Petroleum Development Oman L.L.C.
PR-1243B
Emergency Procedures part III: Volume 12
Medical Emergency Response
Manual
Part II: Site Specific MER Procedures
User Note:
The requirements of this document are mandatory. Non-compliance shall only be
authorised by the Document Owner or his Delegate through STEP-OUT approval.
A controlled copy of the current version of this document is on PDO's EDMS. Before
making reference to this document, it is the user's responsibility to ensure that any hard
copy, or electronic copy, is current. For assistance, contact the Document Custodian or
the Document Controller.
Users are encouraged to participate in the ongoing improvement of this document by providing
constructive feedback.
Please familiarise yourself with the
Document Security Classification Definitions
They also apply to this Document!
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I Document Authorization
II
Revision History
Chapter
No.
All
Section
No.
All
Description
Date
Initials
First Version of the Procedure
March 2007
NA
Reference
Indicator
MCO11N
III Scheduled Local Review & Update of Site Specific MER Manual for
Site Name
Date of Review Medic
& Update
Signature
Site Manager
Signature
Notes
IV
Distribution List
CUSTODIAN
CECC - MAF
MCC
MCO/1
MCO/2
MCO/3
MCO/4
MCO/11N
MCO/22S
Sahara PAC Clinic Fahud
Sahara PAC Clinic, Nimr
Renaissance PAC Clinic, Fahud
Renaissance PAC Clinic, Nimr
PAC Clinic, Qarn Alam
OIS
MCN
MCN/1
MCN:
Fahud
Lekhwair
Qarn Alam
Yibal
Marmul
Nimr
Bahja
All contractor clinics
COPY
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
CUSTODIAN
LEBC’s (All Areas):
Fahud (ONO/1F)
Lekhwair (ONO/1L)
Qarn Alam (ONO/1Q)
Yibal (ONO/1Y)
Marmul (OSO/1M)
Bahja (OSO/1B)
Nimr (OSO/1N)
LEBC - MAF
MAF Coast (OIS/1)
Air Ops (TSL)
TSL/3
OIS/2
COPY
24
25
26
27
28
29
30
31
32
33
34
35
V
Glossary of Terms, Definitions,and Abbreviations.
ACLS
AED
ALARP
ATLS
BLS
BU
CCR
DD
DFA
ECG
ETO
FA
KPI
LEBC
LECC
MAF
MCC
MER
MCI
Advanced Cardiac Life Support
Automatic External Defibrillators
As Low As Reasonably Practicable
Advanced Trauma Life Support
Basic Life Support
Base Unit
Central Control Room
Deputy Director
Designated First Aider
Electrocardiogram
Emergency Telephone Operator
First Aid
Key Performance Indicator
Local Emergency Base Controller
Local Emergency Control Centre
Mina Al-Fahal
Chief Medical Officer
Medical Emergency Response
Multiple Casualty Incident
CONTENTS
I
II
III
IV
V
Document Authorization …………………….……………………………………..…….……3
Revision History ………………………………………………..……………….……..….……3
Scheduled Local Review & Update of Site Specific MER Information…………..…….3
Distribution List …………………………………………………………………………….…...4
Glossary of Terms, Definitions, and Abbreviations ………………………………………5
1
1.1
1.2
1.3
1.4
1.5
INTRODUCTION................................................................................................................. 7
Overview ............................................................................................................................. 7
Objective ............................................................................................................................. 7
Scope .................................................................................................................................. 8
Site Characteristics…………………………..…………………………………………………....9
Related Business Control Documents ………………………………………………………….9
2
PDO MER PROCEDURE ..................................................................................................10
2.1
2.2
2.3
2.4
2.5
2.6
Overview ………………………………………………………………...…………………………10
First Response and Call-Out Procedure ……………………………………………………………11
Tier 2-3 Medevac Procedure ……………………………………………………………………….11
Tier 4 Medevac Procedure …………………………………………………………………………12
Site Specific Medical Infrastructure ……………………………………………………………….13
Site Specific General Infrastructure ……………………………………………………………….14
3
3.1
3.2
3.3
SITE SPECIFIC MER ORGANIZATION AND RESOURCES.......................................... 15
Site Specific MER Organization ........................................................................................ 15
Site Specific MER Manual Responsibilities ...................................................................... 16
Site Specific MER Equipment ........................................................................................... 17
4
4.1
4.2
4.3
4.4
4.5
4.6
MER PROCEDURES ........................................................................................................ 18
Information Prompt List ..................................................................................................... 18
MER Contact Information.................................................................................................. 18
First Response and Call Out Procedure ........................................................................... 19
Tier 2 –3 Medevac Procedure........................................................................................... 20
Tier 4 Medevac (Tier 3 to Tier 4 Hospital) Procedure....................................................... 22
Multiple Casualty Incidents (MCI) Procedure.................................................................... 23
5
5.1
5.2
5.3
5.4
5.5
IMPLEMENTATION AND PERFORMANCE MONITORING ........................................... 24
Inspection and Maintenance Program .............................................................................. 24
MER Exercises.................................................................................................................. 24
MER Skills Maintenance ................................................................................................... 24
KPIs ................................................................................................................................... 24
Audits ................................................................................................................................ 24
5.6
Management Review........................................................................................... 24
ATTACHMENTS .............................................................................................................................. 25
• Attachment 1 Site MER Response
• Attachment 2 Medical Personnel
• Attachment 3 MER Responsibilities
• Attachment 4 Medical Equipment
• Attachment 5 Medevac Resources and Contact Information
• Attachment 6 Initial Call - Information Prompt List
• Attachment 7 Multiple Casualty Incidents (MCI) - Responsibilities
• Attachment 8 Multiple Casualty Incidents (MCI) - Triage Protocol
• Attachment 9 Hazards and Effects Management
1
Introduction
1.1
Overview
This Site Specific Medical Emergency Response (MER) Manual outlines the facilities and
equipment available at
Site Name
and defines the organization and procedures for
responding to a medical emergency. It must be read along with PDO Medical emergency Response
Manual PR-1243.
This MER Manual provides a framework for the management of medical emergencies and describes
the appropriate response. The Site Specific MER Manual is part of the overall Emergency
Response Plan, but provides specific information for medical emergencies. Where appropriate,
reference is made to the Emergency Response Plan.
An updated copy of this Site Specific MER Manual should be always readily available at:
1. Medical Clinic & Site Ambulance
2. LEBC/ LECC Room/ Site Manager
3. Site CCR/ ETO/ Radio Room
4. Copy to Regional PDO Clinic (MAF/ North/ South)
o
Nothing in this document is intended to prevent the Incident Commander from using their
judgment or expertise to initiate necessary action to secure the safety of the facility and its
occupants during a medical emergency situation.
1.2
Objective
The objective of the MER Manual is to help ensure an effective response to medical emergencies
by:
•
Documenting the organization roles and responsibilities of personnel managing the medical
emergency.
•
Defining interfaces between the different response teams.
•
Providing clear concise instructions and guidance on what action to take in response to a
medical emergency.
•
Detailing communication requirements.
•
Providing templates to facilitate the medical emergency response.
•
Specifying equipment / facilities / resources that are available during the medical emergency.
1.3
Scope
This MER Manual covers
Site Name
and associated operations that comprise:
•
•
An overview of the site and associated facilities is presented in Figure 1
Figure 1 Overview of Facilities
An overview of the MER response for the site is provided in Attachment 1.
1.4
Site Characteristics
The details of the site are presented in Table 1.
Table 1 Site Characteristics
Site Category
Nature of Site
Activities Performed at Site
Population at Site
Hours of Operations
Specific High Risks
1.5 Related Business Control Documents
Code of
Practice
Procedures
Ambulance Code of Practice
Medical Emergency Response Manual Part I
E R Document: Part III Contingency Plan : Vol.
2 : Well Engineering
PR-1243
PR-1287
E R. Document(s) part III, Contingency Plan
Vol. 3 : Production Operations
E R Document: Part III Contingency Plan Vol.
14 : Government Gas System
PR-1066
E R Document: Part III Contingency Plan :
Mina Al-Fahal Offices
E R Document: Part III Contingency Plan :
Vol. 9 : Air Operations
PR-1329
PR-1246
PR-1269
2 PDO MER PROCEDURE:
2.1 Overview
2.2
First Response and Call Out Procedure
The ‘First Response personnel at the emergency location shall:
•
•
•
•
Take immediate action in case of a medical emergency; call 5555
Contact the nearest Designated First Aider (DFA);
Advise the Site Manager and the Site Medical Professional of the emergency (often through a site
control center (CCR) or radio room).
Provide information about:
o Location of the emergency;
o Number of casualties and condition of these casualties (vital life support)
o Situation on Site;
o Identity of caller.
On the receiving side (Site Manager, site control centre, radio room) shall:
•
•
•
•
•
2.3
•
•
•
•
•
•
•
Ensuring all essential information is captured, perform confirmation of emergency location;
Inform and alert relevant MER personnel e.g (Site Manager, Site Medical Professional, where
applicable nearest DFA) through telephones and or paging system, radio etc
Maintaining communication with the emergency site;
Imposing radio silence and discipline;
Accurate note taking throughout the emergency.
Tier 2-3 Medevac Procedure
The Site Medical Professional shall communicate with the personnel at the emergency
location, advise the Site Manager and go to the emergency location immediately if
warranted;
If significant transport is needed to mobilize more Medical Professionals to the casualty
(e.g. helicopter flight, long overland trip in ambulance), this shall require approval of the Site doctor,
site manager or MCC.
The Site Medical Professional shall advise the Site Manager of the need and conditions
(urgency, ambulance or common vehicle) for transport of the casualty to the Site Clinic,
Extended Site Clinic or Tier 3 Hospital (Medevac);
If warranted, the Site Medical Professional shall consult with Remote Medical Support (MCC) and
continue to do so during the emergency;
The Site Medical officer or deputy shall take the final decision on the need for Medevac and the way
it shall be executed;
If an aircraft is needed for the Medevac, the Pilot or the Vessel Master shall advise
the Site Manager on their ability to transport the casualty and they shall have the right to
refuse or delay the transport if in their opinion the prevailing conditions entail unacceptable
risk;
If it is decided to proceed with the Medevac:
1) The Site Medical Professional in liaison with site manager shall:
o Be in command and issue the corresponding instructions and nominate
o communicators, observers and record keepers for the duration of the emergency;
o Send a Tier 2 MER Professional to the casualty who shall accompany the casualty
o during the Medevac;
o Impose radio silence and discipline as appropriate;
o Mobilise the MER assistants (stretcher bearers etc. as appropriate) to the
o emergency location;
o Call Out the aircraft or ambulance.
o Advise the Tier 3 Hospital of the imminent arrival of a casualty.
o Inform PDO Emergency Duty Coordinator;
o Inform the relevant authorities directly involved in the MER;
o May delegate tasks to subordinates.
2) The Site Medical Professional shall:
o Coordinate the medical actions of his team (DFAs, MER assistants, other Tier 2
MER Professionals);
o Provide relevant medical information about the casualty to the service providers,
such as ambulance service and Tier 3 Hospital;
o Advise the MCC or Company Health Adviser
3) The Emergency Duty Coordinator, DD shall:
o Advise the PDO Company management;
o Inform relevant authorities;
o Maintain contact with the PDO press if warranted;
o Contact Next of Kin of the casualty(s)
4) The Company Medical Officer on site shall:
o Contact the Tier 3 Hospital;
o Advise Emergency Duty Coordinator.
The Tier 2-3 Medevac Procedure shall contain up to date and complete list of emergency communication
information (telephone numbers, radio frequencies, contact persons).
2.4
Tier 4 Medevac Procedure
If appropriate specialist medical care (Tier 4) is required and available in country of operation, the decision to
transfer the client to Tier 4 hospital is at the discretion of the treating doctor at Tier 3 hospital. Transport out
of Oman will require the approval of PDO MCC/health adviser and PDO management. Requirements for local
government authorisation prior to transport out of country shall also be considered.
2.5 Site MER Infrastructure
The infrastructure that is available to provide support in the event of a medical emergency is
presented in Table 2.1
Table 2.1 Infrastructure of Surrounding Area & their Contacts
Facility Type
Facility Name
Distance
Contacts
Tier 3 Hospital
Tier 4 Hospital
Nearby
Clinics
Level 1 call
Level 2 call
Level 3 call
Airstrips
Areas to avoid during MER
Adjacent Facilities (including
3rd party) that can provide
support
N.B. Medical Facilities Levels of Call in case of MCI on instructions from Site Medic/ Site
Manager:
Level 1 call: Number or Nature of casualties requires summing help from some of the nearby clinics
Level 2 call: Number or Nature of casualties requires summing help from all clinics within the area
Level 3 call: Number or Nature of casualties requires summing help from clinics outside the area
2.6
Site Specific General Infrastructure
A diagrammatical representation of the infrastructure of the surrounding area is given in Figure 2.1.
Figure 2.1 Overview of infrastructure of surrounding area
3
3.1
Site Specific MER Organization and Resources
MER Organization
An overview of the MER organization at the site is presented in Figure 3.1
Figure 3.1 MER Organization
On-Scene Commander
Company Health
Advisor/ PDO Doctor
Site Medic
Clinic
Dedicated Site
First Aiders
Remote Medical
Support
First Responder
A list of the designated first aiders, medical professionals and remote medical support provider(s)
together with contact information is provided in Attachment 2.
3.2
Site Specific MER Manual Responsibilities
The responsibilities for management and maintenance of MER Site Specific manual are:
Site Manager, The most senior responsible position on the Site (e.g. Senior Site Supervisor)
•
Ensuring this MER Manual is distributed and understood by the workforce.
•
Ensuring process is in place to maintain MER Manual.
•
Ensuring MER exercises are performed in line with company requirements
•
Liaising with Site Medical Professional
•
Maintaining MER Manual and contact information.
•
Verifying medical equipment is maintained.
Roles and responsibilities for key personnel during MER, in the form of checklists, are provided in
Attachment 3.
3.3
MER Equipment
An overview of the site MER equipment is presented in Table 3.3 below
Table 3.1 MER Equipment
Medical Facilities on Site
Location of Site Control Center
Communication Facilities
MER Equipment
First Aid Boxes
(see Attachment 4)
Automatic External Defibrillators
(see Attachment 4)
Medevac Transport
For details and contact information see Attachment 5
4 MER Procedures Checklists
ER procedures have been developed to provide guidance on tasks to be performed during a medical
emergency. These are provided in the form of flow charts providing an overview of the process and
required action to respond to the following MER events:
Tier 0 - 1 First Response and Call Out Procedure
Tier 2 – 3 Medevac Procedure
Tier 4 Medevac Procedure - Transfer to Specialist Hospital
Multiple Casualty Incidents (MCI)
•
o
Nothing in this document is intended to prevent the Incident Commander from
using their judgment or expertise to initiate necessary action to secure the safety of the
facility and its occupants during a medical emergency situation.
4.1
Information Prompt List
It is important when providing initial details of the medical emergency to provide as much
information as possible. To assist with this an emergency response prompt list has been developed
and is provided in Attachment 6.
4.2
MER Contact Information
The contact details for personnel that would provide support in the event of a
medical emergency is provided in Attachment 2 – Medical Personnel.
4.3 First Response and Call Out Procedure
MEDICAL EMERGENCY RESPONSE
CHECK?
First Response and Call Out
First Responder identifies injured party and makes initial assessment
Contact
Designated First Aider (DFA)
Notify Site Control Center of Potential Medical
Emergency and recommended response
Make Area Safe
Stabilize Injured Party until
Designated First Aider
arrives on site
≤ 4 minutes
Designated First Aider arrives on
site and assesses injured party
Tier 2 activation
required?
Yes
Initiate Tier 2-3 Medevac Procedure
No
Treat injured party at site
4.3
Tier 2 –3 Medevac Procedure
4.4
Tier 4 Medevac (Tier 3 to Tier 4 Hospital) Procedure
Note: this procedure is not site controlled, but managed by the Medical Professionals.
4.5
Multiple Casualty Incidents (MCI) Procedure
* Responsibilities associated with Multiple Casualty Incidents (MCIs) are outlined in Attachment 7.
* Triage Protocol for MCI is outlined in Attachment 8.
5
5.1
Implementation and Performance Monitoring
Inspection and Maintenance Program
To ensure medical equipment is adequately maintained and will function as required during a
medical emergency an inspection and maintenance program is in place. The MER equipment forms
part of the routine inspection program and scheduled according to the table provided in
ATTACHMENT 4.
5.2
MER Exercises
A series of MER exercises shall be performed to test the effectiveness of the MER. The
requirements for holding drills and exercises is identified in PDO MER Manual PR-1243 (Appendix
2).
MER exercises are managed through the emergency response plan, which details the schedule and
type of exercises to be performed.
5.3
MER Skills Maintenance
To ensure the competency of MER personnel is maintained, there is a requirement for personnel to
meet the initial competency requirements and to undergo refresher training. The qualification
criteria and training requirements are defined in the PDO MER Manual section 3.2.3. Skills
maintenance is managed through the competency assurance program.
5.4
KPIs
Key Performance Indicators (KPIs) shall be developed, maintained and regularly reviewed to
monitor the implementation and effectiveness of Medical Emergency Response. KPIs developed
shall be specific and measurable and be monitored and reviewed as part of the HSSE monitoring
and reporting process.
5.5
Audits
Medical Emergency Response shall be subjected to periodic audits to assess compliance against the
requirement of the MER Standard. MER should be included in the Terms of Reference of local and
independent HSE Management System audits.
5.6
Management Review
The effectiveness of Medical Emergency Response shall be periodically assessed by management.
This Site Specific Manual should be reviewed and updated locally by medic in charge and sit
manager on an annual basis or if any changes to the Site specific contents is required. Regional PDO
doctor (MAF, North, South) should be informed upon completion of the review and updated if any
changes have taken place.
ATTACHMENTS
Attachment 1
Site Initial MER Response*
* Site Initial MER Response should be kept in a prominent, accessible place at the site. All Site
employees should be aware of its’ location.
Medical Emergency Response
Site:
Site Manager :
Emergency Action
Contact
Caall
ll 55555
555
•
Raise Alarm
•
Make Area Safe (if possible)
Provide details:
•
Stabilize injured party
•
# injured
•
Remain with injured party until medical assistance
arrives
•
Injury
•
Location
•
Cause of injury (if known)
Non Emergencies
For all other injuries and illnesses
Contact
•
Site medic : ……………………………
•
Use first aid kit, if necessary
On Site Medical Emergency Response Equipment & their Location
•
First Aid Kits
• Automatic External Defibrillator (AED)
* Please indicate down the DFA responsible for regular inspection and maintenance of Site FA Kits and
AED
Shift
A
B
On Site Medical Emergency Responders (DFA)
Name
Certification Location
Contacts
Attachment 2
Medical Personnel
Designated First Aiders Shift A (Please indicate personnel responsible for scheduled inspection of FA Kit & AED)
#
Name
Location
Latest Certification
Contacts
Designated First Aiders Shift B (Please indicate personnel responsible for scheduled inspection of FA Kit & AED)
#
Name
Location
Latest Certification
Contacts
On Site Medical Professionals
#
Name
Emergency Certification
BLS ACLS ATLS
Rig
Other
Medic
Remote Medical Support Providers
#
Name
Location
Location
Contacts
Contacts
Attachment 3
MER Responsibilities
First Responder
‰
Assess Scene and communicate with site ETO/CCR/Telephone Operator
‰
Make Area Safe for patient and responders
‰
‰
• If unable to make area safe – move casualty to safe location (if safe to do so)
Provide Care – remember Do’s and Don’ts
Handover to DFA – communicate information on injuries, action taken and cause of injury (if known)
Designated First Aider
‰
‰
‰
‰
Assess Scene and condition of casualty
Provide Care - provide initial first aid care and stabilize patient
Call Out - alert Tier 2 MER professional of medical emergency
Provide Care -remain with patient and await arrival of Tier 2 MER professional
Tier 2 Professional (on site)
‰
‰
‰
‰
‰
Assess Scene and condition of casualty
Provide Care - provide care to stabilize / treat patient
Consult Medical Support Provider – obtain advice (as required) on diagnosis / treatment
Communicate Medevac requirement – notify Incident Commander of required Medevac response
Accompany Patient to Tier 3 hospital (if medevac required)
Remote Medical Support
‰
‰
Provide Advice - readily available to provide advice to the site Tier 2 Professional
Facilitate Response - provide assistance with response (as required)
Incident Commander
‰
‰
‰
‰
‰
Coordinate Response
Verify Tier 2 Professional notified
Verify Medevac organized
Verify Hospital notified
Ensure Shell Health Provider notified
Attachment 4
Medical Equipment
Medical Equipment on Site – First Aid Boxes
#
Location
Size
Medical
Inspection Date
1
2
3
Medical Equipment on Site – Automatic External Defibrillators
#
Location
Make & Model
Medical
Inspection Date
1
2
3
Frequency for Scheduled Clinic MER Equipment Inspection*
#
Medical Equipment
Frequency
1
2
3
4
5
6
7
8
Defibrillators
Oxygen Cylinders
Emergency Bags
Emergency Drugs
Crash Box/ Trolley
ECG
Communication Modes
Ambulance
9
Other MER Equipment as per MER
Manual PR-1243 Appendix 4
Twice/ week or After Use
Once/week or After Use
Once/2 weeks or After Use
Once/week or After Use
Once/week or After Use
Once/week or After Use
Once/week
Daily by Ambulance Driver
Once/week by Medic
Once/2 weeks or After Use
* A signed Check-list should be kept attached to these items
Notes
Attachment 5
Medevac Resources and Contact Information
Medevac Personnel (Ambulance Drivers) Details and Contact Information
Name
Location
Contacts
Mobilization Time /
Restrictions
Equipment
Attachment 6
Initial Caller/Telephone Operator – Action Check List
Initial Caller/Telephone Operator – Assessment Prompt List
Description
Location of incident
‰
‰
‰
‰
‰
‰
‰
‰
Number of casualties
Nature of Injuries / Illness
Time of Incident
Cause of Incident
Name of Casualty
Age of Casualty
Sex of Casualty
Status
Area secure
‰
‰
‰
‰
‰
Personnel dealing with incident
Number of personnel involved
Contained or escalating
Current response activity
Response Requirements
Immediate response needs
‰
‰
Longer term response needs
Contact Information
Name of Informant
‰
‰
‰
Position / Responsibility
Contact Numbers
Attachment 7
Multiple Casualty Incidents (MCI) - Responsibilities
On-Scene Commander
‰
‰
‰
‰
Assess Scene
Assign MER Team - to coordinate:
•
Rescue
•
Triage
•
Treatment
•
Medical supplies
•
Communications
•
Transportation
Verify Primary Search complete
Coordinate and Monitor MER
Site Medical Professional
‰
‰
‰
‰
Coordinate medical supplies and manpower
‰
Communicate with remote site medical support, public health authorities, incident commander (as
appropriate)
Verify number and type of casualties
Coordinate Triage and treatment of casualties
Coordinate patient evacuation
Rescue Team Leader
‰
Coordinate and conduct primary search
‰
Notify casualty numbers – notify Site Medical Professional and Incident Commander once primary search
completed, transfer of casualties to triage area
Logistics
‰
Identify Transportation area – select area which allows easy access from ambulance staging and treatment
area
‰
‰
‰
‰
‰
Coordinate patient transportation - in priority order as determined by Triage and Treatment Officers
Request additional ambulances and air operations resources
Coordinate helicopter / ambulance operations
Acquire and distribute medical equipment and supplies
Maintain records on where casualties were dispatched
Communications
‰
Establish and maintain communication with appropriate company and local authorities as per the emergency
response plan
Remote Site Medical Support
‰
‰
‰
Provide advice and support to the onsite medical professional
Arranging mobilization of additional medical resources to site (as required by the incident)
Coordinating medical response with local and company health authorities
Attachment 8
Multiple Casualty Incidents (MCI) – Triage Protocol
Triage – Mass Casualties and Multiple Injuries
Triage is the sorting or prioritising of MER action based on need for treatment and the available
resources to provide it. In simple terms it aims to ‘do the most for the most gain’. In cases of
multiple causality incidents it also refers to sorting of those who should be treated first because
their problems require priority attention or which patients need to be transferred to a higher care
centre first.
Triage can be performed quickly using START Protocol (Simple Triage And Rapid Treatment):
Guidance of Stages of Triage
Stage 1 – RED - Immediate aggressive resuscitation. Conditions that are a threat to life or limb
with imminent risk of deterioration (e.g. tension pneumothorax or conditions of deep coma,
respiratory rate of <10, or >29).
Stage 2 - YELLOW – Urgent emergency attention required. These are conditions that could
potentially progress to a serious problem requiring emergency intervention, e.g. previously
stable vital signs but clinical suspicion of ectopic pregnancy, proximal long fractures.
Stage 3 - GREEN – Emergency action is delayed or non urgent till concurrent stages 1-2 above
are stable or transferred. Conditions where level of seriousness could benefit from reassurance
and intervention can be delayed for 1-2 hours. Usually relate to mere distress, e.g. sprained
ankle.
Stage 4 - BLACK – The casualty is dead or in a terminal state and beyond resuscitation.
It should always be kept in mind that this staging may not be static, the three main natural steps
of resuscitation should be followed – assess & triage, treat and re-evaluate.
Attachment 9
Hazards and Effects Management
Hazards And Effects Management
This section outlines the risk assessments that have been performed to demonstrate that
the risks associated with medical emergency response have been reduced to As Low As
Reasonably Practicable (ALARP).
Classification of Site Category
•
Classification of Site Category.
Waivers / Deviations
•
Waiver for not having a Site Clinic.
Non Routine Activities
•
List of Non-routine Activities and associated risk assessments or references to
these studies.
Tier Response Times Cannot Reasonably Be Achieved
•
List of ‘Sites and workgroups where Tier response times cannot reasonably
achieved’ and associated risk assessments or references to these studies.
Site Medical Review
•
Reference to Site Medical Review.
Site Specific Risk Assessments
•
Reference to Site-specific risk assessments (e.g. Health Risk Assessment, Impact
Assessment).
ALARP Demonstration
•
Risk assessment (or references to the study) to demonstrate that chosen alternative
solution for smaller Sites not having a Site Clinic ensures risks are ALARP.