THE E& P FORU M

HEA LTH M A N A GEM EN T GU ID ELIN ES

FOR REM OTE LA N D -BA SED
GEOPHY SICA L OPERATION S
Report N o. 6 .3 0 /1 9 0
A pril 1 9 9 3
 E&P Forum
Health M anagement Guidelines for
Remote Land-Based Geophysical Operations
Report No. 6.30/190
April 1993

E&P Forum, 25–28 Old Burlington Street, London W1X 1LB

Telephone: (0)71–437 6291 Fax: (0)71–434 3721

This report has been prepared for the E & P Forum by their Committee on
Authors
Safety, Health and Personnel Competence through its Remote Seismic
Health Issues Task Force.

Dr D. Daw son Unocal, Chairman

M r S.W. Barber BP
Dr J. Keech BP
The late Dr B. Ballantine British Gas
M r H. Ranke SIPM
Dr G. de Jong SIPM
M r H. Hansen Geco Prakla/IAGC
Dr J. Rodier Elf
M r M . Stormonth Halliburton Geophysical/IAGC
M r J. How ell Western Geophysical/IAGC
M r. R. Low e Western Geophysical/IAGC
Dr A. Barbey Schlumberger
Dr D. A. Clyde Conoco
Dr C. Roythorne formerly BHP
M r J. Pion Total
Col. K. P. Walker Executive M edical Centre/IAGC
M r J. E. Striefel Amoco

The Oil Industry International Exploration and Production Forum (E&P

The E&P Forum
Forum) is the international association of oil companies and petroleum
industry organisations formed in 1974. It w as established to represent its
members’ interests at the International M aritime Organisation and other
specialist agencies of t he Unit ed Nat ions, governm ent al and ot her
int ernat ional bodies concerned w it h regulat ing t he explorat ion and
production of oil and gas. While maintaining this activity, the Forum now
concerns it self w it h all aspect s of E& P operat ions, w it h part icular
emphasis on safety of personnel and protection of the environment, and
seeks to establish industry positions w ith regard to such matters.
At present the Forum has 52 members made up of 37 oil companies
and 15 national oil industry associations, operating in 52 different countries.
The w ork of the Forum covers:
● monitoring the activities of relevant global and regional international
organisations;
● developing industry positions on issues; and
● disseminating information on good practice through the development
of industry guidelines, codes of practice, check lists etc.

W hilst every ef f ort has been m ade t o ensure t he accuracy of t he

Disclaimer
information contained in this publication, neither E&P Forum nor any of its
members w ill assume liability for any use made thereof.

Acknow ledgments Design and lay-out: Words and Publications, Oxford

 HEA LTH M A N A GEM EN T GU ID ELIN ES FOR
REM OTE LA N D -BA SED GEOPHY SICA L OPERATION S

IN TROD U CTION 2
CONTENTS
HEA LTH RISK M A N A GEM EN T 3
Risk Identification and Control of Environmental
and Occupational Health Risks 3
Camp Standards 3
Hazardous animals & plants 4
Local diseases 4
Life style habits 4
M edical fitness 4
Sexually transmitted diseases 4
Work and w ork environment 4
Clinical w aste 5

Evaluation of existing Local and International

M edical Support Systems 5
Local M edical Support 5
International M edical Support 5

Provision of Health Care in the area

of the Crew ’s operation 6
Risk Scoring System 6
M odular System of Health Care 6
Equipment 9

HEA LTH M A N A GEM EN T SY STEM 10

Policy and Objectives 11
Organisation, Responsibilities and Resources 11
Standards and Procedures 11
Planning and Implementation 12
Performance M onitoring 12
Audit 13
M anagement Review 13

A PPEN D ICES 14
1. Fitness Guidelines 14
2. M edical and First Aid Equipment 21
3. Immunisation Guidelines 23
 HEALTH M ANAGEM ENT GUIDELINES FOR REM OTE LAND-BASED GEOPHYSICAL OPERATIONS

INTRODUCTION
A set of guidelines on health risk management for remote land-based and
transition zone geophysical operations has been prepared for member
companies. These guidelines are in support of the E & P Forum Safety
Schedules, IAGC Land Geophysical Operations Safety M anual, and associ-
ated training guidelines. They specifically cover situations w here there is
no immediate access to adequate medical facilities, either by direct com-
munication or access in terms of distance and time.

Company and contractor have a joint commitment to health risk manage-

ment stated in health policies and should develop a health management
system w hich needs to be based on a full and careful appraisal of the
health risks to w hich personnel w ill be exposed.

Prior to the start of operations and preferably as part of the reconnais-

sance/field survey activity, a full assessment of health risks and available
medical support infrastructure in the area of operation should be per-
formed. The assessment may be undertaken by either Company and/or
Contractor as deemed appropriate, but the Company must retain respon-
sibility for ensuring that an adequate assessment of health risks is carried
out and that appropriate control measures and medical support are put in
place. There should be a frank exchange of available health risk and medi-
cal support information during the bid process and foreseeable require-
ments should be specified in the contract.

The section on Health Risk M anagement describes the identification,

assessment and control of health risks associated w ith the w ork environ-
ment and w ork activities, as w ell as the evaluation of local medical sup-
port infrastructure. Detailed guidelines on medical fitness, equipment
requirements and immunizations are provided in Appendices.

The Health M anagement Systems section provides a description of a

management system to ensure that control measures are put in place and
maintained, and that performance is being monitored w ith the aim of con-
tinuous improvement.

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 HEALTH RISK M ANAGEM ENT

HEALTH RISK M ANAGEM ENT

A thorough and comprehensive hazard identification and risk assessment
should be perform ed at the earliest opportunity by Com pany and/or
Contractor, assisted by designated medically qualified personnel, and
other appropriate personnel.

The identification and assessment should cover an assessment of all

environmental and occupational health risks, an evaluation of existing local
and international medical support systems, and the determination of the
need for and type of medical support in the field.

Company and Contractor management should ensure that appropriate

control and preventive measures are provided and maintained. The sup-
port of Company and/or Contractor medical personnel and other appropri-
ate personnel w ill be required for guidance and compliance in achieving
these objectives. The Company must retain responsibility for ensuring
these measures are provided and maintained. An appropriate health risk
management system can then be set in place.

This section is divided into three parts. The first part lists the various envir-
onmental and occupational health risks requiring careful assessment.
Indications for control measures are given.

The second part describes the evaluation of existing local and international
medical support systems.

The assessment of health risks, together w ith the evaluation of local and
international medical support systems, w ill identify the level of medical
support to be provided in the area of the crew ’s operations as described in
the final part of this section.

Opposite each risk in the follow ing listings are the control and preventive
measures required to be set in place. Each of these measures should Risk Identification and Control of
receive detailed attention (see ‘Planning and Implementation’ in the next Environmental and Occupational Health Risks
section). The IAGC Land Geophysical Operations Safety M anual and con-
tractors HSE M anual are useful guides for providing the standards and
practical implementation of these measures.

Risk Identification Control M easures and Prevention

● Cam p standards
Food & drink
General camp hygiene
Training of food handlers and
medical surveillance;
Foodhandlers’ clothing;
Standards for food supplies, storage,
preparation and cooking;
Drinking w ater standards;
Immunizations (see Appendix 3).
Standards for:
living quarters;
toilet facilities;
w ashing facilities;
lighting/ventilation/temperature control;
sew age, w ater and rubbish disposal.

continued …

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 HEALTH M ANAGEM ENT GUIDELINES FOR REM OTE LAND-BASED GEOPHYSICAL OPERATIONS
Risk Identification
● Hazardous anim als and plants
Insects
Animal bites
Plants
● Local diseases
Local diseases
● Life style habits
Life Style Habits
● M edical fitness
M edical Fitness
● Sexually transm itted diseases
Sexually Transmitted
Diseases
● Work and w ork environm ent
Chemical and physical
exposure (hazardous
chemicals, noise, ionising
radiation, vibration)
Heat/sun/cold/altitude
Immersion/diving
Stress/fatigue/w ork cycles
4
Control M easures and Prevention (continued)
Camp location and construction standards;
Eradication of breeding grounds as far as
possible;
Fogging, sprays, insect repellent;
Suitable clothing and mosquito nets;
Permethrin impregnated cloths and nets;
Chemoprophylaxis.
Education;
Suitable clothing;
Camp location and construction standards.
Education;
Suitable clothing.
Surveillance;
Education;
Immunization & chemoprophylaxis
(see Appendix 3).
Education;
Implementation of Substance Abuse
M anagement Strategies (see E & P Forum
Report 6.23/173).
Education and health promotion;
Pre-assignment and periodic health
assessments (depending on job content,
identified health risks, and subject to
national regulations);
Health assessment and post assignment
assessment follow ing significant health
problems. See ‘Fitness guidelines’ (Appendix 1).
Education;
Condoms.
Technical and procedural control measures;
Personal protective equipment;
Education and training.
Education/clothing/acclimatization;
Work procedures.
Specialised support systems.
Equipment standards, ergonomics,
conditions of w ork;
Physical fitness; Education;
Recreation; Acclimatization;
Sleeping conditions.
 HEALTH RISK M ANAGEM ENT

Risk Identification Control M easures and Prevention (continued)

● Work and w ork environm ent (continued)

Transportation/
driving accidents See Forum Health & Safety Schedules.

Personal hygiene Education;

Camp standards.

● Clinical w aste
Clinical w aste Procedures for disposal of contaminated
clinical materials and equipment.

Before start-up of the operation, a thorough evaluation must be undertak-

en of existing local and international support systems. Company and Evaluation of Existing Local and International
Contractor should jointly review means of casualty evacuation. The provi- M edical Support Systems
sion of medical support and evacuation may be undertaken by either
Company or Contractor, but it is the responsibility of the Company to
ensure that appropriate medical support and means of evacuation is avail-
able to the crew .

If utilization of the existing medical facilities is to be made, the measures

out lined under ‘ Local M edical Support ’ (below ) m ay be provided by
Company or Contractor.

Evaluation/assessm ent Upgrade standards

● Local m edical support

The follow ing aspects require careful evaluation:
Qualifications and Training of local medical staff
experience of local
health professionals

Range and quality of Contribution of equipment and/or

equipment and supplies, supplies as required
including medicines and
emergency equipment

Construction and Improve construction and hygiene

hygiene standards of standards, w here practicable
medical facilities

M edical and hospital Agreement on procedures for inpatient

administration procedures and outpatient treatment
and standards

Transportation/ Provision of ow n transportation

Communication (ambulance) and communication

● International m edical support

International medical support and evacuation systems in the country
of operations need to be evaluated and improved if they are found to
be unsatisfactory.
Logistics International M edivac access
Communication or membership;
Availability Authorisation and implementation
procedures to be fully understood.

5
 HEALTH M ANAGEM ENT GUIDELINES FOR REM OTE LAND-BASED GEOPHYSICAL OPERATIONS

Company and Contractor should w ork together to ensure proper provision

Provision of Health Care in the
of health care in the area of the crew ’s operation. The level and extent of
Area of The Crew ’s Operation
in-field health care facilities and personnel w ill be determined by risk scor-
ing of the follow ing tw o key aspects:
■ the assessment of environmental and occupational health risks in the
area of operations (see Risk Identification and Control of Environmental
and Occupational Health Risks);
■ quality, availability and accessibility of local medical support system.
(see Evaluation of Existing Local and International M edical Support
Systems).

The initial risk assessment and scoring of the risks as outlined below w ill
be the responsibility of the Com pany and should be supplied to the
Contractor at the bid stage. Prior to the start of operations Company and
Contractor should mutually agree on the risk assessment scoring.

● Risk Scoring System

The result of the environmental and occupational health risk assessment

should be m arked LOW , M EDIUM , HIGH. The evaluat ion of t he
quality/accessibility/availability of local medical support system should be
marked GOOD, FAIR, POOR.

HEA LTH RISK A SSESSM EN T

Risk Scoring Syst em

EN V IRON M EN TA L A N D
OCCU PATION A L HEA LTH RISKS
LOW M EDIUM HIGH
(1) (2) (3)

GOOD (1) 2 3 4
LOCA L
M ED ICA L FAIR (2) 3 4 5
SU PPORT
POOR (3) 4 5 6

The total score of the risk assessment can be derived from the above
matrix as follow s:

Low Risk 2–3

M edium Risk 4
High Risk 5–6

Follow ing the scoring of the risks as outlined above, the level and the
extent of the required qualified personnel in the field can be determined
as described in Figure 1. The qualifications are described in the follow ing
section.

● M odular System of Health Care

Levels of health care starting w ith a basic understanding of w hat to do

w ith an accident (M odule 0 for all personnel) to a supervising doctor
(M odule 5), are described on the follow ing pages.

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 HEALTH RISK M ANAGEM ENT

FIGU RE 1 : Recom m ended N um ber of Trained Healt h Personnel

on Seism ic Crew s
(Based on: Risk Assessment & Size of Crew s on site at any time)

M odules 1–2
Each w ork unit is described as a group of people under one LEV EL OF RISK A SSESM EN T SCORE
supervisor geographically isolated but w orking together. TRA IN IN G (see Risk Scoring System on previous page)
They should have contact w ith each other and a M odule 1
person should be available w ithin 4 minutes of any person M ODULE LOW M EDIUM HIGH
CREW SIZE
in the unit. Each unit should have one or tw o M odule 1
persons and one M odule 2 person. The latter should be 3 0–1 2–3 2–4
SM ALL
available w ithin 20 minutes of smaller groups. 4 1* 1*
(up to 200)
5
M odules 3–5
3 1–2 3–4 3–4
The table on the right show s the additional qualified staff M EDIUM
required depending on crew size. 4 1* 1–2* *
(200–500)
5
The provision of a modular system allow s for an adaptable 3 2–4 4–6 4–6
answ er to a specific risk assessment. Should M odule 4 or 5 LARGE
4 1* 1–2* * 2–4* *
persons and/or equipment be deemed necessary, then this (above 500)
5 0–1 1
should be included in the tender document as a separate
cost it em . W here necessary, t he provision by t he * If the position is filled by a nurse, this person should
Contractor of an appropriate medical evacuation service report to a M odule 5 doctor.
should also be included as a separate cost item in the * * There should be a minimum of one doctor in this
contract documentation. situation.

● Description of M odules

M odules 0–3: Non-professional personnel (personnel trained in first aid

procedures)

M odule 4: In-field doctor or nurse

M odule 5: Doctor

Overall staffing levels for different risk situations are show n in Figure 1,
above.

Training requirements and professional standards for each M odule are pro-
vided below :

■ M odule 0
All staff.
The induction training given to all personnel by local contractor staff
should include instruction on camp hygiene as w ell as w hat to do and
w ho to contact in the event of an injury.

■ M odule 1
Personnel trained in Basic Lifesaving Action. viz:
Cardio-Pulmonary Resuscitation (CPR) and the control of external bleeding;
Training should be given by a competent First Aid Instructor to remote
team leaders, deputies and could be offered to other personnel.
continued …

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 HEALTH M ANAGEM ENT GUIDELINES FOR REM OTE LAND-BASED GEOPHYSICAL OPERATIONS

■ M odule 2
First aiders. Training requirements:
First Aid Course. The course should be of adequate length to properly
cover the follow ing curriculum:
● resuscitation;
● control of bleeding;
● management of the unconscious patient;
● treatment of shock;
● treatment of hypothermia and heat stroke;
● treatment of immersion;
● treatment of injuries;
● treatment of burns and scalds and inhalation of hot gases and fumes;
● personal hygiene in dealing w ith w ounds;
● dressing and immobilisation of injured parts; and
● description and use of M odule 2 first aid kit.

Training should be by certified First Aid Instructor and refreshed at

regular intervals.

Recommended levels of staffing, see Figure 1 for guidance.

■ M odule 3
Personnel trained in Advanced First Aid.
An Advanced First Aider first aid course to include additional training to
a M odule 2 person, such as food hygiene, and administration of certain
drugs under supervision.

Recommended levels of staffing, see Figure 1 for guidance.

Training should be by certified instructors in the relevant disciplines

and should be refreshed at regular intervals.

■ M odule 4
This position can be held by a registered doctor or qualified nurse w ho
is familiar w ith M odules 1 to 3 and fulfils the follow ing stipulations:

Doctor: Preferably at least 5 years postgraduate experience required.

Should never be new ly qualified. M ust have experience in accident
and emergency, tropical medicine and occupational health. The doctor
should have good administrative and communication skills, and be
familiar w ith all available medical facilities adjacent to the operating
area that could be used for medical referral. The doctor’s qualification
and experience should be professionally assessed.

Nurse (Certified registered nurse): Should preferably have had previous

experience in isolated situations w orking single handed. Should have
had recent practical refresher training to include accident and emer-
gency. Should have direct reporting and accessibility to module 4 or 5
doctor. The nurse’s qualifications and experience should be profes-
sionally assessed.

For staffing levels refer to Figure 1 for guidance.

8
 HEALTH RISK M ANAGEM ENT

■ M odule 5
M edical adviser w ho must be familiar w ith all aspects of M odules 1 to
4, have good accident and emergency experience, have an understand-
ing of occupational health and a know ledge of specific diseases local to
the operating area. The doctor should have good administrative and
communication skills, and be familiar w ith all available medical facilities
adjacent to the operating area that could be used for medical referral.
The doctor w ould be the medical coordinator and professional supervi-
sor of that country or area, and be responsible for treatment proce-
dures and any prophylactic measures required for local staff.

The doctor could be full-time or part-time as necessary, and could be

employed either by Company or Contractor.

If three or more M odule 4 persons are utilized, then one M odule 5 doc-
tor w ould be required.

● Equipm ent
It is the responsibility of Contractor local management, w ith guidance from
the relevant medical personnel, to ensure the necessary equipment is in
place, and that it is kept clean and w here appropriate in a sterile condition.
The supply of the appropriate medical equipment as defined in these
guidelines is the responsibility of the Contractor and should be included in
the contract document.

The equipment listed in Appendix 2 should be available for each modular

trained individual.

Sufficient number of kits should be provided for all M odule 1 and 2 persons
to have immediate access. A number 3 M odule person should have reason-
able access to M odule 3 equipment. It is the responsibility of the module
individuals through their line management to ensure kits are kept secure
and up-to-date, and that storage facilities are suitable for the contents.

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 HEALTH M ANAGEM ENT GUIDELINES FOR REM OTE LAND-BASED GEOPHYSICAL OPERATIONS

HEALTH M ANAGEM ENT SYSTEM

The follow ing sections of these guidelines w ill assist companies in devel-
oping a health management system for geophysical operations, w ith the
m ain object ives t o ensure t hat t he act ivit ies of t he Com pany and
Contractor are planned, carried out, controlled and directed so that health
risks are minimised.

A model health management system based on international quality man-

agement practice (e.g. ISO 9000 standards) is illustrated in Figure 2. The
model contains the essential elements required to effectively manage
health matters. The system should comply w ith the national or internation-
al legal framew ork and take into account the corporate health guidelines
w ithin w hich the Company and Contractor conduct their business.

FIGU RE 2 :
Healt h M anagem ent Syst em

POLICY AND
OBJECTIVES

ORGANIZATION,
RESPONSIBILITIES IM PROVEM ENT
AND RESOURCES PROCESS

STANDARDS AND
PROCEDURES CORRECTION

PLANNING AND
IM PLEM ENTATION CONTROL

PERFORM ANCE
M ONITORING

AUDIT
COM PLIANCE

M ANAGEM ENT
REVIEW

10
 HEALTH M ANAGEM ENT SYSTEM

The key functions of a successful health management system can be

classified into three broad areas. These are:
● formulating policy and developing the organisation, w hich includes
identifying health objectives and review ing progress tow ards their
achievement;
● planning, implementing and auditing of health activities and
standards;
● performance measurement and reporting.

Both Company and Contractor should formulate local health policies.

Policy and Objectives
The policy should be:
● Simple, concise and easily understood (translated into local language);
● Communicated to all w orkers;
● Review ed regularly.

A list of objectives under the policy should be prepared to suit the local
environment, e.g:
● To ensure clean and safe w ater;
● To have a M edical Emergency Evacuation Plan.

● An overall management structure and its relation to the

Organisation, Responsibilities and Resources
implementation of health aspects w ithin the organisation must be
available to employees;
● Each employee must have responsibility for their ow n and their
colleagues’ health and must be made aw are of their specific role and
responsibilities for health;
● Health protection is a line responsibility w ith medical/occupational
health advisers assisting line management in the development and
implementation of the programme.

At least the follow ing should be in place:

● Roles defined;
● Resources allocated;
● M eans of achieving objectives specified;
● Performances monitored;
● Specific tasks targets and procedures defined;
● Compliance checked;
● Health reporting to management.

Health standards and procedures are set by corporate policies, legal

Standards and Procedures
requirements, the E & P Forum Health and Safety Schedules for Land
and M arine Geophysical Operations, the IAGC Safety M anuals and this
document.

The standards can be divided into four groups:

● M anagem ent Standards:
M anagement sets the framew ork in w hich companies operate and
deal w ith corporate policies, objectives, accountabilities and controls.
● Equipm ent/m aterial/personnel standards:
To be determined by management in conjunction w ith the M odule 4 or
5 person (see Fig. 1).
● Working M ethod Standards:
To review the w ay in w hich day-to-day activities w ith respect to health
and hygiene w ill be carried out, monitored and verified. Responsibility
of management in conjunction w ith M odule 3, 4 or 5 person.

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 HEALTH M ANAGEM ENT GUIDELINES FOR REM OTE LAND-BASED GEOPHYSICAL OPERATIONS

● Com petence Standards:

To describe the competencies needed to fulfil the respective role in a
health management system and how competence is assessed. See
M odular System of Health Care, in previous section.

Prior to the start of operations and preferably as part of the reconnais-

Planning and Implementation
sance/field survey activity, a full assessment of health risks and available
medical support infrastructure in the area of operation should be per-
f orm ed. The assessm ent m ay be undert aken by eit her Com pany or
Contractor as deemed appropriate, but the Company must ensure that
this is carried out and that appropriate control measures and medical sup-
port are put in place. There should be a frank exchange of available health
risk and medical support information during the bid process and foresee-
able requirements should be specified in the contract.

A forw ard planning meeting after the bid acceptance and prior to mobilisa-
tion should be held betw een Company and Contractor representatives.
The Contractor’s field supervisor and area manager should be made fully
aw are of the contract’s health requirements.

Contractor’s management plan should emphasise:

● Implementation of identified control measures. See Evaluation of
Existing Local and International M edical Support Systems and
Provision of Health Care in the Area of the Crew ’s Operation in the
previous section;
● Informing, instructing and training of w ork force;
● Health surveillance;
● Record keeping;
● First-aid and medical emergency response procedures;
● Communications;
● A schedule of meetings (HSE) for all sections of the crew . The
meetings should be used for:
• Training;
• Health promotion;
• Discussion of health concerns;
• Analysis of w ork injuries and sickness; and
• Feed-back from crew members on their ideas for improvement

The Health plan may be implemented in a phased manner, dependent on

the introduction and build up of the seismic crew . The medical assess-
ment at the start up should check that the necessary health control mea-
sures are in place and the implementation of the safety plan is on target.

M easurement is an essential aspect of maintaining and improving per-

Performance M onitoring
formance. Health monitoring is a line management responsibility and
should cover the w hole range of health performance standards w hich
have been established. On a day-to-day basis the follow ing should be
established:
● Setting of general targets
e.g. Number of food hygiene inspections required;
Frequency of site visits by doctor to line camps;
Frequency of casualty exercises.
● M easurem ent of perform ance against these targets
e.g. One food hygiene inspection performed each w eek;
One site visit by doctor every tw o w eeks;
One casualty exercise each month.

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 HEALTH M ANAGEM ENT SYSTEM

● Investigation and Reporting

Illnesses and injuries that may be w ork-related should be thoroughly
investigated and reported to management. Recommended action to
prevent or minimise these illnesses and injuries should be
implemented.

Company and Contractor should have programmes in place to ensure reg-

Audit
ular auditing of the health management system. These audits should be
structured in terms of scope and participants, and procedures should be
adopted to monitor timely implementation of recommendations. An action
party should be nominated to co-ordinate and follow up the recommenda-
tions.

The audit represents a pow erful tool because it identifies any deficiencies
in the system and proposes corrections at regular intervals to prevent
damage to health. Audit recommendations w ill identify corrective actions
w ith an emphasis upon root cause identification. The Company should pre-
pare a plan to implement corrective actions w ith particular emphasis upon
tracking of audit action items. Actions identified in one area or facility
should be addressed w hen appropriate in similar areas of operations.
Short term review of the progress should be carried out by the supervisors
and the responsible manager supported by the health advisor. The imple-
mentation plan can be review ed if necessary. Similarly, health-related
action items arising from any incident report should be dealt w ith in the
same w ay.

The audit findings and the resulting remedial action should be communi-
cated to the relevant parties.

The Company and Contractor management should review the health man-
M anagement Review
agement system at agreed periods of operation depending upon the per-
formance review . If necessary, changes should be made to the system to
improve its efficiency. These changes may require new tools, policies, or
procedures, or enhancement to existing policies, procedures or practices.

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 HEALTH M ANAGEM ENT GUIDELINES FOR REM OTE LAND-BASED GEOPHYSICAL OPERATIONS

APPENDIX 1
These guidelines should be considered as advisory only and should be
Fitness Guidelines
applied by a physician know ledgeable of the local area.

Infectious Diseases
Active infectious disease must be treated before assignment. Catering
staff require special examination to identify acute or chronic disease
involving gastrointestinal tract, chest, ear, nose, throat and skin.

M alignant Neoplasm s
Each case should be considered individually and the natural history and
prognosis of the neoplasm taken into account. The progress and likelihood
of complications of the disease and the availability of treatment on site
must be carefully evaluated.

Diseases of Digestive System

● Dental caries, abscess or severe gum disease should be treated
before assignment. Dentures or other orthodontic appliances should
be w ell fitting and functional;
● History of digestive disorders causing severe or recurrent symptoms
requiring special diet or medication, e.g. oesophagitis, gastritis,
cholelithiasis, inflammatory or parasitic bow el disease, is
unacceptable1 until satisfactorily treated and re-assessed;
● Acute gastric erosion may be considered follow ing healing,
demonstrated by endoscopy, w ith absence of symptoms;
● Proven active peptic ulceration is unacceptable1. Where there is a part
history of peptic ulceration a person may be acceptable provided that
the examining physician is satisfied that the risk of complications is
reduced to an absolute minimum by successful surgery or the use of
appropriate medication. Healing is normally assessed by endoscopy;
● Diaphragmatic hernia is only unacceptable1. if disabling symptoms are
present;
● Hernia is unacceptable1. until satisfactorily surgically repaired;
● Haemorrhoids, fistulae and fissures causing intractable pain, or
frequent recurrent bleeding, are unacceptable1, unless treated.
Abscesses and fistulae are unacceptable1;
● A person w ith a stoma is unacceptable1.

Diseases of Liver and Pancreas

● Chronic or recurring pancreatitis is unacceptable1;
● Diseases of the liver are unacceptable1 w here the condition is serious
or progressive and/or w here complications such as oesophageal
varices, or ascites, are present. This includes chronic active
Hepatitis B. Asymptomatic Hepatitis B carriers may be acceptable.

1When used in this appendix the term unacceptable means the presence of the condition under circumstances
w hereby the condition w ould cause the person to be a safety or health hazard to him or herself or to others,
w here the conditions cannot be controlled by the measures as described in this document.

14
 APPENDIX 1

Cardiovascular System
The cardiovascular system should be free from acute or chronic disease.

● Congenital Heart Disease

If this is unassociated w ith symptoms, or haemodynamically significant
change, it is acceptable.

● Valvular Heart Disease

• If there is significant haemodynamic change, it is unacceptable1;
• An individual w ho has undergone successful cardiac surgery for
valvular or congenital heart disease, may be fit for assignment in
remote areas, if free of all symptoms and off all therapy. If
otherw ise, then cardiac review is needed. Individuals in this group
may require more frequent assessment.

● Ischaemic Heart Disease

M yocardial insufficiency (e.g. uncontrolled angina), is unacceptable1.

● M yocardial Infarction
Normally a past history of myocardial infarction is unacceptable1. After
an infarct, it is likely that medical assessment for w ork in remote areas
w ill be inappropriate for a least one year. Specialised cardiac opinion
should be obtained in all cases.

● Coronary Bypass Surgery (CABS) and Angioplasty

Individuals w ho have undergone these procedures must have their
cardiac fitness proven before return to w ork. A cardiological opinion is
essential, and w ill be appropriate not earlier than six months after the
event. This assessment must include submaximal exercise testing.
Individuals w ith cardiac transplants are not acceptable.

● Cardiac Arrhythmias
If these produce symptoms, or are associated w ith haemodynamic
abnormality, then expert cardiac opinion is recommended.

● Cardiomyopathy
These individuals are unacceptable1.

● Cardiac Enlargement
Fitness w ill depend on the underlying cause.

● Pacemakers
The subject of pacemakers is highly specialised and acceptability to
w ork in remote areas must include assessment of:
• The underlying condition and indication for insertion;
• The type of pacemaker;
• The effect of the seismic environment on the unit (i.e. radioactivity,
explosives, cold, heat, etc.);
• The risk of physical damage to the unit.

1When used in this appendix the term unacceptable means the presence of the condition under circumstances
w hereby the condition w ould cause the person to be a safety or health hazard to him or herself or to others,
w here the conditions cannot be controlled by the measures as described in this document.

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 HEALTH M ANAGEM ENT GUIDELINES FOR REM OTE LAND-BASED GEOPHYSICAL OPERATIONS

Hypertension
As a general rule, hypertension is acceptable provided it is uncomplicated
and w ell controlled by treatment.

Peripheral Circulation
The follow ing conditions are unacceptable1:
● Current or recent history of thrombophlebitis or phlebothrombosis w ith
or w ithout embolisation;
● Varicose veins associated w ith varicose eczema, ulcers or other
complications;
● Arteriosclerotic or other vascular disease w ith evidence of circulatory
embarrassment, e.g. intermittent claudication, or aneurysm.

Pulm onary Circulation

● A history of more than one pulmonary embolism is unacceptable1. A
single episode requires careful assessment.

Cerebro-vascular Disorders
● Any cerebro-vascular accident including history of transient ischaemic
attack or evidence of general cerebral arteriosclerosis, including
dementia, is unacceptable1.

Diseases of Blood or Blood Form ing Organs

There should not be any significant disease of the haemopoietic system
and the follow ing are unacceptable1 for w orking in remote areas:
● Anaemias until investigated and successfully resolved;
● Leukaemia, polycythemia and disorders of the reticulo endothelial
system unless in long term remission;
● Haemorrhagic disorders;
● Any other disease of blood forming organs w hich may adversely affect
performance or safety;
● Individuals w ith immuno suppression are unacceptable1;
● Splenectomy is generally unacceptable1.

M ental Disorders
Care is necessary w hen assessing an individual during remission from one
or more episodes of mental illness. An established medical history or clini-
cal indication of any of the follow ing is unacceptable1 for w orking in
remote areas:
● Personality disorders characterised by anti-social behaviour;
● Psychoses;
● Phobias;
● Chronic anxiety states and recurrent depression;
● Alcohol abuse;
● Drug abuse.

Diseases of The Nervous System and Sense Organs

● Organic nervous disease causing, or likely to cause, any significant
defect of intellect, muscular pow er, balance, mobility, vision, sensation
or coordination is unacceptable1.

1 When used in this appendix the term unacceptable means the presence of the condition under circumstances

w hereby the condition w ould cause the person to be a safety or health hazard to him or herself or to others,
w here the conditions cannot be controlled by the measures as described in this document.

16
 APPENDIX 1

● Established medical history w ith current diagnosis of epilepsy of any

type, or disturbance of consciousness is unacceptable1. Any other
convulsive disorder, disturbance of consciousness or neurological
condition likely to render the individual unable to perform duties safely
is also unacceptable1. This category includes epileptiform seizure
follow ing episodic drinking, tranquilliser w ithdraw al, or stroboscopically
induced (e.g. the flicker of helicopter blades).
● Established history of migraine w hich does not interfere w ith the
individual’s ability to w ork efficiently and safely is acceptable.

M usculo-skeletal System
● There must be no deformity, or amputation of body or limb,
significantly to reduce mobility, interfere w ith performance of duties, or
prevent compliance w ith all evacuation procedures. An upper limb
prosthesis may be acceptable providing the above criteria can be met.
● Acute chronic or recurrent disease of peripheral nerves, muscles,
bones or joints significantly affecting mobility, balance, coordination or
ability to perform normal duties, or installation evacuation procedures,
or survival training is unacceptable1.

Skin
The skin should be healthy, w ithout evidence of clinical disease.
● Any skin condition likely to be aggravated or triggered by items in the
environment, is unacceptable1.

Endocrine and M etabolic Disorders

● Adequately controlled thyroid disease may be acceptable but in all
cases, thyroid disorders require careful assessment;
● Uncomplicated stable diabetes mellitus treated by diet alone (or diet
and an oral hypoglycaemic agent) and satisfactorily controlled, may be
acceptable, but w ill require more frequent assessment. Insulin
dependence is unacceptable1;
● Individuals suffering from other endocrine disorders such as Addison’s
disease, Cushing’s syndrome, acromegaly, diabetes insipidus and
hypoglycaemia, either functional or due to pancreatic or adrenal
pathology, are unlikely to be acceptable for remote areas but should be
individually considered and carefully assessed;
● All cases of gross obesity require individual assessment. Those in w hom
exercise tolerance, mobility, general health, or personal hygiene are
adversely affected are unacceptable1. As a general rule, those in w hom
the Body M ass Index exceeds 35 w ill probably be unacceptable1;
● Well controlled gout may be acceptable.

Genito-urinary System
● The presence of renal, ureteric or vesical calculi is generally
unacceptable1. Recurrent renal colic w ithout demonstrable calculi
requires careful assessment. Successful treatment by surgery or
lithotripsy may be acceptable;
● Recurring urinary infections are unacceptable1 until investigated and
treated.

1When used in this appendix the term unacceptable means the presence of the condition under circumstances
w hereby the condition w ould cause the person to be a safety or health hazard to him or herself or to others,
w here the conditions cannot be controlled by the measures as described in this document.

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 HEALTH M ANAGEM ENT GUIDELINES FOR REM OTE LAND-BASED GEOPHYSICAL OPERATIONS

● Any renal disease w hich could lead to acute renal failure, i.e. nephritis,
nephrosis, is unacceptable1. Polycystic disease, hydronephrosis or
unilateral nephrectomy w ith disease in the remaining kidney, is
unacceptable1 unless otherw ise indicated by a nephrologist;
● Renal transplant is unacceptable1;
● Enuresis or incontinence, recent or active, is unacceptable1;
● Prostatitis is unacceptable1. Prostatic hypertrophy, or urethral stricture
interfering w ith adequate bladder evacuation is unacceptable1;
● Gynaecological disorders, such as menorrhagia, disabling
dysmenorrhoea, pelvic inflammatory disease or prolapse, are
unacceptable1;
● Hydrocoeles, or painful conditions of the testicles, require careful
assessment;
● Sexually transmitted disease should be treated. A diagnosis of HIV
positive need not debar from assignment. Such employees should
receive regular surveillance;
● Pregnancy should be carefully evaluated w ith regard to the personal
history and risk assessment. In general, the risks w ould be
unacceptable1.

Respiratory System
● A history of spontaneous pneumothorax is generally unacceptable1,
except for a single episode w ithout recurrence for one year, or after a
successful surgical procedure;
● Obstructive airw ays disease, such as chronic bronchitis, emphysema,
and any other pulmonary disease causing significant disability or
recurring illness, such as bronchiectasis, is unacceptable1;
● Restrictive or fibrotic pulmonary disease resulting in significant
symptoms or disability is unacceptable1;
● Open pulmonary tuberculosis is unacceptable1 until treatment is
concluded and the attending physician has certified that the patient is
no longer infectious;
● A history of asthma requiring frequent or recurrent medication
including oral steroids requires careful assessment.

Ear, Nose and Throat

● Ear
• Active otitis externa (acute or chronic) requires treatment;
• Disorders of the tympanic membrane (e.g. dry perforations and
grommets) and the middle ear require further assessment. Chronic
middle ear disease is unacceptable1 until treated;
• Intractable inner ear disorders w ith severe motion sickness, vertigo,
etc (e.g. M eniere’s disease) are probably unacceptable1;
• A functional hearing loss sufficient to interfere w ith communications
or to impede safety (e.g. inability to hear audible w arning devices) is
unacceptable1. Intrinsically safe hearing aids may be w orn, but the
examinees should not be dependent on such an aid to hear a safety
w arning. M easurement of auditory acuity is best performed by
screening audiometry.

1When used in this appendix the term unacceptable means the presence of the condition under circumstances
w hereby the condition w ould cause the person to be a safety or health hazard to him or herself or to others,
w here the conditions cannot be controlled by the measures as described in this document.

18
 APPENDIX 1

● Nose
Chronically infected sinuses, or frequently recurring sinusitis are
generally unacceptable1.
● Throat
Chronically infected tonsils or frequently recurring tonsillitis require
careful assessment.

Eyes
● Any eye disease or visual defect rendering, or likely to render, the
applicant incapable of carrying out job duties efficiently and safely, is
unacceptable1. A history of conditions such as glaucoma, uveitis,
require specialised assessment;
● A monocular individual is acceptable provided the job functions can be
performed efficiently and safely;
● Colour perception should be adequate for the particular type of
assignment to be undertaken.

M edicines
Individuals being treated w ith certain medicines require careful
consideration:
● Individuals on anticoagulants, cytotoxic agents, insulin,
anticonvulsants, immunosuppressants, and oral steroids;
● Individuals on psychotropic medications, e.g. tranquillisers,
antidepressants, narcotics, hypnotics. A previous history of such
treatment w ill also require further consideration;
● Any employee in possession of medications must report these to the
M odule 4 or 5 employee. The individual must ensure an adequate
supply to last longer than the normal tour of duty. A change in dosage
should also be reported;
● Any previous adverse drug reaction must be brought to the attention of
the M odule 4 or 5 employee.

Catering Crew
Food handling and hygiene are of paramount importance.

Before assignment, and regularly thereafter, the follow ing procedures may
be follow ed in the case of anyone handling, or likely to handle food:
● Thorough clinical examination of potential communicable disease sites,
e.g., skin, ears, upper respiratory tract and gastro-intestinal tract;
● Chest X-ray in the preassignment medical examination w ill be required
only on clinical indication. The individual’s medical history, clinical
examination findings or current medical practice w ill determine the
need for further chest X-rays.

Additional investigation may be required if the employee has been absent

due to infectious disease.

1When used in this appendix the term unacceptable means the presence of the condition under circumstances
w hereby the condition w ould cause the person to be a safety or health hazard to him or herself or to others,
w here the conditions cannot be controlled by the measures as described in this document.

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 HEALTH M ANAGEM ENT GUIDELINES FOR REM OTE LAND-BASED GEOPHYSICAL OPERATIONS

Work Factor Considerations

Work factors to be considered in the assessment of medical fitness to
w ork in remote areas:
● Physical exertion (climbing w alkw ays, stairs, w ork tasks, etc.);
● Shift w ork
● Climate
● Altitude
● Change in routine
● Absence from home
● Total control by employer
● Lack of privacy
● Helicopter and boat travel
● Exposure to height
● In-Water exercises
● Claustrophobia
● Smoke exposure
● Heat and cold exposure
● Peer group pressure
● Explosives
● Lack of communication

20
 APPENDIX 2

APPENDIX 2
The contents of each kit should be professionally review ed to an
M edical and First Aid Equipment
appropriate level.

M odule 0
None required

M odule I
Basic First Aid Kit plus C.P.R. mask and gloves:
● Guidance Card
● Individually w rapped sterile adhesive dressings
● Sterile eye pads w ith attachment
● Sterile triangular bandages
● Safety pins
● M edium sterile unmedicated dressings
● Large sterile unmedicated dressings
● Extra large sterile unmedicated dressings
● Alcohol free cleansing w ipes

M odule 2
First Aid Kit:
● Guidance leaflet
● Adhesive dressings (assorted)
● Sterile eye pads
● Various sterile dressings
● Sterile triangular bandages
● Butterfly closures
● Crepe bandages 6”
● Elastic adhesive bandages 4”
● Various Band-Aids
● Surgical scissors
● Splints (inflatable or vacuum plus cervical collar)
● Thermometer (digital)
● Forceps
● Burns packet
● Antiseptic solution
● Burn blanket
● Hypothermia bag
● Paracetamol
● Rehydration sachets
● Eye antiseptic
● Antihistamine
● Antacid
● Antiseptic skin cream
● Sterile gloves
● M outh ointment
● C.P.R. M ask and gloves

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 HEALTH M ANAGEM ENT GUIDELINES FOR REM OTE LAND-BASED GEOPHYSICAL OPERATIONS

M odule 3
Content to include M odule 2 plus the addition of a such of the follow ing
item that he is competently trained to use or certified to administer:
● Suture Set
● Sphygmomanometer
● Stethoscope
● Oro-pharyngeal Airw ay
● Intramuscular injection needles and syringes
● Laxative
● Cough pastilles
● Antidiarrheal medication
● M etronidazole
● Eye antiseptic
● Suppositories for haemorroids
● Antispasmodics2
● Doxycycline2
● Curative anti-malarial tablets2
● 1% Hydrocortisone (topical)2
● Throat lozenges
● Anti fungal preparation (topical)
● Ear drops
● Xylocaine 1% (no adrenalin)2
● Potent analgesic2
● Antiemetic2
● M anufacturer’s prescribing information must be available in the pack.

M odule 4
To include complete M odule 3 set plus:
● Intravenous giving sets and fluids
● Cut dow n set
● Endotracheal Set
● Laryngoscope
● Ambubag or Doctors Resuscitation kit
● Supply of pharmaceuticals as agreed w ith Contractor’s medical officer
or M odule 5 person.

The quantities w ould depend on w hether in the field or the base camp. At
base camp, one may consider a cardiovascular emergency kit, anti-shock
kit, and a resuscitator.

If anti-snake venom is provided, the M odule 4 person must be fully trained

and experienced in its use and its dangers. Only the appropriate anti-
venom(s) for that area should be provided.

2 The M odule 3 person should contact a M odule 4 or 5 person prior to use.

22
 APPENDIX 3

APPENDIX 3
The Contractor’s medical advisor should advise appropriate immunizations
Immunization Guidelines
for those medically certified to w ork in the contract area.

Im m unizations for expatriates prior to travel

● Core immunizations:
Polio, Tetanus, Typhoid, Hepatitis A, Hepatitis B, Yellow fever (may be
entry requirement).

● To be considered depending on risk such as:

H.D.C.V (Rabies), Japanese B. Encephalitis, Tick borne Encephalitis,
M eningitis, Diphtheria, B.C.G.

Additional im m unizations that m ay be necessary

to com ply w ith entry requirem ents.
● Cholera3

3 Despite cholera not being recommended by the World Health Organisation (WHO) some countries may still
require a certificate of immunization for entry purposes.

23