1. Introduction... 2 Medical screening... 2 PADI... 2 Insurance... 2 Roles in the event of an emergency... 2
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1 Medical and Evacuation Procedures Borneo 2019
2 Contents 1. Introduction... 2 Medical screening... 2 PADI... 2 Insurance... 2 Roles in the event of an emergency Medical facilities and evacuation routes... 3 Lesan Conservation Forest site... 3 Derawan Island Evacuation procedures Reporting and Logging Mass Evacuations and Disaster Management... 5 Major Incident With Prior Warning... 5 Major Incident With No Prior Warning... 5 Last updated: 18 August 2017 Med & Evac Procedures Borneo
3 1. Introduction Medical screening As with all expeditions careful planning is essential to ensure that all individuals enjoy a safe successful trip. Some members of the expedition team (including all volunteers and staff) may have significant pre-existing health problems or disabilities, which in the field, could potentially jeopardize their safety. As a result all participants are required to complete a medical questionnaire prior to their departure. These details are collected prior to the expedition through the Opwall portal ( and are sent to both medics and our insurers so we re able to discuss any implications to the site medical kit or the individual s itinerary. All medical details are assessed and discussed at a pre-expedition medical meeting. The team of medics will discuss any potential medical issues, advise anyone if a further consultation with a medic is required and will also suggest additions to the medical kits in light of any pre-existing health problems highlighted. The details are distributed to camp managers and taken out to site. PADI All those who are undertaking a diving or snorkelling element during the expedition will be required to complete an additional PADI (Professional Association of Dive Instructors) medical questionnaire according to the rules and regulations set out by PADI. Like the Opwall medical questionnaire, this is completed online via the Opwall portal. All individuals who answer yes to any of the questions on the form will be required to get their GP or, in many cases, a dive medic, to sign a declaration which can be printed out from the portal after filling in the form. This declaration can then be uploaded to the portal or ed to your nearest Opwall office. Insurance All staff and volunteers are covered by insurance purchased by Operation Wallacea which includes medical costs and repatriation of 1million. Operation Wallacea staff have determined evacuation routes from each site including overland and by air, the western standard hospitals that will be used and the costs, so that if evacuation is required there is no delay in the insurance company approving the evacuation and medical costs. Roles in the event of an emergency Carefully planned evacuation protocols are in place for the Desan forest and the Derawan island sites. All staff will have training on the evacuation procedures and protocols. Because of the variability of influential factors such as weather conditions and nature of potential injuries, a number of different evacuation scenarios must be prepared for prior to the season. All staff are fully briefed in these scenarios, and this report describes the most commonly used and available evacuation options. It is the responsibility of the site manager at the relevant site to determine if an emergency scenario exists and to ensure the patient is stabilised ready for evacuation. If necessary they can consult with the emergency medical assistance providers (via the insurance policy) or with doctors from the target hospital by phone. The site manager at each of the sites is also responsible for ensuring that all relevant staff are aware of the ongoing incident and follow up actions. All staff involved in the major accident or emergency procedure should keep detailed notes of times, actions taken, contacts made, costs incurred etc. After the incident has been closed it is the responsibility of the site manager to compile a detailed report Last updated: 18 August 2017 Med & Evac Procedures Borneo
4 and submit this to the Opwall office. The type of evacuation should be classified as Medium Priority, High Priority or Emergency. Medium Priority Cases in which the patient is in no immediate danger but the onsite facilities and local facilities are unable to cope were their condition to deteriorate or where the condition cannot be assessed on site. This requires the patient to be moved as quickly as possible without the need to hire special vehicles to the nearest appropriate suitable local facilities. High Priority Cases where the patient s health is at risk if immediate action is not taken. An example of this is a broken bone. This requires the patient to be moved as quickly as possible by ambulance to the nearest appropriate suitable local facilities. Emergency Priority Cases where the patient s life is at risk if immediate action is not taken. An example of this is a snakebite suspected to be from a venomous species. This requires the fastest possible transfer by vehicle or air to a western standard hospital. 2. Medical facilities and evacuation routes This information was put together in August 2017 based on a site visit in April 2017 and will be updated again by a senior Opwall staff member visiting 6 months before the start of the first survey season. Lesan Conservation Forest site There will be a qualified doctor, accident or emergency nurse or paramedic on site at all times when the surveys are underway. There is a boat on standby at all times on the river next to the main camp. If there is an evacutaionrequired then the procedure will be for the Lesan Conservation Forest camp manager to radio through to the Operation Wallacea Trust (OWT) team who are based with a 4 wheel drive vehicle in Kelay village to meet the boat as it arrives with the patient (approximately 1 hour in the boat). The vehicle transfer to the hospital in Tanjung Rehab is then 2 hours by road. Students leaving the camp will be working on one of the four transects that have been installed in the forests being studied and will have a guide and scientist leading each of the groups with walkie talkie radio connections back to base camp. If an injury happens on one of the transects then the camp manager organises for a stretcher which will be kept in camp to be taken out to the site aklong the transect where the injury has occureed and local staff will carry the patient back to the main camp with the doctor rendezvousing with the patient in the shortest possible tme from their base in the camp. Emergency, high priority and medium priority evacuations These will all be taken using the boat and vehicle route described above to the Bersalin Berau Hospital, Jl. Rambutan 77311, Maluang, Tanjung Redeb. The only difference between the levels of evacuation sis that for emergency evacuations the ambulance will be despatched to intercept the vehicle coming from Kelay village. The Bersalin Berau hospital is western standard hospital built to support the palm oil and logging industry and has large outpatient and inpatient departments, including laboratories, a diagnostic unit with x-ray and ultrasound, male and female wards, snake antivenom and operating theatres. Last updated: 18 August 2017 Med & Evac Procedures Borneo
5 Phone: Derawan Island There will be a qualified doctor, accident or emergency nurse or paramedic on site at all times when the surveys are underway. There is a boat on standby at all times at the Derawan Dive Resort and in the event of an emergency then the procedure is to take the patient by boat (40 minutes) to the hospital in Tanjung Batu. There is suffcient oxygen at the Derawan Dive Resort to evacuate two patients at a time to the hospital. There is a medical centre on Derawan island which has basic medical supplies for minor injuries and a nurse on standby to support the tourist industry on the island. However, for minor injuries these will be treated by the Opwall medic on site. Emergency, high priority and medium priority evacuations The procedure is to transfer patients by boat to Tanjung Batu (40 minutes) with the Opwall medic and oxygen if needed. If the medic is off site then the diving operations need to stop until he returns. The boat will be met at the jetty by an ambulance if an emergency evacuation or a 4 wheel drive vehicle if a High Priority evacuation for the 10 minute transfer to the Derawan islands Hospital, Jl. Sabbaani, Tanjung Batu. This hospital has doctors and basic facilities but does have a recompression chamber for any diving related incidents. For more serious injuries then the ambulance would continue to the Bersalin Berau hospital (2.5 hours) Air evacuations In an extreme situation requiring an air evacuation (such as a serious spinal injury or adverse weather conditions making a boat transfer from Derawan impossible) then a helicopter would be needed from PT National Utility Helicopters, Jl. Sultan Hasanudin, Kariangau, Balikpapan Bar., Kota Balikpapan, Kalimantan Timur 76134, Indonesia 3. Evacuation procedures It is the responsibility of the site manager at the relevant site to determine if an emergency scenario exists and to ensure the patient is stabilised ready for evacuation. Once a major incident or emergency at any of the Borneo sites is identified, the Opwall UK office, which is manned 24/7, must be notified. The site manager will decide the level of emergency evacuation required for the patient in consultation (if required) by phone with the on site medic and doctors from the medical assistance providers or the local hospital. These should be classified as Emergency (requiring the fastest possible transfer by air to hospital facilities), High Priority (requiring the patient to be moved at the fastest speed possible by to hospital facilities) or Medium Priority (requiring the patient to be moved as quickly as possible without the need to hire special vehicles or boats to the nearest appropriate medical facilities). In all Emergency or High Priority cases where a patient is being transferred to medical facilities they should be accompanied by one of the Operation Wallacea staff. All staff involved in the major accident or emergency procedure should keep detailed notes of times, actions taken, contacts made, costs incurred etc. After the incident has been closed it is the responsibility of the site manager to compile a detailed report and submit this to the insurance company for processing. Last updated: 18 August 2017 Med & Evac Procedures Borneo
6 4. Reporting and Logging During evacuations it is crucial that a log is kept on site by the site manager and by the Emergency Coordinator in the UK office detailing times, personnel involved and all relevant details of each step of the evacuation process. All medium priority evacuations must be logged by the site manager and included in the post-season report. For high priority and emergency evacuations the site manager and Emergency Coordinator and any other staff involved in the incident must make a report immediately following the incident. A full safety assessment must be carried out after all evacuations and if a similar incident is likely all activities must be stopped until the situation has been rectified. The Emergency Coordinator will collate the reports of all high priority and emergency evacuations and will submit the final report to the UK office. The Emergency Coordinator will also submit the costs and report to the insurance company for re-imbursement of costs. 5. Mass Evacuations and Disaster Management There is the possibility, albeit incredibly small, that a large scale incident could occur which would require a large number of Operation Wallacea volunteers and staff being repatriated. Such incidents could include political unrest, natural disaster and terrorist attacks. These incidents can be broken into two types, those with prior warning and those without. Major Incident With Prior Warning Some major incidents come with a degree of prior warning. A good example of this is political unrest resulting in violent clashes in the area in which we are operating, which would have a build up period. We constantly monitor the political situation of the area we work in and our partners on the ground are the Operation Wallacea Trust (Indonesia) who have a permanent presence on site year round and are well connected politically. If they advise that the political situation has become unsafe they we would order a full evacuation. In such an incident the Emergency Coordinator would liaise with the insurance company and relevant embassies to agree the best route for repatriation. Major Incident With No Prior Warning Some incidents, such as a terrorist attack or natural disaster, would have no prior warning. In cases such as these the field staff would get all volunteers and staff to a place they deemed safe by which ever means they decide best. From here the Emergency Coordinator would contact the volunteers embassies to coordinate an evacuation strategy. The details of such an evacuation would vary dramatically depending on the situation and as such it is impossible to produce highly detailed procedures. Last updated: 18 August 2017 Med & Evac Procedures Borneo
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