(Int Marit Health 2016; 67, 2: 79-82)

No abstract

Some tropical areas are particularly challenging for employers when it comes to deal with both risk assessment and impact assessment of malaria. On our recent operations in Indonesia, we had to cope with health issues related to malaria that raised more questions than we were able to answer regarding occupational health, corporate social responsibility, and legal issues. These questions include: How do we manage malaria prevention and chemoprophylaxis for indigenous people working in highly endemic malaria areas (i.e. Western Papua)? Can we make a distinction between individuals for whom malaria is recorded as an occupational disease and those for whom the illness is not work-related? To cope with this interesting topic, we conducted a case study with the support of the International SOS medical team based in APAC. It consisted of a review of the regulations applicable in Indonesia by taking into account several criteria such as labor laws, occupational/public health, health risk assessment, and health impact assessment. We wanted to learn more about our Duty of Care and how to report or record malaria cases when, as a company, we transfer someone from one Indonesian island to another. We took the case of an employee hired in Jakarta (Java) who travelled to Western Papua for two months and then came back home: Does he require malaria chemoprophylaxis or is he considered semi-immune? Do we record malaria as an occupational disease if he contracts it? What about CSR and company liability if he is infected and becomes a "reservoir" for new Plasmodium falciparum species in his home island where his family and community have no semi-immunity against? The study shows clearly that this issue merits more than just a workplace Health Risk Assessment. Through Health Impact Assessment, knowledge of local regulations, laws, and medical practices is mandatory for understanding and safely managing malaria prevention as well as avoiding litigation or inappropriate actions.

In many places, Medevac is either technically challenging due to length (5 days in our experience in Arctic conditions), lack of quality medical support ashore, or hostile environment. To mitigate medical risks in these extreme environments, the authors implemented an innovative integrated medical support solution onboard seismic vessels since 2013.To limit unnecessary Medevac, we emphasized on the upgrade of diagnostic tools, through rapidly deployable mobile digital X-ray, ultrasound, and point of care laboratory automates. These equipment were used by a specifically trained medical team including an emergency physician and a registered nurse backed up by an adapted top side support.Therapeutic tools were also upgraded and the most dramatic improvement was the implementation of Fresh Whole Blood Transfusion (FWBT) and Lyophilized Plasma to address trauma induced life threatening hemorrhages and slow uncontrolled bleedings from medical origin (mostly gastro intestinal). The authors are presenting the different steps (most of them conducted onboard at sea) involved in the complex process of FWBT, from blood donors' qualifications and management to actual transfusions. The pros and cons of blood transfusion in extreme remote environment are discussed, including, health care professionals training, equipment requirements, legal and ethical issues, decision making in complex blood group matching, medical benefits and risks. Some clinical examples will be provided to illustrate the medical context in the oil & gas industry working environment in remote area and how this fully integrated onboard hospital address them.Finally based on experience in Arctic and other extreme environment the authors developed others medical solutions, more agile to support scouting surveys. This whole range of medical services aims to make oil and gas operations safer in the most extreme environments.

No abstract