Offshore medics shoulder increasing burdens amid heightened health focus

By Stephen Forrester, Contributor

While HSE has long been a core focus area in the oil and gas industry, the offshore health professional – a group that includes doctors, nurses and paramedics, termed “medics” – often gets overlooked. Every rig must have at least one health professional onboard to legally operate, yet industry recognition of the role these individuals play and how critical they are to the overall drilling operation has been limited. Regardless, those working in this focus area have stayed the course, often with a noble dedication to doing what needs to be done when no one else will answer the call. The COVID-19 pandemic has helped the industry better understand the burden medics shoulder.

Drilling contractors and offshore medics

While the offshore drilling industry had previously prepared for and dealt with infectious diseases, the scale and impact of the COVID-19 pandemic still caught the industry off guard, said Dr Robina McCann, Company Medical Director for Seadrill. Drilling contractors had developed protocols around other diseases, like Ebola, but many of those plans never had to be activated. Further, plans were smaller in scope due to the limited area of impact.

With COVID-19, perception of the role of the medic shifted, Dr McCann said. “Everyone suddenly understood how important the medic was,” she explained. “It’s not that they weren’t understood before, but rather that people realized that the medic was the person with the specialized skill set that could help them with their problems.”

With the pandemic came an onslaught of new tasks for the offshore medic, including handling all virus testing and preparing procedures for what to do if there is an outbreak. Medics have also managed the process for escalation in the event of infection, to whom they should escalate, and how evacuation of infected individuals from the rig is handled.

Whether infection occurs is only part of the puzzle, as all tested individuals become part of the ever-growing pile of documentation on the rig related to the virus. On top of COVID-related duties, medics have also been tasked with providing psychological support to the crew — such that some medics now require training in psychology.

“Throughout the pandemic, some of our operations people had to maintain quarantining for up to 14 days in a hotel,” Dr McCann said. “We had guys psychologically breaking in that time, having panic attacks from the stress. So, the medics were being asked to step up and help detect and prevent that from happening, as well.”

All of this means the medic’s workload has doubled or tripled over the past two years, with little recognition despite the increased risks to their own safety and health.

Dr McCann explained that the confluence of these factors has led to burnout not only in the onshore global health workforce in general but also, more specifically, an exodus of talent from the offshore medical profession. “The industry has lost a lot of medics,” she said. “Globally, we’ve seen a trend over the last two years that has seen many medics and health professionals just quit. They said they were scared, and they didn’t want to do it anymore. Some didn’t even want to work onshore and left the healthcare sector entirely.”

Dr McCann said she hopes that medics get more recognition for the job they do, considering the importance of the work and the personal risk they’re taking. “The industry needs to move away from checking a regulatory box to purposefully and intentionally looking at how critical this role is and making sure they know they’re valued,” she remarked. 

One approach Dr McCann took to establish better connections with offshore medics was to schedule regular support and knowledge sharing meetings. Because the medical professionals on rigs are typically hired via a third-party provider, such meetings didn’t used to take place. She also lobbied to implement high-level personal protective equipment early in the pandemic, as she wanted to ensure that Seadrill did its part to keep medics safe as they worked on the front lines. 

The company believes that health and safety extends beyond the traditional focus on injury prevention to include physical and mental wellbeing. Medics play a huge part in that strategy, Dr McCann explained, noting: “We work with the medics to provide a true holistic prevention and promotion model offshore.”

However, as the drilling contractor does not have final say on the number of medics deployed to an offshore asset, she also noted that the onus should be on the operating companies to look at how to better support the crew — even if that means having two medics onboard instead of one. 

Barry Quinn, HSE Director for Noble Corp, agreed there needs to be more focus on health, as well as more emphasis on the role of offshore health professionals. “We want to look more critically at the role they play and what they’ve done, especially during the pandemic,” he said. “The medics are often the unsung heroes of our industry because they’re almost forgotten when nothing is going wrong. But now, they’ve shown the industry why we have them and why we respect and value their efforts and services. These are highly educated, highly experienced professionals, and what they’ve done through the pandemic is vastly different from what they used to do.”

Mr Quinn echoed Dr McCann in saying that a major change for offshore doctors and health professionals has been a new focus on mental health and wellbeing, which requires additional training and longer hours. “Through the pandemic, rig crews have suffered greatly,” Mr Quinn said. “Whether they couldn’t get home due to extended rotations or company policy, or because they’re dealing with quarantine protocols and new regulations, everyone has been struggling and fatigued — and the medics have often been on call 24/7 to handle that.”

Medics do not get the same break as crew members who work in 12-hour rotations. Unless there are two medics onboard, even a “break” offers another chance for a crew member to ask for something outside the confines of the medic’s office.

Fundamental changes in approach to health

Injury and mental health are just two pieces of the puzzle. In addition to their standard duties, health professionals have also been tasked with performing extensive pandemic-related procedures. Additional layers of paperwork and testing have made the job much more difficult and time-consuming. Even though the volume of work performed by any individual medic is staggering, Mr Quinn said there can be disconnect between what the medic does and what the crew thinks they do. Furthermore, although the medic spends much of their time with the crew and naturally builds a rapport, they are almost always a third-party contractor and can feel left out of specific milestones or drilling contractor goings-on.

“The medics, and all the health professionals who support us across the globe, are a core part of our industry,” Mr Quinn explained. “We cannot operate without them, and we sometimes take for granted what they do, especially when things are looking good. But when things are bad, when we really need them, they step into the limelight.” Trust and respect are critical components enabling a medic to effectively engage with the crew.

It is also important not to forget the ongoing support of the shoreside medical crews — who assist the offshore medic when necessary and who are sent to shore when there’s an injury or infection that requires immediate attention from doctors and nurses, Mr Quinn said. “The support of our medical team onshore — whether it’s to facilitate testing, develop procedures, provide guidance, or transfer equipment and supplies — is so crucial.”

He added that the COVID-19 pandemic has fundamentally changed how the industry will approach medical concerns moving forward. Even though the severity of the virus appears to be abating, its consequences will reverberate through the policies and procedures of operators and drilling contractors for years to come. Companies will now take a much more holistic and long-term approach to health, especially when it comes to transmissible viruses. They will also be more vigilant in monitoring and safeguarding crew mental health and psychological wellbeing. 

“We’re going to do what we do best and take all the collective and cumulative learnings from the pandemic and apply them to do things better,” Mr Quinn said. “We’ve learned a lot — how to be smarter, how to be more efficient, how to take better care of people — and the medics have really played their part in that.”

The role of third-party service providers

Most drilling contractors do not directly employ the health professionals staffing their offshore vessels. Instead, such individuals are largely engaged contractually via third-party service providers like International SOS (ISOS). ISOS employs thousands of health professionals and deploys a small portion of them to high-risk remote environments, like offshore rigs.

Wallace Bruce, Head of Offshore Clinical Operations for ISOS, said he sees the role of the medic evolving even as demand for these highly trained professionals increases, particularly in the oil and gas domain. “Once upon a time, the role just focused on the health of the crew — making sure everyone was doing well,” he said. “Over the past couple years, especially with the appearance of COVID-19, there has been a new focus within drilling contractors’ health agendas on occupational and mental health.”

Becoming an offshore medic isn’t easy, as candidates must receive training on core medical skills while also learning occupational health, which involves things like health monitoring, water quality management and noise management. “We’re seeing new attention being given to the preventive side of things, like helping crew members avoid noise-induced hearing loss,” Mr Bruce explained.

The COVID-19 pandemic has brought with it an outsize focus on mental health and wellbeing. Challenges for medics stem not just from the virus itself but also from the anxiety of having to work longer hours — often without any change in compensation. This is leading to a new awakening to the criticality of the medic’s role and the need to employ more trained medical personnel. “Most times, the medic is the hub where people go to speak and express their thoughts,” Mr Bruce said. “They go there for an open ear. That’s a big way their job has changed.” 

The pandemic, Mr Bruce continued, has been an ongoing learning experience for ISOS, especially with government regulations, local mandates and company protocols being innately complicated and changing frequently. Along the way, the company has improved how it adapts to changing situations, as well as kept tabs on lessons learned that can be used in case another highly contagious virus emerges in the future.

Although he hopes that day never comes, Mr Bruce remarked that the company is more prepared than ever. “We’ve had two years to get good at this,” he said. “One of the important things we’ve done is establish documentation that we didn’t have previously, like isolation plans specific to a rig. In the past, there might have been focus on dealing with catastrophic events, having things like triage systems. Now, plans include testing, isolation and how to get an individual off a rig. Those core documents never existed in such detail before.”

If there has been an upside to the pandemic, Mr Bruce noted, it was that it changed the perception of health across industries. “Our clients are realizing the importance of health. While medics used to focus on patching someone up or dealing with an emergency, we’ve now seen several added layers because of COVID,” he said. “People can now see the true value of what an offshore medic brings to the table, especially in this remote environment.”

Many medics remain fatigued, yet many have persisted because they feel called to the profession. “There is an element of selflessness in the work, which is a reminder that these are individuals who willingly place themselves in harm’s way for the greater good,” Mr Bruce explained. “These are people who just get things done. They understand what’s at stake, and they know what they signed up for.”

View from the rig – an offshore doctor’s perspective

Dr Fabian Vicente Castañeda Romero is an emergency doctor and physician onboard Seadrill’s West Titania jackup. On any given day, his job pulls him in two distinctly different, but ultimately connected, directions. One is the obvious — the medical portion — which involves treatment of patients, whether for illness, minor injuries or, in the worst case, major sickness or injury requiring escalation and removal from the rig. The other part is the administrative side, which includes medical equipment inspections, documentation and record-keeping, inventory of supplies and medication, and so on. Some days pass with the medic only involved in office procedures, while on other days there may be a nonstop line of patients. 

While there is basic medical equipment on a rig, there is not anything for advanced procedures, nor is there medication for more serious issues. The doctor, then, is also responsible for rapid situational assessment so that a patient can be quickly sent to shore for proper treatment and care if needed. Dr Castañeda refers to this as being a “first-contact practice,” where simple concerns can be addressed quickly but complicated issues requiring specialized equipment or a team of professionals are sent to shore. 

“We have defibrillators, oxygen tanks, pain medication and a hospital bed,” he said. “But we can’t do X-rays or lab tests, and we can’t do surgery. If we have a patient with a broken bone, we try to stabilize them and control the damage until we can get them back to shore.”

The nature of this process makes offshore health professionals very clinically apt, able to deal with issues efficiently and with high standards of care so that permanent damage is not sustained. The challenge, then, is workload and availability. With most rigs having only one medic onboard, managing multiple injuries or illnesses at once can become a test of endurance. Dr Castañeda said that on his vessel, many crew members also use him as a pseudo-psychologist, visiting simply to talk about problems and explore thoughts on the state of the world.

“For many of the crew members, they know that you’re a professional, and because you’ve been working and living with them on the rig, there’s a sort of bond,” he said. “This has been going on for years, but after COVID-19, it’s been happening a lot more. We’ve seen a higher incidence, for example, of anxiety attacks and stress-related health issues. It’s been difficult for two years, and some people are struggling to keep it together.” 

Dr Castañeda confirmed that the COVID-19 pandemic has dramatically increased the workload of offshore medics, with frontline workers taking on the added burden of managing pandemic-related processes and procedures. “Seadrill has taken the pandemic very seriously,” Dr Castañeda said. “They were very aware of what would happen as things got worse, so they’ve done campaigns to encourage crew members to talk to the doctor and get the help they need. But it feels like it never stops, because COVID-19 has come in waves. As soon as you think things are going to slow down, there’s a new variant.”

Dr Castañeda is responsible for testing and diagnosis, treatment, isolation protocols, proper documentation, and ensuring the infected are removed from the rig via a specialized helicopter service as quickly as possible.

Health and safety standards on the rig are still very rigorous, with masking and constant sanitation seen as non-negotiable. While these efforts have been worthwhile, there is also a sense of burnout from the medics involved, with some reducing their hours and some leaving the profession entirely. 

“It was just too much,” Dr Castañeda explained. “We had all our regular duties, and now all the COVID-19-related duties, as well. It was a big change for all of us, because the workload tripled or quadrupled from what it used to be. It was overwhelming.”

While having a second health professional onboard can ease the burden and eliminate the need for 24-hour shifts, not all operators are willing to allot the capital necessary for that expense, and there are no standards that can force them to do so.

Although there has been a slowdown in the frequency and intensity of cases offshore, Dr Castañeda urged caution in assuming the pandemic — and its related stresses — are over. He also asked for understanding and compassion from the general offshore community, as he and his fellow offshore doctors and health professionals are putting their lives on the line to help the crew stay safe. He has tried to manage not only the challenges and expectations of the crew members but also his own fear that he will not be able to return home to his family. “Often, what the doctors do is taken for granted, but I hope that people can really learn to appreciate us,” he said. “Whether you’re onshore or offshore, take a moment to tell your doctor they’re doing a great job, and thank them for helping you.”  DC