For many businesses, Occupational Health and Safety risk management may simply be a matter of training enough staff in first aid.

But when it comes to saving lives on a mine, rig or platform, especially where workers are in remote areas and often far from the nearest sophisticated hospital, having a qualified, experienced medical professional on hand can mean the difference between life and death.

While many other businesses rely on volunteer personnel recruited from the existing workforce Immediate Assistants Medical Director Dr Mark Gillett said this became challenging with the growing number of Fly In Fly Out (FIFO) workers who were less likely to put their hands up for the initial and ongoing training required.

“You also have to factor in the number of volunteers needed to meet health and safety requirements as well as the number of hours they will be away from their regular jobs for ongoing training and responding to potential emergencies,” Dr Gilllett, who is a busy Emergency Physician at a major metropolitan hospital, said.
Hiring from within the workforce is fraught with risks because even the most qualified onsite paramedics are limited in what they can do in a real emergency.

“Unlike a nurse or doctor, paramedics don’t have a license to operate solo,” he said.
“They need to work under a clinical governance framework.

“This means working under a senior Medical Director with drug licences, health-department approved protocols, certification procedures, ongoing education, professional development and adequate malpractice insurance coverage.”

A paramedic working independently of the State Ambulance Service or Health Department is unlikely to have a Poisons Permit, which is necessary before they can legally store and dispense even the most basic, over-the-counter medicines.

They are also unlikely to have adequate malpractice insurance coverage and will be unable to perform more complex life-saving procedures such as intubation (inserting a breathing tube), inserting an IV drip for fluid resuscitation or giving the pain relief drug morphine.

“Our Advanced Life Support Paramedics are so skilled in emergency response they can literally perform their tasks to treat a patient upside down, at night, in the dark with no problems at all.”

Immediate Assistants offers an alternative to in-house Emergency Rescue Team (ERT) services providing skilled personnel, state-of-the-art equipment and fire and rescue vehicles.

“We only employ paramedics and Emergency Services Officers (ESOs) with at least five years practical experience in civilian or military emergency services,” Dr Gillett said.

“It makes much more sense to compliment the best equipment with career professionals who have advanced training as well as years of experience under their belts.”

Immediate Assistants also provide full-time career professionals ESOs, highly skilled in vehicle rescue, fire-fighting, breathing apparatus and confined space rescue as well as vertical rescue.

Companies using Immediate Assistants services for their workforce also receive more bang for their buck because they will have access to full-time career professionals who have crossover training and hold nationally accredited qualifications.

“For example our paramedics and security guards have also been trained in rescue techniques as part of our policy of integrated emergency response,” Dr Gillett said.

“We believe this represents Best Practice in emergency response.”

These same paramedics also add value by being involved in Return to Work coordination, Drug and Alcohol Testing, a variety of wellness initiatives (dehydration, sleep apnoea, fatigue education, etc) and, because they are accredited trainers and assessors, providing nationally accredited training.

For more information about the services offered by Immediate Assistants, please visit www.immediateassistants.com or contact us on 1300 788 559 (Australia) or 0800 633 427 (New Zealand).

Immediate Assistants provide professional paramedics, emergency services officers and security guards to the resource sector across Australia and New Zealand.

Workers from Curragh Mine, 250 kilometres west of Rockhampton, can get on with their jobs safe in the knowledge that if sickness or injury strike they will receive qualified medical assistance despite the fact the nearest major hospital is hundreds of kilometres away.

Curragh Mine’s Executive General Manager Rod Bridges said having instant access to the very best in paramedic and Emergency Response personnel can make all the difference to Occupational Health and Safety, especially in rural or remote areas.

“Immediate Assistants’ paramedics working at Curragh bring a level of professionalism and training to the mine site that is second to none”, Mr Bridges said.

“Support can be as basic as removing a splinter to keeping someone who has had a heart attack alive until we get them to hospital.

“The paramedics work with the Emergency Services Officers that IA also provides: trained rescue professionals who can recover people from vehicles, put out fires and perform all those crucial emergency response operations.”

Mr Bridges said that with 1,200 employees on site, safety is a vital aspect of Curragh Mine’s business, and it depends upon Immediate Assistants.

“It’s essential that we can guarantee that our people can come to work and return home safely,” he said.

“IA paramedics’ level of training and medical expertise certainly helps us achieve our vision regarding the safety for the entire workforce on site.

“They have provided prompt back-up for a number of incidents during the past two to three years, we thank them for that, and we’re looking at a long-term relationship with Immediate Assistants.”

Having an on-site medical service means injuries such as strains and sprains can be diagnosed and appropriately treated on the spot, rather than sending employees off-site where they would often face the frustration of long waits for treatment and time off work.

This in turn incurs an unnecessary Loss Time Injury (LTI) burden.

Immediate Assistants’ paramedics are highly trained and experienced in Return to Work Co-ordination.

This helps to minimise LTIs, while at the same time, effectively and appropriately managing injured workers back to work earlier.

Immediate Assistants customised Wellness Programmes also positively contribute to worker education and preventative strategies.

“The paramedics and ESOs work well with our employees and members of the Emergency Response Team,” Mr Bridges said.

“Their level of professionalism, their level of training and medical expertise certainly guarantees that.

“It has proven to be a very successful partnership.”

For more information about the services offered by Immediate Assistants, please visitwww.immediateassistants.com or contact us on 1300 788 559 (Australia) or 0800 633 427 (New Zealand).

Immediate Assistants provide professional paramedics, emergency services officers and security guards to the resource sector across Australia and New Zealand.

QME Queensland Mining and Engineering Exhibition 2012

Mackay Showground, QLD
24-26 July 2012

Visit website

IQPC Mine Rescue and Emergency Management Conference 2011

Duxton Hotel, Perth, WA
29-30 November 2011

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The latest Immediate Assistants newsletter items:

• Paramedic treats double lightning strike victims at mine site
• Immediate Assistants provide peace of mind at Curragh Mine
• Outsourcing; a life-line for mines

Read or download November 2011 newsletter (PDF 220kb)

They say lightning doesn’t strike twice but Adam Tyne, Immediate Assistants’ Paramedic at a mine site 140 kilometres north of Mt Isa recently treated two employees who might dispute that.

“It was lunch time so everyone was making their way to the lunch room when the lightning struck without warning,” Adam said.

“Two people in separate areas of the camp reported feeling electricity pass through their bodies.”

A lightning strike represents a weather-related medical emergency and has the same effect as electrocution.

It can cause heart and lung damage, superficial burns, temporary paralysis, ruptured eardrums, loss of consciousness and cardiac arrest.

“Neither of the men, who were both in their early 20s, had burns so we know they didn’t suffer a direct lighting strike,” Adam said.

“One of them, a cook who was in the outside deck of the lunch room had worse effects than the other because he had cardiac changes on his ECG and was in quite a bit of pain.

“He happened to have titanium plates throughout his body from previous surgeries and it seems the lightning strike may have affected one of them.”

Being so far from the nearest hospital, Adam stabilised both patients and kept them comfortable until he could rendezvous on the main road 50 kilometres away with the Queensland Ambulance Service to take them into Mt. Isa.

Adam Tyne is a level five paramedic whose qualifications include advanced training in paramedical science.

by Dr. Adrian Cohen.

The first part of this article is easy: here’s a list of standard equipment for a mine ambulance:

• Paramedic Field Pack
• Stretcher
• Spinal set (CombiCarrier, headed, cervical collars)
• Extrication device (KED/RED)
• Limb splint set
• Oxygen C and D size cylinders
• AED

and here’s a list for a mine rescue vehicle:

• Turn out gear sets incl. boots/helmets
• BA sets complete with harness and mask
• Tally board
• Rope rescue packs
• Rescue tripod
• Vehicle rescue tools
• Glass management kit
• Vehicle airbags
• Hydraulic diesel pump
• Vehicle stabilisation Kit
• Fire suppression system

Like most things in the industry, these “things’ are easy: capex expenses, three quotes, preferred suppliers etc.

What’s not so easy is the CRUCIAL element without which none of the rest of this gear is worth a cent: the PEOPLE who make it work. The “necktop” computers, “meatware” for the hardware, the Human Resources that every mine operator knows are the essential ingredient in the Emergency Response pie.

So perhaps the question is equally WHO you need, as well as what.

Firstly, you’re going to need a Paramedic. And preferably one cross-trained in ERT skills so that they form a valuable part of the overall response team. But what’s a Paramedic, and how do you know a good one?

Any risk assessment of the resources industry will tell you that you need an Advanced Life Support Paramedic with a Diploma or Bachelor of Science and clinical experience. The Emergency Services Registry of Australasia (www.esra.com.au) was created to provide a reliable and consistent framework to credential paramedics and other rescue personnel: you need an ESRA Level 5 Paramedic.

Remember too that there are no “solo” paramedics: they must remain part of a continuum of care, commencing with a Medical Director, Clinical Governance Model, case-review, legally compliant medical record-keeping, insurance coverage, professional development and support.

Now, for the Emergency Services Officers (ESOs). Your risk assessment should again differentiate that the best people for this job are ones who do it for a living: career professionals who bring experience from civilian and military agencies to the resources environment. Your existing volunteer ERT personnel can play an important part of the overall response.

The necessary competencies are found in the Resource Industry Training Package RII30709: Certificate III in Mine Emergency Response and Rescue. They include sixteen units of competency made up of five mandatory units and eleven elective units.

Mandatory Units of Competency

1. HLTFA301B Apply first aid
2. RIICOM201A Communicate in the workforce
3. RIIOHS201A Work safely and follow OHS policies and procedures
4. RIIRIS201A Conduct local risk control
5. either
   RIIQUA201A Maintain and monitor site quality standards
   RIIGOV201A Comply with site work processes/procedures (Coal)

Elective Units of Competency

1. HLTFA402B Apply advanced first aid PMAOHS211B Prepare equipment for emergency response PMAOMIR444B Develop incident containment tactics
2. PUAAMS007B Coordinate search and rescue operations PUAFIR207B Operate breathing apparatus open circuit PUAFIR306B Render hazardous materials incidents safe
3. PUAFIR307B Monitor hazardous atmospheres PUASAR002B Undertake road accident rescue PUASAR004B Undertake vertical rescue
4. PUASAR005B Undertake confined space rescue PUASAR008B Search as a member of a land search team RIIERR201A Conduct fire team operations
5. RIIERR205A Apply initial response First Aid RIIERR301A Respond to mine incident RIIERR302A Respond to local emergencies and incidents
6. RIIERR303A Operate in self-contained regenerative oxygen breathing apparatus RIIERR304A Control emergencies and critical situations RIIERR305A Control underground fires
7. RIIERR306A Conduct underground search RIIERR307A Extricate casualties from underground incident RIIERR308A Extricate and transport people involved in incidents
8. RIIERR309A Establish and operate from fresh air base RIIERR310A Provide support for rescue operations RIIRIS301A Apply risk management processes

These qualifications are also ratified by the Emergency Services Registry Australasia (ESRA) www.esra.com.au

Now that the specifications for your team are set, and they have the right equipment, you are poised to perform well in the ERT environment. Provided that you make sure to provide plenty of opportunities for training your team, and once or twice a year you provided a realistic exercise to assess their skills (and those of the people around them as part of your Incident Management Planning).

In summary then, the equation looks like this:

Hardware (equipment and vehicles) + Humans (Level 5 Paramedics + career professional ESOs) = ERT Best Practice

reproduced with permission from APRS Pty. Ltd

Immediate Assistants has produced a set of Wellness brochures and posters, to address key health issues affecting employees. The brochures offer guidance for behaviour which results in improved personal health and reduced LTI.

The issues addressed include:

• Alcohol
• Dehydration
• Drug Education
• Fatigue
• Healthy Eating
• Skin Cancer Prevention
• Sleep Apnoea
• Smoking Cessation
• Weight Loss

Immediate Assistants supports this education campaign with training and safety monitoring programmes.

by Dr. Adrian Cohen

To date, the word “Paramedic” has been ill-defined. Anyone with basic ambulance service training, or a 7-10 day “EMT” or “Industrial Medic” course on top of a first aid certificate could claim to be a paramedic, because there was no accepted definition.

However, in 2010, the Emergency Services Registry Australasia (ESRA) was created to provide a reliable and consistent framework to credential paramedics and other rescue personnel.

For the first time, certification was linked not only to qualifications but also to experience. The basic qualification to be designated a Paramedic (ESRA Level IV) is a Certificate IV in Health Care (Ambulance), a minimum one years full time tertiary study level, which then needs to be followed by clinical placement within a hospital or ambulance service and meaningful, “realworld” experience.

Advanced Life Support and Intensive Care Paramedics (corresponding to ESRA Levels V and VI) require a minimum 3 years of study at the Diploma, Advanced Diploma or Bachelor of Science level and then clinical experience. So, freshly armed with a qualification and a brace of years in a state ambulance service, your Level IV Paramedic is ready to go…..or are they??

Once outside the confines of the ambulance service or health department, they are no longer able to utilise the Protocols and Procedures of those organisations. They are effectively “outliers”, marooned in a no-man’s land without clinical oversight, assistance from superiors or legal coverage for their actions. They cannot give medications, as without a Poisons Permit (different in each state jurisdiction and in the offshore environment), it is illegal to purchase, provide, store, carry and/or administer drugs. This even includes non-prescription and basic over-the-counter drugs, let alone complex antibiotic, analgesics (most especially narcotics like morphine) or intravenous fluids.

Only within an effective Clinical Governance model, comprising oversight, poisons licensing and legislative responsibility can a paramedic practice in their chosen profession.

Effectively, this means they must be employed by an organisation that provides all of these elements, in exactly the same way as their previous ambulance service or health department did.

There are no “solo paramedics”……..they remain part of a continuum of care, commencing with a Medical Director, Clinical Governance Model, ongoing education, case-review, legally compliant medical record-keeping, up-link to assistance, insurance coverage, Professional Development and support.

Companies that contract medical staff directly without approved Clinical Governance expose themselves to significant risk.

Best Practice in emergency response is enabled only after management accepts that given these real risks, the highest standard of holistic response must be afforded to and implemented across all operations.

Where best practice emergency response systems have been implemented, it is also generally the case that overall costs for maintaining these capabilities are lowered. Additionally, management is protected from OHS and legislative standpoints and production is quarantined from threat.

For the last 50 years, mines rescue has been evolving and coming to terms with the expectations of our modern age. Televised real-life rescues, reality television shows, “larger than life” film and TV productions and community expectation that “city-style? services be available in remote areas and offshore, fuel the need for mine management to be 100% certain that they can respond appropriately.

The long-anticipated OHS Harmonisation threatens more scrutiny, fines and conceivably individual criminal prosecution and jail-time. Everyone from the board room down to the boiler room, including managers, need to critically review the standard and capability of emergency response in place and ask some hard questions of your current paramedics or paramedical service company:

• What is your tertiary qualification and when was it obtained?
• Have you been recertified to this level since and, if so, by what organisation?
• What is your ESRA paramedic level?
• What Clinical Governance is provided for you?
• Who holds your Poisons Permit?
• What Protocols and Procedures do you operate under?
• When did you last undergo a recertification?
• What Professional Development activities do you participate in, and who
• approves or audits these?
• Who is your Medial Director?
• What Malpractice or Professional Indemnity insurance do you carry?
• Who do you call for help?

Professional paramedics can only exist within a professional organisation, medically governed and working within a robust Clinical Governance framework.

reproduced with permission from APRS Pty. Ltd

by Dr. Adrian Cohen

A complete emergency response capability is having the security of knowing that any and all emergencies at your site can be handled to the satisfaction of: the injured party, their colleagues, management, stakeholders, regulators and the community.

This is summed up by the words “best practice”.

The key to best practice in emergency response is recognising and implementing acceptable standards. Where this is accomplished in terms of emergency response, it is also generally the case that overall costs for maintaining this capability are lowered, training needs decreased, the management are protected from OHS and legislative standpoints and production is quarantined from threat: since ERT activities can occur with full-time, experienced career professionals, not with miners who have other tasks and responsibilities.

For the last 50 years, mine rescue has been evolving and coming to terms with the expectations of our modern age. Televised real-life rescues, reality television shows, ‘larger than life’ film and TV productions and community expectation that ‘city-style’ services be available in remote areas and offshore, fuel the need for mine management to be 100% certain that they can respond appropriately RIGHT NOW.

Similarly, the long-anticipated OHS Harmonisation and attendant scrutiny, fines and conceivably individual criminal prosecution and jail-time means that everyone from the board room down to the boiler room, including managers, need to critically review the standard of systems, personnel and equipment involved in emergency response activities and ask the hard questions:

• Is it good enough in 2011 to use anything less than advanced life support paramedics, career professionals with on-road experience putting in IVs, giving narcotics, dealing with major trauma, heart attacks and spinal injuries?
• Is best practice reflected in a range of personnel drafted from various backgrounds assembled into a volunteer ER team on the day?
• Is it sufficient to ‘desktop exercise’ your ER plan once a year then put it back in the cupboard?
• Is there a different standard permitted for small mines compared to ‘the big guys’?
• Do our current emergency response capabilities fully mitigate our obligations as an employer?

Regulators and coroners alike operate under consistent principles which place the burden on operators to understand best practice and adhere to it. Knowledge of the law and of industry standards and the latest developments is expected, and mine safety managers are expected to ensure adequate Risk Management strategies are in place and ensure that they are functional.

• “We’re too small for that” is not an acceptable excuse
• “That’s OK for the ‘big states over east’ but we’re different” is not an acceptable excuse
• “They didn’t have that at my last job” is not an acceptable excuse
• “We didn’t budget for it” is not an acceptable excuse

So what can be considered to be best practice in emergency response?

Looking at the two key elements, medical and rescue, the first important paradigm is that these two areas should be integrated, exactly as occurs in urban areas with ambulance and fire service.

But rather than risk denuding the local region of community-based services, it should be entrenched that resource companies, either individually or collectively, provide dedicated, full-time professional emergency response services to meet their duty of care, and ultimately their legal obligations.

To date, the word ‘paramedic’ and the level of their training and experience have been ill-defined. Anyone with basic ambulance service training, or a 7-10 day ’EMT‘ course on top of a first aid certificate could claim to be a paramedic, because there was no accepted definition.

However, in 2010, the Emergency Services Registry of Australasia (www.esra.com.au) was created to provide a reliable and consistent framework to credential paramedics and other rescue personnel.

The Best Practice standard for providing the higher-level interventions required on a mine site should be Advance Life Support or Intensive Care Paramedic (being able to put in IV medications and fluid, give drugs and perform advanced airway maintenance) represented by a minimum ESRA Level IV Paramedic.

For rescue, the standards have already been set under the Public Safety and Resource Industry Training packages: nationally accredited qualifications which by definition cross borders and disciplines.

The elements which are required include:

• RIIERR201A Conduct Fire Team Operations
• PUAFIR207B Operate Breathing Apparatus Open Circuit
• PUASAR004B Undertake Vertical Rescue
• PUASAR002A Undertake Road Accident Rescue

In terms of true integration, it makes sense for paramedics to have training in these disciplines too, and for emergency services officers to have paramedical training (well above first aid level) to be able to work as part of a cohesive team for the benefit of the patient.

A model of rescue-trained advanced care paramedics, and paramedically trained emergency services officers provides a integrated emergency response capability which not only ticks all the boxes, but covers all the bases, ultimately costs less, manages and mitigates mine management risk and protects the production capability of the enterprise.

In this case, Best Practice also equals win-win.

reproduced with permission from APRS Pty. Ltd