Pack of 5  
6. Procyclidine Injection 10mg/2ml ampoule - Pack of 5  
7. Zopiclone Tablets 7.5mg  

Ophthalmic
1. Aciclovir Eye Ointment 3% -  
2. Chloramphenicol eye ointment 1%  
3. Dexamethasone Sodium Phosphate (Minims) eye drops 0.1%  

32
4. Flourescein sodium (Minims), 1% eye drops  
5. Fusidic Acid Eye Drops 1%  
6. Genticin Eye/Ear Drops 0.3%  
7. Hypromellose Eye Drops  
8. Emergency Eyewash (Sodium Chloride 0.9%)  
9. Optrex Eye Lotion, 300 ml with eye bath  
10. Pilocarpine Nitrate (Minims) eye drops 2%  
11. Sodium Cromoglycate Eye Drops 2%  
12. Tetracaine (Amethocaine) hydrochloride (Minims) eye drops 0.5%  
13. Tropicamide Eye Drops (Minims) 0.5% - Pack of 20  

Respiratory
1. Beclometasone (CFC Free) Inhaler 200 mcg/metered dose - 200 dose  
2. Benylin (Non-Drowsy) Chesty Cough  
3. Benylin (Non-Drowsy) Dry Cough  
4. Ipratropium Bromide Inhaler CFC Free 20mcg actuation - 200 dose  
5. Ipratropium Bromide Nebules - 250mcg/ml  
6. Oxygen - see equipment section  
7. Salbutamol inhaler 100 microgram/metered dose - 200 dose  
8. Salbutamol Injection 500mcg/1ml ampoule - Pack of 5 Not required 
9. Salbutamol Nebules 5mg  
10. Spacer (Aerochamber) Device Std  

Dermatology
1. Aciclovir Cold Sore Cream  
2. Aciclovir Tablets 800mg (Shingles Pack)  
3. Betamethasone (Betnovate) Cream Not required 
4. Calamine Lotion BP  
5. Cetavlex (Antiseptic) Cream  
6. Daktarin (Miconazole nitrate), 2% Cream  
7. Deep Heat Rub  
8. Delph Sun Cream SPF30 Not required 
9. Delph Sun Cream SPF30 pump dispenser Not required 
10. E45 Cream  
11. E45 Cream  
12. Eurax Cream  
13. Flamazine (Silver Sulphadiazine) 1% Cream  
14. Fucidin cream  
15. Hydrocortisone Cream 1%  
16. Hydrocortisone Ointment 1% - 15g  
17. Hydrogen Peroxide 6%  
18. Lyclear (Permethrin) Cream Rinse  
19. Lypsyl (Original) - Pack of 36  
20. Magnesium Sulphate Paste  
21. Mycota Cream  
22. Mycota Foot Powder  
23. Permethrin Dermal Cream 5%  
24. Sudocrem (Replaces Zinc Ointment)  
25. White Soft Paraffin  

Solutions & Ingredients

1. Clinell Hand and Surface Sanitiser  
2. Hibiscrub  
3. Sodium Chloride 0.9% (Normasol) Sterile Sachets 25ml  
4. Tisept (Chlorhexidiene & Cetrimide) Sterile Sachets 25ml  
5. Videne (Povidone Iodine) Antiseptic Solution 10%  

Gynaecology***
1. Clotrimazole (Canesten) 500mg Pessary  
2. Clotrimazole Cream 1%  
3. Fluconazole Capsule 150mg  
4. Levonorgestrel (Levonelle) Tablet 1500mcg  
5. Mefenamic Acid Capsules 250mg  
6. Syntometrine (Ergometrine maleate, Oxytocin ) Inj. 1ml  
7. Tranexamic Acid Injection 100mg/ml - 5ml ampoule Not required 
8. Tranexamic Acid Tablets 500mg Not required 

Post Exposure Prophylaxis***

1. Kaletra (200mg Lopinavir and 50mg Ritoavir) Tablets  
2. Truvada (emtricitabine 200mg, tenofovir disoproxil 245mg) Tablets  

Anaesthesia***
1. Hypnomindate Injection - 20mg/10ml Not required 
2. Ketamine Injection - 10mg/ml (20ml vial) Not required 
3. Ketamine Injection - 50mg/ml (10ml vial) Not required 
4. Propofol Injection - 1% (20ml) Not required 
5. Propofol Injection - 2% (50ml) Not required 
6. Thiopental Injection - 500mg Not required 
7. Lidocaine (Xylocaine) Pump Spray - 10%  
8. Neostigmine with glycopyrronium - 500mcg/ml in 1ml amps Not required 
9. Suxamethonium - 100mg/2ml Not required 
10. Pancuronium - 2mg/ml in 4ml amps Not required 
11. Rocuronium - 100mg/10ml Not required 
12. Alfentanil Hydrochloride Injection 500mcq/mL - 10ml ampoule Not required 
13. Alfentanil Hydrochloride Injection 500mcq/mL - 2ml ampoule Not required 

33
14. Fentanyl Citrate Injection 100mcg/2ml Not required 
15. Morphine Sulphate Injection - 10mg/1ml  
16. Midazolam Injection - 10mg/5ml  
17. Flumazenil Injection 500mcg/5ml  
18. Naloxone Hydrochloride Injection 400mcg/1ml ampoule  

Specific Antidotes***
1. Calcium disodium EDTA (Versenate™) (for lead, copper, zinc, cobalt, or cadmium toxicity)  
2. Calcium gluconate 10% (for hydrofluoric acid exposure)  
3. Dimercaprol / BAL (for arsenic, lead, or mercury toxicity)  
4. Hydroxocobalamin (Cyanokit™) (for cyanide, acrilynitrile, or HCN exposure)  
5. Methylene blue 1% (for methaemoglobinemia from organic nitros and organic amines exposure)  
6. Naloxone Hydrochloride Injection 400mcg/1ml ampoule  

34
Appendix L: Medical Equipment and Supplies Equipment for Specific Hazard or Specific Extreme
Environment
The typical equipment for locations with specific hazards or specific extreme environment is listed below. Please note that
hazards and risks and in different locations differ significantly. Exact requirements should be based on the site’s health
risk assessment (HRA). As with other workplaces, medical devices should only be used by qualified site medical
professionals.
Extreme
Remote
Equipment for Specific Hazard or Specific Extreme Environment Remote
Site Clinic
Site Clinic

Mass Casualty
1. Triage tags, tent and flag kit  
2. Body bags  
3. Foldable stretchers  

Heat
1. Cooling fans  
2. Cooling area  
3. Ice maker  
4. Ice packs  
5. Rectal thermometer  

Cold
1. Core body warming devices  
2. Peripheral body warming devices  
3. Rectal thermometer  

Altitude
1. Medications for altitude sickness (acetazolamide, dexamethasone, nifedipine)  
2. Point of care testing for blood gases  
3. Oxygen and oxygen delivery device  

Diving
1. Point of care testing for blood gases  
2. Oxygen and delivery device (including a demand-valve regulator, and a non-rebreather mask)  
3. Hyperbaric-safe vital signs monitor equipment (BP, Pulse, Resp, SpO2)  
4. Hyperbaric ventilator (e.g. Siare IPER) Not Required 
5. Hyperbaric syringe pump (e.g. Pilote Hyperbaric) Not Required 
6. Heimlich valve (for chest tube)  

Drug and Alcohol7

1. Point of collection test kits for Drug testing  
2. Breath alcohol testing kit, or breathalyser  

7
Drug and alcohol testing must only be done within the scope of the company’s drug and alcohol policy, and the local legislation. Use
established testing protocols, and under the oversight of a qualified Medical Review Officer.

35
Appendix M: Health Promotion Program Components

Component Sub-component
Diet • Making delicious healthy food available in an attractive way.
• Portion sizing strategies (smaller portions by default).
• Making nutritional information visible for individual food.
Exercise • Physical activity program.
• Team competitions.
• Training and specialist input for the site exercise program.
Health Education • Delivering health education either via face to face talks/discussions, or via electronic
media, or posters. Focus on either cardiovascular risk, or any site-specific risk.
Monitoring Progress • Monitoring of health parameters (e.g. weight, steps, physical activity, sleep patterns,
calorie intake, smoking, etc) using a computer program or by Medics at the site clinic
Quit smoking • Education.
• Counselling (either via telephone, video conference or face to face by the medic).
• Nicotine replacement products.
Resilience See https://eu001-sp.shell.com/sites/AAAAA3024/Resilience/whatis.aspx

36
Appendix N: Sample Contract Clauses

Standard Clauses
The following are standard clauses for Contracts where Medical Emergency Response is identified as a risk in the
contracted activity.

 The CONTRACTOR will establish and maintain Medical Emergency Response

 The CONTRACTOR will provide:
o first aid treatment, including defibrillation, by a Designated First Aider within four minutes;
o assessment and stabilisation by a medical Emergency professional within one hour;
o admission to and care at the nearest Local Hospital within four hours; and
o referral to an appropriate Specialist Hospital (casualty specific).
 Where response times or requirements above cannot be met, the CONTRACTOR will:
o perform a Risk Assessment,
o provide medical Emergency Response Risk mitigation measures, and
o demonstrate that the Risks are As Low As Reasonably As Low As Reasonably Practicable.

Supplementary Clauses
For Remote Locations, any of the following clauses can be considered. Discuss with your Health focal point.

 The CONTRACTOR will establish health provisions as outlined by Shell Remote Healthcare Guide (Document
Number) for <Remote/Extreme Remote> Locations.
 The CONTRACTOR will
o establish a Medical Emergency Response Plan,
o put in place MER resources, and
o conduct MER drills, as outlined by as outlined by Shell Remote Healthcare Guide for <Remote/Extreme
Remote> Locations.
 The CONTRACTOR will verify that the Competency of the Remote Healthcare Practitioner meets the requirements of
Shell Remote Healthcare Guide for <Remote/Extreme Remote> Locations.
 The CONTRACTOR will implement Remote Medical Support (Topside) as outlined by Shell Remote Healthcare
Guide for <Remote/Extreme Remote> Locations.
 The CONTRACTOR will implement Telemedicine as outlined by Shell Remote Healthcare Guide for
<Remote/Extreme Remote> Locations.
 The CONTRACTOR will equip and supply the Site Clinic as outlined by Shell Remote Healthcare Guide for
<Remote/Extreme Remote> Locations.
 The CONTRACTOR will implement Fitness to Work (FTW) as outlined by Shell Remote Healthcare Guide for
<Remote/Extreme Remote> Locations.
 The CONTRACTOR will implement a Workplace Health Promotion Program as outlined by Shell Remote
Healthcare Guide for <Remote/Extreme Remote> Locations.
 The CONTRACTOR will implement a Food and Drinking Water Safety program as outlined by Shell Remote
Healthcare Guide for <Remote/Extreme Remote> Locations.

37
Appendix O: Remote Healthcare Components for Various Oil and Gas Activities

Remote Locations Extreme Remote Locations Special Situations

Remote Production Facilities8 and Seismic and Drilling Campaigns10 Marine Operations Shell Aircraft Social Investment Projects
Remote Seismic/Drilling campaigns9 (e.g. STASCO)
Medical capability • Able to support emergency cases for up to 12 • Able to support emergency cases for up to • Able to support emergency • Able to support emergency • Able to provide scheduled, non-
expectation hours on-site before medevac. 72 hours on-site before medevac. cases for up to 72 hours cases for up to 4 hours emergency, primary healthcare on-
• Able to provide on-demand non- onboard before shore onboard before landing, site (e.g. antenatal clinics,
emergency, primary healthcare on-site transfer, without a RHCP. without a RHCP. management of chronic illnesses).
(e.g. management of chronic illnesses).
On Site RHCP Medic Physician None None Visiting Medic
Competence • Professional Training • Professional Training Ship Captain’s advanced first Aircrew first aid training Variable
• RHCP Training • RHCP Training aider, as you say typically the
master or first officer as
outlined in the IMO STCW
1995 convention. Repeated
every 3 years.
Medical Equipment Standard RL Equipment and Supplies List As per Appendix J, include portable patient Statutory. Basic First Aid equipment and Variable
and Supplies ventilator, Point of Care Testing System (e.g. supplies, as per CAA/EASA
iStat), and digital ultrasound. recommendations. (e.g. as
supplied with Tempus IC)
Topside Support Yes Yes Yes Yes Yes
Telemedicine • 2-way voice • Clinic-based telemedicine equipment • Tempus PRO, used in • Tempus IC • VSee box
• Secure email (with attachment) based on Windows PC and Cisco codec conjunction with VSee • May require satellite communications
(e.g. Cisco, AMD, Viju). video teleconferencing equipment.
software on a PC/iPad.
Alternative 1: Alternative: Alternative:
• Tempus PRO, or • Tempus PRO, used in conjunction with • Clinic-based telemedicine equipment
• Tempus PRO, used in conjunction with VSee VSee video teleconferencing software on a based on Windows PC and Cisco
software on a PC/iPad PC/iPad. codec (e.g. Cisco, AMD).
Alternative 2:
• Clinic-based telemedicine equipment based on
Windows PC and Cisco codec (e.g. Cisco,
AMD, Viju).
Fitness to Work Shell Remote Location Work protocol (based on  RHCP to review FTW certificates and Seafarer’s medical Aviation medicals (for crew NA
OGUK) medical notes prior to mobilisation. examination only) as per CAA/EASA
 Consider modifying OGUK protocol and
standards.
Food and Drinking Implement HACCP Implement HACCP Implement HACCP NA NA
Water Safety

8
Includes offshore and land based facilities
9
Includes offshore and land based campaigns
10
Includes offshore and land based campaigns

38