Businesses increasingly conduct operations in remote areas where medical evacuation [Medevac(s)] carries more risk. Royal Dutch Shell developed a remote healthcare strategy whereby enhanced remote healthcare is made available to the patient through use of telemedicine and telemetry. To evaluate that strategy, a review of Medevacs of Shell International employees [i.e. expatriate employees (EEs) and frequent business travellers (FBTs)] was undertaken.A retrospective review of Medevac data (period 2008-12) that were similar in operational constraints and population profile was conducted. Employee records and Human Resource data were used as a denominator for the population. Analogous Medevac data from specific locations were used to compare patterns of diagnoses.A total of 130 Medevacs were conducted during the study period, resulting in a Medevac rate of 4 per 1000 of population with 16 per 1000 for females and 3 per 1000 for males, respectively. The youngest and oldest age-groups required Medevacs in larger proportions. The evacuation rates were highest for countries classified as 'high' or 'extreme risk'. The most frequent diagnostic categories for Medevac were: trauma, digestive, musculoskeletal, cardiac and neurological. In 9% of the total, a strong to moderate link could be made between the pre-existing medical condition and diagnosis leading to Medevac.This study uniquely provides a benchmark Medevac rate (4 per 1000) for EEs and FBTs and demonstrates that Medevac rates are highest from countries identified as 'high risk'; there is an age and gender bias, and pre-existing medical conditions are of notable relevance. It confirms a change in the trend from injury to illness as a reason for Medevac in the oil and gas industry and demonstrates that diagnoses of a digestive and traumatic nature are the most frequent. A holistic approach to health (as opposed to a predominant focus on fitness to work), more attention to female travellers, and the application of modern technology and communication will reduce the need for Medevacs.
Abstract Description of the Proposed Paper Remote Health Care strategy (RHC) is an integrated approach, developed for delivery of health care in Arctic operations. It meets medical emergency response requirements and supports our principle "No harm to people". RHC includes aspects of: prevention; technology; supplies/equipment, competence and communication. It brings a virtual hospital to a patient, rather than taking a patient to a hospital. We will present outcomes of implementation in Greenland, Siberia and W-Africa. We will add to these experiences with comparative data analysis of global cases in expatriates, business travellers and Marine Operations where RHC was not in place. We will discuss how RHC could have impacted these outcomes and look prospectively at benefit in future Arctic operations. Application RHC is uniquely applicable in the Arctic but it is also applicable in any remote area of the world. In less geographically remote regions where the main restriction is lack of infrastructure, it can improve access to health by improving prevention, networking, decision support, access to external resources and education. It was designed to support operations but can be adapted and scaled to support community health and underpin strategic social investment. RHC is one model to move towards the recently articulated goal of the International Maritime Organization of delivering the same quality health care off shore as on shore. Results, Observations, and Conclusions We will demonstrate how one can improve health outcomes in the absence of local health infrastructure by employing RHC. We will show how our strategy is supported by a retrospective analysis of original data and vindicated by early experiences of deployment. We will demonstrate how RHC is supporting pilot projects in community health in a region with lack of access to health care. We will showcase results of an original review in our marine operations and how this supports a future RHC approach in our vessel fleet. Significance of Subject Matter The RHC strategy is a game changer for the industry, allowing it to operate safely despite lack of local health infrastructure, lack of rotary wing support and in harsh conditions where access to traditional modes of medical care is foresee ably not available. With highly-elliptical orbit satellite, sensor, near patient technology and streaming imaging rapidly improving, the real challenge lies in combining technology with enhancing capacity, competence, mind-set and behaviours of on-site medical practitioners, distant medical top side cover and even for recipients of care.
This study examines whether the availability of telemedicine on offshore installations reduces medical evacuation rates.This is a prospective cohort study on offshore platforms in the United States, Malaysia, and the United Kingdom. Emergency evacuation rates were compared between locations with telemedicine (United States) and 2 control groups without telemedicine (Malaysia, United Kingdom).Three hundred eighty-four cases in the telemedicine group and 261 cases in the control groups were included. The odds (adjusted and unadjusted) of medical evacuation were significantly higher for assets without telemedicine, contractors, and age older than 60 years. Analysis indicated a shift from emergency evacuation to routine transport for the telemedicine group.Telemedicine reduces emergency medical evacuations from offshore installations. This reduction is likely due to an increased capacity for transforming emergency care into routine care at the offshore location.
Many studies have explored the risk perception of frequent business travelers (FBT) toward malaria. However, less is known about their knowledge of other infectious diseases. This study aimed to identify knowledge gaps by determining the risk perception of FBT toward 11 infectious diseases.Our retrospective web-based survey assessed the accuracy of risk perception among a defined cohort of FBT for 11 infectious diseases. We used logistic regression and the chi-square test to determine the association of risk perception with source of travel advice, demographic variables, and features of trip preparation.Surveys were returned by 63% of the 608 self-registered FBT in Rijswijk, and only the 328 completed questionnaires that adhered to our inclusion criteria were used for analysis. The majority (71%) sought pre-travel health advice and used a company health source (83%). Participants seeking company travel health advice instead of external had significantly more accurate risk knowledge (p = 0.03), but more frequently overestimated typhoid risk (odds ratio = 2.03; 95% confidence interval = 1.23-3.34). While underestimation of disease risk was on average 23% more common than overestimation, HIV risk was overestimated by 75% of FBT.More accurate knowledge among FBT seeking company health advice demonstrates that access to in-company travel clinics can improve risk perception. However, there is an obvious need for risk knowledge improvement, given the overall underestimation of risk. The substantial overestimation of HIV risk is probably due to both public and in-company awareness efforts. Conversely, typhoid risk overestimation was statistically associated with seeking company health advice, and therefore specifically reflects the high focus on typhoid fever within Shell's travel clinic. This study serves as a reminder that a knowledge gap toward infectious diseases besides malaria still exists. Our article will explore the future requirements for more targeted education and research among FBT in companies worldwide.
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