QUALITY SYSTEM HSE-MS MANUAL

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LEVEL 4: REFERENCE #: HSE-REF-21.1

ALL HMS AMS RMS

Date: Nov 2006
TITLE: PANDEMIC ACTION PLAN Revision: 0
Approved by: Oscar Combs Authorized by: John McCaffrey No. of Pages: 10

1.0 PURPOSE

The purpose of this work instruction is to provide information on pandemic outbreaks and to detail
the actions to be taken to minimize the impact on staff and, where possible, to allow normal
operations to continue.

2.0 APPLICATION

This work instruction applies to all Nabors staff.

3.0 DEFINITIONS

Avian Flu - (a.k.a. Bird Flu)-. An infection caused by avian (bird) influenza (flu) viruses that occur
naturally among wild birds worldwide. While the wild birds carry the viruses in their
intestines, they do not usually get sick from them. However, avian influenza is very
contagious and can cause illness and death in domesticated birds. There have been
cases recorded of transmission of the virus from infected birds to humans, sometimes
with fatal results. Scientists worldwide believe it is possible that the virus will mutate,
making it possible for human to human transmission which could result in a pandemic
event.
Epidemic - An outbreak of a disease or condition that spreads more quickly and more extensively
among a group of people than would normally be expected.
Local Area - An area surrounding a Nabors worksite and residential location. Boundaries are ill-
defined but generally described as a local commuting area.
Pandemic - A disease or condition existing in the form of a widespread epidemic that affects
people in many different countries. The last influenza pandemic occurred in 1918 and
is estimated to have caused 40 million deaths.
Pandemic Action Plan - A systematic plan designed to:
1. Take early preventive measures to protect staff from foreseeable
viral infections.
2. Institute a system for minimizing the risks of infection in the
workplace in the event of an epidemic or pandemic event.
3. Provide a tiered system of response tied to the existing Nabors Alert
Levels and SECON States.
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Region/Regional Area - A general political or geographic area within a country that may or may
not have clearly defined boundaries.

4.0 RESPONSIBILITIES

Area Managers. Responsible for briefing all staff in their area of control on the information and
actions detailed in this work instruction, and for taking appropriate actions should an epidemic or
pandemic event occur.

All Nabors Staff. Responsible for reading this work instruction and following the actions laid down
here in the event of a declared epidemic or pandemic event.

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5.0 PROCEDURE

5.1 General. Health authorities around the world generally agree that it is not a question of if a
pandemic influenza will occur; it is when it will occur. The two most worrying
characteristics of a pandemic event are that it spreads rapidly and widely. While deaths
occur most commonly in the very old and the very young, every person is at risk. Thus,
the first precaution against infection is to ensure staff receive all available inoculations. As
viruses are transmitted via direct contact with an infected host, the second precaution is to
attempt to minimize contact and control the virus’s spread if at least some contact is
unavoidable. The Nabors' Pandemic Action Plan is based on this strategy and applies to
epidemics and pandemics generally, including Avian Flu.

5.2 Avian Flu. While avian flu is not the only virus with the potential to become pandemic, it is
of particular concern because of the number of confirmed cases in humans in a growing
number of countries. As of August 2006 the H5N1 strain has been detected in 55 countries
and has resulted in 141 human deaths in nine of those countries. The fact that other
events have recently seized world headlines has not diminished the threat from Avian Flu.
The most up-to-date information is available through organizations such as the World
Health Organisation, the US Centers for Disease Control and Prevention, and commercial
service providers such as International SOS. (See contact details under Website Links.)
Some general notes on Avian Flu are contained in Appendix 9.1.

5.3 Pandemic Action Plan. The Pandemic Action Plan commences prior to the deployment
of any staff or dependants. It can be broken into the following phases:
1. pre-deployment,
2. during deployment, and
3. post deployment.
5.3.1 Pre-deployment.
1. All staff and dependants must receive information briefings on epidemics and
pandemics, including: specific information on the latest situation regarding Avian
Flu, its spread and symptoms; actions to reduce the risk of infection; and actions
if infection is suspected or confirmed.
2. Area Managers must ensure that detailed plans are in place in accordance with
this work instruction and that the necessary supplies of masks and other
protective equipment as may be specified from time to time are available and in
good condition.
5.3.2 During Deployment.
1. On arrival, as part of their normal deployment briefing, all staff and dependents
must be made aware of any locations in the local area which might be
considered to increase their risk of exposure. These would include places in
which hygiene is considered to be unsatisfactory (in the case of pandemics
generally) or, in the case of Avian Flu, areas in which they might come in contact
with infected birds either wild or domestic, or with infected pigs.
2. In the event of an outbreak Area Managers must assess the possible risk to staff
and dependants and impose the most appropriate Alert Level and/or SECON
State. This should be done in consultation with Nabors Headquarters.

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5.3.3 Post Deployment.

1. Staff and dependants evacuated from an area in which an influenza outbreak
occurred or was suspected, but who are not exhibiting any symptoms of
exposure to any strain of influenza should be encouraged to visit their local
medical practitioner for a checkup.
2. Staff and dependants evacuated from an area in which an influenza outbreak
occurred or was suspected, and who are exhibiting any symptoms must be
advised to go directly to the casualty ward of their local hospital.
3. In all cases, staff must be asked to inform the Director of HSE at Nabors
Headquarters of the outcome of the visit.

5.4 Alert Levels. Alert Levels establish a universal set of procedures that provides the
framework for NDIL to evacuate personnel from an area in an orderly and timely manner.
Alert Levels consist of four levels which provide a graduated response to the threat
environment as it relates to the need to evacuate a specific site, location, Country or Area.
They apply equally to a security incident, or to an epidemic or pandemic event. The levels
increase in their severity from Normal Operations to Alert Level 3.

5.4.1 Alert Level Normal Operations. Normal Operations – all operations in a given
location occur in an environment that has no perceived risk that may necessitate
evacuation of any Nabors staff member or dependants.
5.4.2 Alert Level 1 (Warning) – normal drilling operations continue, dependants Standby
to evacuate. Activated when it is considered that conditions are such that a threat to
the lives, health and welfare of resident dependants of expatriate and TCN staff may
exist and they may be endangered by their continued presence in-country. It signals
the commencement of the Warning Phase for Alert Level 2.
5.4.3 Alert Level 2 (Alert) – drilling operations may continue in a restricted security
environment; evacuation of families and non-essential personnel; rig crews standby
for evacuation. Activated when it is considered conditions are such that the life,
health and welfare of resident dependants of expatriates are endangered by their
continued presence in-country, and expatriate employees may be endangered by
their continued presence in-country. It signals the commencement of the Warning
Phase for Alert Level 3.
5.4.4 Alert Level 3 (Evacuate) – evacuation of staff and crews imminent (crisis situation).
Activated when it is considered continued operations are extremely dangerous to the
life, health and welfare of expatriate and TCN employees.

As it is a tiered system each Alert Level preempts the next so that at any given level staff
should be preparing for the next. This preparatory action is called the “Warning Phase”.
During this period any stipulated or commonsense issues that need to be addressed to
make allowance for a further elevation must be done.

5.5 SECON States. SECON States provide a graduated response to local, regional or global
events that present a security threat as it pertains to Nabors operating sites. They are
designed to enhance local area security by imposition of security restrictions for limited and
specified periods of time in response to specific threats. The States are color coded in
ascending order of severity, lowest to highest: Green, Orange and Red. Listed below are
some restrictions which may apply in the case of a possible pandemic event; they may be
in addition to restrictions imposed for other reasons, such as a security incident or threat.
They are summarized in Appendix 9.3.

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5.6 SECON State Green. The following restrictions may apply at this state 1:

5.6.1 Staff
1. Normal access and ID protocols
2. Normal work practices
3. Normal work clothes and safety equipment
5.6.2 Visitors
1. Normal access and ID protocols
5.6.3 Movements
1. Normal Journey Management Protocols in force
2. Normal restrictions on local area movement (this may include restrictions on
visiting rural areas in general or certain areas in particular for example wetlands,
poultry farms and pig farms).

5.7 SECON State Orange. The following restrictions will apply at this state:

5.7.1 Staff
1. Normal access and ID protocols
2. Local staff to be monitored for symptoms and requested to wear protective
masks
3. Local staff living in high-risk areas required to wear protective masks at work and
to maintain a separation distance of at least 1 m from other staff
4. Introduce staggered and segregated (from local workers) meal and rest breaks
5. All staff to be briefed on the heightened risk
6. Stocks of protective masks and clothing to be checked for quantity and condition
5.7.2 Visitors
1. Normal access and ID protocols
2. Casual visitors asked to defer visits
3. Essential visitors required to wear protective masks
5.7.3 Movements
1. Normal Journey Management Protocol in force
2. No movement into high-risk areas, for example wetlands, poultry farms and pig
farms
3. Restricted movement into crowded areas, such as markets, where the possibility
of infection is increased
5.7.4 Other
1. All dependants to be briefed on the heightened risk and measures to be taken for
them to minimize their exposure. Protective equipment to be provided if
necessary.
2. All staff and dependants to avoid public transportation, crowded places and
public gatherings where possible
3. No access by vehicles or equipment which have been in high-risk areas
4. No access for any live wild or domestic birds, or pigs
5. Suspect vehicles and equipment to be sprayed with an approved disinfectant

5.8 SECON State Red

5.8.1Staff
1. Normal access and ID protocols
2. All staff to wear protective masks and clothing
3. All staff to practice separation procedures
4. All staff to be actively monitored for symptoms
5. Local staff to be placed off shift until further notice if necessary

1
Local conditions will dictate which restrictions must be imposed.
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6. All staff to be briefed on the heightened risk

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5.8.2 Visitors
1. Normal access and ID protocols
2. Access granted only to visitors/contractors essential to ongoing operations
3. All visitors to be required to wear protective masks and clothing, and to observe
separation distances
5.8.3 Movements
1. Restricted Journey Management Protocol enforced
2. No movement of staff on non-essential tasks
5.8.4 Other
1. All dependants to be briefed on the heightened risk and advised to adopt
protective measures and to remain indoors. Protective equipment to be provided
if necessary.
2. All staff and dependants prohibited from visiting crowded places and public
gatherings
3. Vehicle movement inside perimeter to be minimized to essential movement only
4. All vehicles and equipment entering perimeter to be sprayed with an approved
disinfectant

5.9 Planning Considerations

5.9.1 General. The World Health Organisation lists six phases of a pandemic 2.
1. Inter-pandemic Period
a. Phase 1. No new influenza virus subtypes detected in humans
b. Phase 2. An influenza virus subtype that has caused a human infection may
be present in animals but the risk of human disease is considered to be low
2. Pandemic Alert Period
a. Phase 3. Human infection with a new subtype, but no human to human
transmission
b. Phase 4. Small clusters of infection with limited human to human
transmission but spread is highly localized (suggesting that the virus is not
well adapted to humans)
c. Phase 5. Larger clusters but human to human spread still localized (the
virus is becoming better adapted to humans but may not yet be fully
transmissible)
3. Pandemic Period
a. Phase 6. Increased and sustained transmission in general population

5.9.2 World Health Organisation (WHO) General Planning Assumptions. The World
Health Organization is the United Nations specialized agency for health. It provides a
wide range of services including planning guidelines for events such as disease
outbreaks. In its planning document for pandemics it recognizes that they are
unpredictable. However, experience from previous episodes indicates that, for the
general population:
1. Susceptibility to the pandemic influenza virus will be universal.
2. Efficient and sustained a person-to-person transmission signals an eminent
pandemic.
3. The clinical disease attack rate will be 30% in the overall population; the rates will
be highest among school-age children (about 40%) and decline with age.
Among working adults, an average of 20% will become ill.
4. Some persons will become infected but not develop clinically significant
symptoms. (asymptomatic or minimally symptomatic individuals can transmit
infection and develop immunity to subsequent infection)

2
The WHO (World Health Organization) presently classifies the world as being in Phase 3.
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5. About 50% of those affected will seek medical assistance. (this percentage may
increase if effective antiviral drugs are available)
6. Rates of serious illness, hospitalization and deaths will depend on the virulence
of the pandemic virus and can vary dramatically. Risk groups for severe and
fatal infection cannot be predicted with certainty, but are likely to include: infants,
the elderly, pregnant women, and persons with chronic or immunosuppressive
medical conditions.
7. Rates of absenteeism will depend on the severity of the pandemic. In a severe
pandemic they may reach 40% during the peak weeks of a community outbreak,
with lower rates of absenteeism during the weeks before and after the peak.
8. The typical incubation period for influenza is approximately 2 days.
9. Persons who become ill may shed the virus and can transmit infection for one
half to one day before the onset of illness. Viral shedding and the risk of
transmission will be greatest during the first two days of illness. Children will play
a major role in transmission of infection as their illness rates are likely to be
higher because they shed more virus over a longer period of time and they do
not control their secretions as well.
10. On average, infected persons will transmit infection to approximately two other
people.
11. Epidemics will last six to eight weeks in affected communities.
12. Multiple waves of illness are likely to occur with each wave lasting two to three
months. Historically, the largest waves have occurred in the fall and winter, but
the seasonality of the pandemic cannot be predicted with certainty.
5.9.3 Nabors Specific Planning Assumptions. Area and Country Managers will need to
take into account local considerations, as well as the characteristics of the particular
pandemic in determining planning considerations. In particular, they need to take
into account the composition of their workforce, its proximity to population centers
and other high risk locations, and the potential for infection and cross infection. From
the general planning assumptions it would appear that the following assumptions
would provide a basis for their planning:
1. Their workforce will be susceptible to the influenza virus.
2. They will receive some notice of the outbreak of the pandemic although it is
difficult to quantify this.
3. Approximately 30% of the workforce may be affected if they remain in an
affected area, however the percentage may be less than this given the age and
relative fitness of its members.
4. The percentage affected is likely to be higher if staff are living with dependent
children who are not evacuated before the onset of the pandemic.
5. Not all infected persons will exhibit symptoms but they will still be capable of
infecting others.
6. Rates of absenteeism of 40% or more may be expected from the local workforce
due to family commitments.
7. Rates of absenteeism amongst TCN and expatriate staff may exceed the normal
if they have family affected by the influenza virus in their home locations.
8. The typical incubation period for the influenza virus is approximately 2 days.
9. Persons who become ill may shed virus and can transmit infection for one half to
one day before the onset of illness -- viral shedding and the risk of transmission
is greatest during the first two days of illness.
10. On average, infected persons will transmit infection to approximately 2 other
people.
11. Epidemics will last six to eight weeks and could occur in waves with each wave
lasting two to three months.
12. In considering evacuation it will be essential to consider the pandemic situation in
other countries – it may be safer to remain in location.

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13. In considering ongoing operations it may be necessary to consider bringing in

additional TCN or expatriate staff.
14. If general evacuation is not considered necessary it may be necessary to
consider immediate evacuation of any affected staff.
15. If evacuation of affected staff is not possible it will be necessary to plan to
quarantine and treat them or remove them to a treatment facility in the local area.

5.10 Possible Restrictions. Due to the acknowledged unpredictability of an influenza

pandemic it is impossible to provide hard and fast guidelines on what restrictions should be
imposed at any given time. However, a list of possible restrictions which might apply in
Phases Three to Six of the WHO Global Influenza Preparedness Plan 2005 is contained in
appendix 9.3.

5.11 Conclusion. If a pandemic does occur professional opinion suggests that there may be
little warning, with limited information in the early phases, and its spread may be rapid.
Because of the many unknowns it is vital that management at all levels assess rapidly the
local situation, take early action to contain the virus and prevent its spread, seek the most
up-to-date information, and consult with Nabors Head Office.

6.0 REFERENCES
6.1 Nabors Country Brief for deployed location

7.0 WEBSITE LINKS

7.1 World Health Organisation (www.who.int/en/)
7.2 Centers for Disease Control (www.cdc.gov)
7.3 International SOS (www.internationalsos.com) member login 11BCPA000057

8.0 APPENDICES
8.1 General Notes on Avian Flu
8.2 World Health Organisation Phases
8.3 Actions on Alert Levels and SECON States

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Appendix 9.1 General Notes on Avian Flu

1.0 General. Bird flu can affect humans of any age and gender. Generally, those people who are
more susceptible to being infected with any sort of virus are more at risk: i.e. old, young, weak, or
rundown (suffering from stress) or suffering from other illness or injury. Therefore all staff and
their families deploying to areas that are at risk should ensure that they are in good health
physically and mentally.

2.0 Areas of Concern. Countries affected by the Avian Flu H5N1 virus are listed in paragraph 8.0.

3.0 Symptoms. Symptoms of avian influenza in humans have ranged from typical human influenza-
like symptoms (e.g., fever, cough, sore throat, and muscle aches) to eye infections, pneumonia,
severe respiratory diseases (such as acute respiratory distress), and other severe and life-
threatening complications. The symptoms of avian influenza may depend on which virus caused
the infection.

4.0 Protection. Currently there is no commercially available vaccine to protect humans against
H5N1 virus that is being seen in Asia and Europe. However, studies done in laboratories
suggest that some of the prescription medicines approved in the United States for human
influenza viruses should work in treating avian influenza infection in humans. However, influenza
viruses can become resistant to these drugs, so these medications may not always work 3.

5.0 Spreading of the virus. So far, there is no conclusive evidence of human-to-human

transmission of the avian flu. People get the avian flu through close contact with sick birds or
their faeces. The virus is contained in the droppings and secretions of sick birds. Therefore all
staff should avoid places where flocks of birds congregate: zoos, ponds, bird farms, etc,

6.0 Risk to Staff. At the time of writing there is little or no risk to travellers, TCN s and expatriates.
The Centers for Disease Control have advised travellers visiting affected countries to avoid
poultry farms and live animal markets and avoid contact with any surface that has been
contaminated with animal faeces or other secretions. People travelling to tropical countries where
influenza transmission can occur year-round should consider having an influenza vaccination.

7.0 Prevention. Like most illnesses, avian flu can best be prevented though vigilant attention to
good hygiene. Avoid surfaces contaminated with animal faeces or other secretions. Ensure that
meat and other poultry products are thoroughly washed and cooked. Furthermore, ensure that all
foodstuffs are thoroughly washed and prepared. Wash your hands often and well with hot soapy
water. Use a disposable tissue to wipe eyes and nose, and only do so with clean hands.

8.0 COUNTRIES AFFECTED BY H5N1 SINCE DECEMBER 2003

 Afghanistan
 Albania
 Austria
 Azerbaijan
 Bosnia
 Bulgaria
 Burkina Faso
 Cambodia
 Cameroon
 China, including Hong Kong SAR and Tibet Autonomous Region
 Cote d'Ivoire

3
Information obtained from the CDC Website http://www.cdc.gov/flu/avian/gen-info/facts.htm and was
correct as at the 27th of January 2006
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 Croatia
 Cyprus
 Czech Republic
 Denmark
 Djibouti
 Egypt
 France
 Georgia
 Germany
 Greece
 Hungary
 India
 Indonesia
 Iran
 Iraq
 Israel
 Italy
 Japan
 Jordan (the single human case there was imported from Egypt)
 Kazakhstan
 Kuwait
 Laos
 Malaysia
 Mongolia
 Myanmar
 Niger
 Nigeria
 Poland
 Romania
 Russia
 Serbia
 Slovakia
 Slovenia
 South Korea
 Spain
 Sudan
 Sweden
 Switzerland
 Thailand
 Turkey
 Ukraine
 United Kingdom
 Vietnam
 West Bank/Gaza Strip
Countries in bold have also reported human cases. See the WHO table of confirmed human cases and
deaths.

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Appendix 9.2 World Health Organisation Phases

Source: WHO global influenza preparedness plan 2005

The World Health Organisation currently assesses the world to be in Phase 3.

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