Treatment at a distance

The steady northward move of Norway’s petroleum operations is taking them steadily further from civilisation and hospitals. But that does not need to mean a long way from health care.

Medical evacuation becomes challenging in the Barents Sea because of the distances involved, and makes big demands on emergency response plans.

In the south-eastern sector opened for exploration in 2013, for example, flying time to and from the blocks furthest from land is likely to be two hours each way.

Communication over great distances is a familiar problem to Torkjel Tveita, professor and consultant at the intensive care unit of Tromsø University Hospital in northern Norway.

“One of the most distinctive features of health provision in this region is precisely the long transport stretches involved,” he observes.

“We’ve overcome this challenge with an approach where we start treatment already in the patient’s home in order not to waste valuable time en route to hospital.”

As an example, he cites a person living far from the nearest hospital who experiences chest pains. Specially trained paramedics fly to this patient and do an electrocardiogram (ECG).

The results are transmitted to the hospital. If an acute heart attack is diagnosed, the paramedics can start immediate treatment to open a blocked artery. Important time is saved.

Hypothermia

Tveita has done considerable research on involuntary loss of body heat (hypothermia), where successful trials have also been conducted in taking the hospital to the patient.

“When people get so chilled that they suffer heart failure, they must be warmed up in a heart-lung machine,” he explains. “That used to be possible only in hospital, but small models in a transportable size have now been developed.

“Imagine somebody has fallen in the sea and got so cold their heart has stopped beating. With a helicopter 90 minutes away, the total journey time could make saving the victim unrealistic.

“But flying in a mobile heart-lung machine with qualified personnel who know how to connect it up means we’ve not only taken a bit of the hospital to the patient, but half the intensive care unit.”

Three hours

According to the petroleum industry’s own guidelines, it must not take more than three hours from the time an injury is reported until the patient reaches hospital.

That cannot be achieved in remoter areas, such as Barents Sea South-East. Alternatives proposed include increased medical preparedness and more use of telemedicine.

Tveita agrees that the latter can help to improve acute medical interventions on an offshore installation. But a life-threatening injury requiring long-distance transport calls for a completely different level of expertise, he emphasises.

“While telemedicine is OK for making a diagnosis, you need to be aware of its limitations. Advanced medical treatment requires specialist knowledge and equipment at both ends of the phone line.

“We may also have to think in terms of more stringent health requirements for personnel who’re going to work far from land in the Barents Sea.”

Unnecessary

For his part, Roy Erling Furre, second deputy leader at the Norwegian Union of Energy Workers (Safe), believes the system must be so good that tougher standards of this kind become unnecessary.

“I’d prefer to see what improvements can be made to emergency preparedness, so you don’t have to be Superman to go offshore,” he says. “Don’t forget these are supposed to be ordinary workers.”

But he nevertheless agrees that medical staff on the facilities will need to have additional expertise.

“Although the industry is initially due to operate in waters close to land, weather conditions in the Barents Sea are less predictable than elsewhere,” Furre notes.

“You may be unable to get a helicopter in the air, or have to wait offshore until a Polar storm has passed. That’s when the nurse or doctor on board need to be sufficiently well qualified.”

Not clear

Furre maintains that the regulations related to medical preparedness are not clear enough with regard to conditions in the far north.

“Our current rules were largely drawn up for activity in the established areas of the NCS, where we know the challenges well. I wouldn’t exclude the need for new requirements eventually.”

Responsibility for supervising medical preparedness on the NCS rests with the Norwegian Board of Health Supervision, through the county governor of Rogaland.

County medical officer Pål Iden points out that the HSE regulations assign responsibility for ensuring adequate health services on a facility – regardless of its location on the NCS – to the operator.

“It’s up to the industry to make risk assessments and define the acceptance limits. As the regulator, we’ll check that these meet the requirements for prudent activity.

“Regulations in Norway are developed through collaboration between companies, unions and government, so the authorities will be in close consultation on solutions in any event.”

Tveita is blunt about the key aspect of medical preparedness: “As with all other aspects of medicine, this primarily involves prevention. That is and will remain the most important aspect.”

Logistics and emergency preparedness in the Barents Sea Published: 20 February 2014