This document is uncontrolled when printed.

Guidance for prevention and management of cases of COVID-19 on Offshore Installations during the Delay Phase

Version 1.1

Publication date: 29 April 2020

Prepared by Health Protection Scotland in association

with Health & Safety Executive, Civil Aviation Authority

and Oil & Gas UK

Health Protection Scotland

1

Version history

Version Date Summary of changes

1.1 29/04/2020 First published

Health Protection Scotland

2

Contents

Target Audience ................................................................................................................... 3

Glossary ............................................................................................................................... 3

Definitions ............................................................................................................................. 4

Key resources ...................................................................................................................... 5

PPE, decontamination and cleaning ................................................................................. 5

Guidance for the public ..................................................................................................... 5

Guidance for employers .................................................................................................... 5

Background .............................................................................................................................. 6

Current status ....................................................................................................................... 7

Offshore installations ............................................................................................................ 7

Assumptions ............................................................................................................................ 8

Guidance .................................................................................................................................. 8

Risks addressed in this guidance ........................................................................................... 10

Principles ............................................................................................................................... 11

A. Guidance notes on routine transport of persons to the OI from onshore (see Algorithm A)

............................................................................................................................................... 11

Algorithm A. Summary of decisions and actions for routine transport of persons to the OI

from onshore (see guidance notes for details) ................................................................... 13

B. Guidance notes on routine activity on the OI ..................................................................... 14

Algorithm B. Summary of Summary of decisions and actions for routine activity on the OI

(see guidance notes for details) ......................................................................................... 17

C. Guidance notes on routine transport of persons from the OI to onshore ........................... 18

Algorithm C. Summary of decisions and actions for routine transport of persons from the OI

to onshore .......................................................................................................................... 20

Health Protection Scotland

3

Target Audience

Duty holders, topside doctors, and installation medics on Offshore Installations (OIs)

Helicopter companies involved in transport of personnel on and off OIs

Glossary

Duty Holder: Owner or operator of the offshore installation.

Duty Holder’s Medical Advisor: A qualified medical practitioner, often a specialist in

Occupational Medicine, who provides medical advice to the duty holder. Sets medical policy

for the duty holder and medics on the duty holder’s installations, but is not usually available

for 24 hour advice to the installation medic.

HPS (Health Protection Scotland): the national agency responsible for protecting the health

of the Scottish public.

HPT (Health Protection Team): A team of Consultants in Public Health Medicine (CPHMs),

Health Protection Nurse Specialists, public health practitioners and others who are part of a

local NHS Health Board in Scotland.

Installation Medic: Usually a nurse or former armed forces medical assistant who provides

medical care on an offshore installation.

Medevac: Movement of personnel from an offshore installation to a place onshore where

they can receive medical care.

Offshore installation (OI): Production platforms and drilling rigs in the UK North Sea.

Onshore doctor: Also known as the Topside doctor. A qualified medical practitioner who

provides medical advice to and support for the Installation Medic who are available 24 hours

per day, 7 days per week.

People on Board (PoB): Those present on an offshore installation.

PHE (Public Health England): The national agency responsible for protecting the health of

the English public.

Topside doctor: Also known as the Onshore doctor. A qualified medical practitioner who

provides medical advice to and support for the Installation Medic who are available 24 hours

per day, 7 days per week.

Health Protection Scotland

4

Definitions

Asymptomatic person: any person without symptoms of COVID-19.

Close contact: A person who has been in close proximity to a suspect case in the previous

14 days while a suspect case was symptomatic.

Isolation: when applied to a person or group of persons, means the separation of that

person or group of persons from other persons, except the health staff on duty, in such a

manner as to prevent the spreading of infection1

Suspect case2: a person who presents symptoms consistent with COVID-19 which are

New continuous cough

and/or

High temperature

Suspect case definition for individuals requiring hospital admission3

Clinical or radiological evidence of pneumonia or

Acute respiratory distress syndrome or

Influenza like illness (fever ≥37.8°C and at least one of the following respiratory symptoms, which must be of acute onset: persistent cough (with or without sputum), hoarseness, nasal discharge or congestion, shortness of breath, sore throat, wheezing, sneezing)

Note on Categories A-D referred to in this guidance

The helicopter companies supporting the offshore industry have developed a risk

categorisation system for helicopter transport. It recognises:

Category A (asymptomatic person),

Category B (asymptomatic contacts of a case),

Category C (case with mild symptoms), and

Category D (case with life-threatening symptoms).

Although the categories distinguish different types of persons, they are not useful in

distinguishing levels of actual risk in terms of contracting or spreading the virus. The

helicopter companies’ guidance treats people in Category B and C as having the

same risk when being transported, whereas in reality an asymptomatic contact will

have a lower risk of being infected than a case with mild symptoms. Therefore in this

guidance, we only refer to these categories for communication purposes and to allow

read-across between industry guidance and this health protection guidance.

1 Definition used in The Public Health (Ships) (Scotland) Regulations 1971

2 Check HPS Guidance for Primary Care for up-to-date definition

3 It is the responsibility of the attending medical practitioner (e.g. topside doctor) to decide whether hospital

admission is required, after consultation with an emergency department physician in an appropriate mainland hospital (this may not be the nearest landward facility but should be the most appropriate one for the case).

Health Protection Scotland

5

Key resources

General UK guidance on COVID-19 can be found below:

PHE advice: https://www.gov.uk/government/collections/coronavirus-covid-19-list-of-guidance

HPS advice: https://www.hps.scot.nhs.uk/a-to-z-of-topics/wuhan-novel-coronavirus/

PPE, decontamination and cleaning

Guidance on infection prevention & control is published by the UK four nations here

https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-

prevention-and-control . Recommended PPE described in tables 2 and 3, as well as Table

4, are of particular relevance in the offshore context

Guidance on case definitions, cleaning and decontamination of isolation rooms, and

waste disposal can be found in HPS Guidance for Primary Care

Guidance for the public

General guidance which is applicable for personnel onshore can be found on NHS Inform https://www.nhsinform.scot/illnesses-and-conditions/infections-and-poisoning/coronavirus-covid-19 which is directed towards the public

Guidance for employers

Health & Safety Executive guidance for employers including duty holders can be found here https://www.hse.gov.uk/news/coronavirus.htm including guidance on social distance in the workplace https://www.hse.gov.uk/news/social-distancing-coronavirus.htm and RIDDOR reporting https://www.hse.gov.uk/news/riddor-reporting-coronavirus.htm

Aims of the Guidance

The aim of this guidance is to reduce the risk of any cases of COVID-19 which may present

offshore from affecting other workers. It does this by providing advice for those involved in

risk assessment and management of any suspect case of COVID-19 on an Offshore

Installation (OI) or while they are in helicopter transit. This advice therefore is based on

principles and practice that would be applied onshore when seeking to prevent transmission

of a droplet-borne infection such as COVID-19.

A risk-based approach ensures that key workers are not unnecessarily inhibited from

supporting critical functions by seeking to ensure that risk management is applied, but that

management is proportionate to the risk. For example, the installation is not treated in the

same way as an onshore household, therefore if a suspect case presents on an OI, we do

not recommend that the whole OI goes into isolation. Rather we recommend that contacts

Health Protection Scotland

6

are distinguished according to risk and managed appropriately. We recommend this because

while workers live continuously on an OI for the duration of their working trip, and the living

circumstances are close, not everyone will be in contact with a suspect while symptomatic.

In order to reduce the risk of COVID-19 infection occurring on an OI this advice covers the

following areas:

1. Preparation before any incident in order to reduce the risk to staff and any cases 2. Safe assessment and management of suspect cases 3. Management of cases during helicopter transport 4. Management of any cases offshore, including those severely unwell 5. Management of cases after arrival in the UK

Background

In late December 2019, the People’s Republic of China reported an outbreak of pneumonia

due to unknown cause in Wuhan City, Hubei Province. In early January 2020, the cause of

the outbreak was identified as a new or novel coronavirus (COVID-19).

While there are a number of coronaviruses that are transmitted from human-to-human which

are not of public health concern COVID-19 can cause respiratory illness of varying severity

ranging from mild and uncomplicated disease to severe disease requiring hospital admission.

Severe cases may present with pneumonia, acute respiratory disease syndrome (ARDS),

sepsis and septic shock, and multi-organ failure. Currently, there is no vaccine and no

specific treatment for infection with the virus.

On the 30th January 2020 the World Health Organization declared that the outbreak

constituted a Public Health Emergency of International Concern. Following further significant

transmission outwith China, on the 11th March the WHO characterised COVID-19 as a

pandemic.

On the 12 March the risk level for the United Kingdom was raised from moderate to high and

forecasts based on modelling indicated that case numbers in the UK would increase

significantly with a doubling time of around 5 days. The UK adopted a new strategy of

1. Only testing suspect cases that require admission to hospital 2. Advising isolation of suspect cases and household contacts4

HPS issued guidance to UKOG on the 15th February, prior to the UK adopting a high risk

status; this was then adopted by OGUK as policy. Extensive further discussions involving

HPS, OGUK, CAA, HSE, helicopter operators and PHE (which manages incidents relating to

OIs in the English North Sea sector) have resulted in this updated guidance, which reflects

an agreed position between HPS and these stakeholders.

4 See NHS Inform guidance

Health Protection Scotland

7

Current status

The UK is currently operating in a “delay” phase of pandemic management due to being in a

period of sustained virus transmission in the population. This is characterised by social

distancing, restrictions on movement and minimising unnecessary travel. This phase will

continue until there is reliable evidence that virus transmission has reduced sufficiently to

justify a return to a policy of testing, tracking and isolation of contacts.

The UK and Scottish governments have adopted a policy of social distancing but recognise

that there are essential services where the recommended social distancing measures cannot

be applied as rigorously as in the general population. Employers of workers in such essential

services are urged to carry out risk assessments with the aim of reducing COVID-19 risk by:

reducing staffing levels to the lowest possible number required to maintain the

production of essential goods and

considering how to minimise close contact through the use of shift systems, ceasing

of non-essential tasks, and implementing social distancing in living, eating, and

working premises.

Employers are still obliged as normal to ensure the safety of staff generally and minimise the

risk of accidents and other dangerous occurrences.

Offshore installations

There are approximately 190 offshore installations (OIs) operating on the UK continental

shelf, 100 of which are manned and the others normally unmanned installations (NUI), which

do not have accommodation or medical facilities but do have workers visiting as required.

Manned installations typically have a population of 100 people on board (PoB) and have

frequent crew changes. The offshore workforce comes from across the UK with Scotland and

England accounting for about 90% of offshore personnel, with 8-9% having homes overseas.

It is therefore common for personnel to travel significant distances from their home to their

place of work.

Offshore installations are outside UK territorial waters and are therefore not provided with

offshore health services by the NHS nor are covered under relevant public health legislation.

Consequently, the NHS in Scotland has no formal responsibility for the provision of advice to

the offshore industry in the event of an offshore incident involving infectious disease. Medical

care on OIs is the responsibility of the Duty Holder and is provided by installation medical

staff, supported by a doctor based onshore (usually known as the ‘topside’ doctor). The

installation medic has 24-hour access to the topside doctor for advice and support and works

to protocols, including arrangements for the management of offshore infectious disease

incidents prepared by the agency supplying the medic and/or the installation duty holder.

The offshore workforce generally live and work in relatively close proximity; consequently,

timely and effective control measures are vital to effectively reduce transmission of infection.

It is therefore essential for the Duty Holder to ensure prompt action will be taken to control

any infection incident.

Health Protection Scotland

8

Assumptions

The incubation period of COVID-19 is considered to be 2-14 days with a median of

approximately 5 days.

Symptomatic persons carry a higher risk of transmitting COVID-19 to others than

asymptomatic persons and so should be managed differently.

Due to the high turnover of staff offshore, the risk presented by asymptomatic persons

offshore is not significantly different than that onshore.

Provided an OI reports having no suspect cases on board, or reports that any suspect cases

are in isolation, then the OI should be considered as presenting a low risk of transmitting

infection to those boarding or visiting the OI, e.g. helicopter crews.

Reasonable measures will have been taken to ensure some social distancing while

maintaining safety of the OI.

In applying this guidance, users will ensure that other risks will be considered to ensure

overall safety of offshore and helicopter employees.

Guidance

For essential services (such as the OG industry) to continue to function effectively, a risk

assessment approach to managing COVID-19 is required; e.g. the 2 metre social distancing

rule recommended generally cannot always be applied with the same strictness in such

services. An offshore installation is NOT considered as equivalent to a private domestic

household for infection control purposes. Instead, an individual risk assessment should be

made and measures taken to apply social distancing as much as is reasonably possible. Risk

assessment should be considered in terms of:

1. Risk of COVID-19 to the individual.

Persons in vulnerable groups at increased risk from severe illness should generally not

be employed offshore but should apply appropriate guidance on social isolation or

shielding onshore. For those living and working offshore important factors that will affect

the level of personal infection risk include:

application of respiratory and hand hygiene,

density of PoB generally and especially while working, eating and sleeping

early recognition of symptoms that are consistent with COVID-19 to facilitate assessment and clinical intervention where necessary

steps should be taken to minimise risks in those areas by suitable risk communication and risk management5

5 Resources and guidance for the public can be found at https://www.gov.uk/coronavirus and

https://www.nhsinform.scot/illnesses-and-conditions/infections-and-poisoning/coronavirus-covid-19

Health Protection Scotland

9

2. Risk of COVID-19 to others Duty holders should ensure that those persons who are symptomatic or are from a household with a suspect case are not permitted to go offshore; they must instead follow current guidance6. In the event of a suspect case presenting while on an OI, the factors that will affect the risk of infection to those on the OI working around any suspect case include:

If respiratory/ hand hygiene and social distancing measures are already implemented

Severity of symptoms

Proximity of persons to the symptomatic person

Time taken between symptom onset and reporting of symptoms

Time taken to ensure isolation of the case

use of appropriate PPE by any persons in proximity to the suspect case.

3. Risk of safe operation of OI or helicopter

COVID-19 risk should not be considered in isolation. In addressing the risk of COVID-19

infection, duty holders and employers should assess how any related risk management

might affect the safety of operations of the OI or transfer helicopters. For example, will

minimising the number of persons kept on board result in an increased risk of accidents

on the facility, or will increased transport of cases off the OI affect the risk to helicopter

operations?

Generally, it is recommended that to minimise risk from COVID-19 duty holders should:

ensure, that all PoB on OIs receive guidance on respiratory and hand hygiene; guidance on identifying relevant symptoms and steps necessary to self-isolate and report if a symptomatic case is identified.

Close contact is minimised for all PoB while living and working on the IO, including sleeping, eating and social facilities.

There are clear processes that ensure timely isolation of any suspect cases, including those presenting with even mild symptoms.

PPE7 is available and can be used by PoB (e.g. offshore medic) who are required to be in close contact with a suspected case; contact should be avoided as a rule, however, and the number of people in contact kept to a minimum.

Immediate medical evacuation (medevac) should be considered as mandatory where any suspect case requires hospitalisation. The topside doctor should contact the nearest tertiary hospital on the mainland, preferably with a helipad, and speak to an Emergency Department (ED) physician. Where the ED physician agrees that admission is appropriate then a Search and Rescue (SAR) helicopter should be requested by contacting HM Coastguard who will liaise with the Aeronautical Rescue Coordination Centre (ARCC) so that the most appropriate SAR aircraft is tasked. ARCC will also arrange communication with the Scottish Ambulance Service to ensure

6 See NHS Inform

7 See Guidance on infection prevention & control. Recommended PPE described in tables 2 and 3, as well

as Table 4, are of particular relevance in the offshore context

Health Protection Scotland

10

the entire patient journey to the receiving hospital is planned with all agencies understanding that the patient is suspected of suffering from Covid-19.

Where a mild or moderate case on an OI is over 50 years or has underlying conditions then it is recommended they be transported to the mainland8 as soon as possible and not isolated offshore.

Helicopter transfer of suspect cases NOT requiring immediate hospitalisation may also be considered in order to maintain safe operation of platform or where there is a higher risk of serious clinical deterioration. Removal to onshore is preferred at an early stage.

It is recognised that isolation of close contacts may lead to operational difficulties that render an installation unsafe. Where practicable, however, consider isolation of higher risk close contacts onshore. If not practicable then where a close contact is high risk (contact <2m >15 minutes)9 then they should be placed under active monitoring.10 Isolation of lower risk close contacts (<2m) of any suspect case is NOT generally necessary or recommended where reasonable hand/ respiratory hygiene and social distancing measures have been implemented. Such lower risk close contacts (<2m) of a symptomatic suspect case should be placed under passive monitoring11 in addition to continued communication to the crew on general measures of hygiene and reporting.

Any rooms where suspect cases have been isolated should be cleaned and decontaminated by a cleaner wearing appropriate PPE (See Key Resources) after the room is vacated by the suspected case.

There is no requirement for HPS, PHE or the local NHS board HPT to be informed of any suspect cases even if they are going to be transported to a mainland hospital. Where a cluster of cases is detected (2 or more suspect cases with evidence of transmission between cases) then appropriate OI protocols for an outbreak should be followed. It is recognised that installations not located in Scottish territorial waters may have a different approach and there may be a local requirement in England to notify a local HPT.

Risks addressed in this guidance

The risks addressed in this guidance are set out below and are considered under three

headings:

A. Routine transport of persons to an OI from onshore B. Routine activity on the OI C. Routine transport of persons onshore from an OI

The scenarios considered include the risks of:

someone falling ill with COVID-19 while offshore

8 Excluding a remote, island or rural location

9 Significant close (<1m) or face-to-face contact for 15 minutes or more in the absence of PPE

10 Contacts notified of the risk and asked to self-monitor for symptoms and report daily to the IM and, where

symptoms develop, to immediately isolate and report to IM 11

Contacts notified of the risk and asked to self-monitor for symptoms and, where symptoms develop, to immediately isolate and report to IM

Health Protection Scotland

11

someone infected with COVID-19 being transported from the UK to a platform

someone falling ill with COVID-19 during transportation of staff off or onshore

transmission to helicopter crew while transporting a suspect case of COVID-19

transmission to helicopter crew while servicing an OI where a suspect case is on board

Principles

During the pandemic (sustained community transmission) phase of COVID-19, where

testing12 of suspected cases is not being carried out routinely in the general population, the

following assumptions apply:

1. Anyone who is asymptomatic (‘Cat A’ or ‘Cat B’ in industry terminology) should be

considered as presenting a LOW RISK of infection transmission to close contacts; no

further actions are required to reduce the risk further.

2. Anyone who is symptomatic (‘Cat C’ or ‘Cat D’ in industry terminology) should be

considered as presenting a HIGH RISK of transmission to close contacts. However,

this risk is reduced to LOW RISK where the suspect case is isolated, or where any

close contacts wear appropriate PPE (See Key resources).

3. For anyone who is symptomatic with severe symptoms or who presents a deteriorating

clinical picture, immediate medical evacuation (medevac) should be arranged due to

the significant risk of further sudden worsening and in the absence of treatment an

increased risk of an adverse ultimate clinical outcome.

A. Guidance notes on routine transport of persons to the OI from onshore (see Algorithm A)

The following guidance sets out actions to take prior to and during transfer from the UK to an

OI. The guidance is set out as a flow chart and addresses the following risks:

Risk of someone infected with COVID-19 being transported from the UK to a platform

Risk of someone falling ill with COVID-19 while transporting staff offshore or onshore

Risk to helicopter crew while servicing an OI where a suspect case is on board

1. All persons planning to go offshore should be given appropriate advice prior to arrival for embarkation. The advice should:

a. be consistent with current advice in the UK that where a person has symptoms consistent with COVID -19 they should self-isolate at home until AFTER 7 days have elapsed from onset of symptoms.

b. emphasise that anyone who is in a household where someone has developed symptoms consistent with COVID -19 should not go offshore until AFTER 14 days have elapsed from the onset of those symptoms OR, if the worker subsequently develops symptoms in that 14 day period, AFTER 7 days from the onset of their own symptoms.

12 HPS is aware that a private testing service is by some non-NHS laboratories. The HPS position on testing in

non-NHS laboratories can be found here: https://www.hps.scot.nhs.uk/web-resources-container/covid-19-laboratory-testing-frequently-asked-questions/

Health Protection Scotland

12

c. make it clear that anyone presenting with symptoms consistent with COVID-19 will not be allowed to travel offshore.

2. Every reasonable effort should be made by industry to prevent persons with symptoms of COVID-19 attending the heliport. If, despite this, a person presenting as a suspect case is identified at the heliport then follow step 3, otherwise follow step 4 for asymptomatic persons.

3. All suspect cases should: a. Be asked to wear a fluid resistant surgical mask (FRSM), if available, and if not

available, to take any other reasonable measures to cover mouth and nose, and b. Minimise contact with other persons at the heliport until return home, where

possible by entering isolation. c. be placed in isolation until arrangements can be made for them to continue

isolation either at home or at another suitable location.

Persons returning home to self-isolate should NOT use public transport. Where

possible they should minimise contact with others. They may use their own transport

for journeys of up to 1 hour. If it is not possible to use private transport, then a taxi may

be contracted.13

4. Only asymptomatic persons should be taken offshore via helicopter, following instructions given by the helicopter operator and crew – no-one who meets the criteria for household isolation should be allowed to travel offshore whether symptomatic or asymptomatic.

5. Where a person presents with symptoms during transit then follow steps 6-8, if asymptomatic then follow step 9.

6. If any person develops symptoms during transit the crew should be advised of this by a passenger sitting more than two rows distant from the unwell passenger, and the helicopter should return to the heliport. During flight the now suspect case should be asked to wear a FRSM if available or if not, to take any other reasonable measures to cover their mouth and nose. The helicopter should not disembark the case onto the OI as there is a risk the patient may deteriorate. In addition, any passengers who were seated in the nearest 2 seats (in all directions), and any other passenger(s) who may have provided close assistance to the suspect case without PPE, should not subsequently travel to the OI (See step 7).

7. On return to the heliport the crew and other asymptomatic persons should disembark minimising risk of further exposure to themselves from the suspect case. All passengers who were seated in the nearest 2 seats (in all directions), and any other passenger(s) who may have closely assisted the suspect case without PPE, should be advised to return home and monitor for symptoms for the next 14 days. The case should then be disembarked to minimise contact with others in the heliport and isolated, as in Step 3 (above).

13 The Taxi should be of suitable size to maintain 2m distance between the case and the driver and preferably

have a bulkhead or screen. The taxi should be cleaned and disinfected after wards following guidance in Key resources

Health Protection Scotland

13

8. If hospital admission is not required then the patient should be isolated for 7 days after onset of symptoms. This may be at home or in another appropriate location supplied by the duty holder/employer. If isolation is at home then the travel advice at step 3 above applies. The suspect case should wear an FRSM, if available, during their journey to their place of isolation. If not available, the suspect case should take any other reasonable measures to cover mouth and nose. The suspect case should be advised that they and their household should follow the isolation guidance on NHS Inform. After the patient leaves the heliport then any room where the patient has been isolated, should be cleaned and disinfected (See Key resources). The helicopter should be cleaned as per manufacturers’ instructions. Any PPE worn should be disposed of safely and hand hygiene measures followed by all on the helicopter (See Key resources).

9. Where an OI does not report suspect cases, or where the OI has any suspect cases present already in isolation, then there is no significant risk to persons disembarking or to the helicopter crew. The helicopter should land on the OI and disembark persons.

Algorithm A. Summary of decisions and actions for routine transport of persons to the OI from onshore (see guidance notes for details)

Health Protection Scotland

14

B. Guidance notes on routine activity on the OI

Risk of someone falling ill with COVID-19 while offshore

Risk of transmission to helicopter crew while transporting a suspect case of COVID-19

Risk to helicopter crew while servicing an OI where a suspect case is on board

1. All persons on board (PoB) an OI should be given appropriate advice on arrival and at regular intervals on the risk of COVID-19, prevention, signs and symptoms and how to report signs and symptoms.14 Posters should be displayed prominently and should include advice on how any POB should isolate themselves, on recognising symptoms, and how they should notify the installation medic (IM). Where no suspect cases are reported then the OI does not present a significant risk to helicopter crews.

2. Where a PoB reports symptoms consistent with COVID-19 then the following steps must be carried out. The IM should ensure the case is isolated, and carry out an assessment of the state of health of the patient in collaboration with the topside doctor. Where the IM is required to be in close contact with the patient then the patient should be asked to wear a FRSM. The IM should wear the appropriate PPE15 while attending the patient. Enhanced monitoring of contacts of the suspect case is recommended where a suspect case is reported (Step 13). Isolation of contacts is not generally recommended (see page 9 above) since symptoms are the most important factor involved in transmission and any residual risk should be reduced by awareness of the risk and by respiratory and hand hygiene, and social distancing measures implemented.

3. If the assessment indicates a requirement for hospital admission then follow steps 4-6, otherwise go to step 7.

4. Where the patient is considered as requiring hospital admission16 (i.e. is in industry terms, ‘Cat D’) then the appropriate helicopter operator should be informed and emergency transport arranged. The helicopter operator should be informed that the patient is a suspected COVID-19 case. The suspect case should be under regular assessment while waiting for helicopter transport by persons in appropriate PPE17. If the patient’s condition deteriorates and intubation is advised by the topside doctor, the IM should wear an FFP3 respirator instead of the FRSM and a fluid resistant gown instead of the apron. The patient should be transported to the helicopter ensuring minimal contact with other POBs. Where persons are required to assist the patient (for example, stretcher bearers) then they should wear the appropriate PPE. There is no requirement for any helicopter crew who are outwith 2m to wear PPE for COVID-19, however they should follow the industry-agreed procedure for transport of a ‘Cat D’ suspected case.18 In flight, only medical personnel should be in close contact the patient and should wear appropriate PPE (gloves, survival suit in lieu of apron,

14

NHS Inform 15

See Guidance on infection prevention & control. Recommended PPE described in tables 2 and 3, as well as Table 4, are of particular relevance in the offshore context 16

This should be based on a discussion between the IM, topside doctor and physician at the ED department of a suitable mainland tertiary facility 17

See Primary Care Guidance in Key resources

18 This should be based on the CAA approved Company Operations Manual entry for transport of a suspected

case with a Category 2 infection

Health Protection Scotland

15

FRSM): if an aerosol generating procedure such as manual ventilation is continued in flight, PPE should be upgraded to include an FFP3 mask and full-face shield or visor. 19 On the installation, rooms where the patient may have been isolated should be cleaned and disinfected following departure of the patient.

5. On arrival at the heliport/ helipad the patient should be disembarked, minimising contact with other persons, especially aircrew.

6. The case should then be transferred to the waiting ambulance or admitted to the hospital minimising contact with others. The helicopter should be cleaned as per manufacturers’ instructions. Any PPE worn should be disposed of safely and hand hygiene measures followed by all on the helicopter: the immersion suit will be considered PPE for those in close contact with the case and should be decontaminated or disposed of.

7. For cases not requiring hospital admission suspect case isolation should continue while options are reviewed.

8. For cases not requiring hospital admission (industry ‘Cat C’) isolation of the patient can take place onshore (Steps 9-11) or on the OI (Step 12). Consideration should be given to whether the patient should be removed from the OI, bearing in mind the risk of deterioration, OI safety and the morale of PoB. While in isolation the patient should have access to food, water, toilet and washing facilities. Meals can be left outside their door. If they are required to leave the room then they should wear a FRSM and persons attending should wear PPE. If anyone is required to enter the room (e.g. IM) then the patient should wear a FRSM and the person entering should wear PPE. If the patient begins to deteriorate at any time IMMEDIATELY follow steps 4-6 If the patient is required to be removed from the OI, for reason other than hospital admission (Steps 4-6), then follow steps 9-11, otherwise for isolation on the OI follow step 12

9. Contact the designated helicopter company and inform them that the patient does not require hospital admission (i.e. is industry ‘Cat C’). For helicopter transport ensure that the patient is transferred to the helipad, wearing a FRSM and with accompanying persons in PPE (gloves, apron, FRSM), ensuring minimal contact with other PoB. The helicopter company should follow the industry-agreed procedure for transportation of a ‘Cat C’ patient20. While in air the suspect case should continue to wear a FRSM.

10. On arrival at the heliport the patient should be disembarked, minimising contact with other persons, especially aircrew, and in a way to minimise contact with others in the heliport to await onward transport: preferably beginning the journey to isolation from airside.

11. The patient should travel to an appropriate place to allow self-isolation for 7 days after onset of symptoms. This may be at home or in another location supplied by the duty holder/employer. Persons returning home to self-isolate should NOT use public transport. Where possible they should minimise contact with others. They may use their own transport for journeys of up to 1 hour. If it is not possible to use private

19

The immersion suit will count in place of the fluid resistant gown

20 This should be based on the CAA approved Company Operations Manual entry for transport of a suspected

case with a Category 2 infection

Health Protection Scotland

16

transport, then a taxi may be contracted21 . The patient should wear a FRSM if available, and if not available, to take any other reasonable measures to cover their mouth and nose, for the duration of any journey. After the patient leaves the heliport then all rooms where the patient has been isolated, should be cleaned and disinfected. The helicopter should be cleaned as per manufacturers’ instructions. Any PPE worn should be disposed of safely and hand hygiene measures followed by all on the helicopter.

12. Any suspect case who is not removed from an OI should remain in isolation until AFTER 7 days have elapsed since symptom onset. The patient should be kept under regular monitoring while in isolation; where they deteriorate then follow steps 4-6. After the period of isolation is complete the patient is no longer considered infectious and they may return to the workforce.

13. When the IM becomes aware of a suspect case then PoB on the OI should be informed and advised to be aware of symptoms for the next 14 days and to report them immediately. Close contacts should be identified for passive or active follow up as appropriate. Processes to ensure reporting of suspect cases should be reviewed and any lessons learned from managing the suspect case applied.

21 The Taxi should be of suitable size to maintain 2m distance between the case and the driver and preferably have a bulkhead or screen. The taxi should be cleaned and disinfected after wards following guidance in Key resources

Health Protection Scotland

17

Algorithm B. Summary of Summary of decisions and actions for routine activity on the OI (see guidance notes for details)

Health Protection Scotland

18

C. Guidance notes on routine transport of persons from the OI to onshore

The following sets out actions to take prior and during transfer to the UK from an offshore

installation. The guidance is set out as a flow chart and addresses the following risks

Risk of someone falling ill with COVID-19 while offshore

Risk of transmission to helicopter crew while transporting a suspect case of COVID-19

1. In preparing for any routine transfer off an OI via helicopter then the IM should be satisfied that there are no known suspect cases (i.e. industry ‘Cat C’ persons) on the OI who are not in isolation.

2. If any suspect case (‘Cat C’ person) is present they should follow step 3, otherwise follow steps 4 and following.

3. Where a case presents with symptoms, no matter how mild, then they should not be allowed to access routine crew rotation transport off the OI. They should be isolated on the platform immediately and the section on Guidance notes on routine activity on the OI followed.

4. Only asymptomatic persons (industry ‘Cat A’ persons) should embark onto the helicopter following standard practice.

5. If a person presents with symptoms on a helicopter during the flight then follow steps 6-8, otherwise follow step 9

6. If someone on a routine crew rotation flight develops symptoms while in air the crew should be advised of this by a passenger sitting more than two rows distant. The now suspect case should be asked to wear a FRSM if available and if not available, to take any other reasonable measures to cover their mouth and nose, while the helicopter continues to the heliport. The helicopter should not return to the OI but continue to the heliport; there is a risk the patient may deteriorate if return to the OI. The helicopter crew should arrange for a medical assessment at the heliport.

7. On return to the heliport the crew and other asymptomatic persons should disembark minimising risk to themselves. All passengers who were seated in the nearest 2 seats (in all directions), and any persons who may have attended the suspect case without PPE, should be advised to self-isolate at home for 14 days. The case should then be disembarked minimising contact with others in the heliport and then isolated for assessment, and an ambulance called if required. If hospital admission is not required, then the patient should await onward transport: preferably beginning the journey to isolation from airside.

8. The patient should travel to an appropriate place to allow self-isolation for 7 days after onset of symptoms. This may be at home or in another location supplied by the duty holder/employer. If isolation is at home, then the patient can use their own transport where the journey is a short. Persons returning home to self-isolate should NOT use public transport. Where possible they should minimise contact with others. They may use their own transport for journeys of up to 1 hour. If it is not possible to use private

Health Protection Scotland

19

transport, then a taxi may be contracted22 . The patient should wear a FRSM if available, and if not available, to take any other reasonable measures to cover their mouth and nose for the duration of any journey. After the patient leaves the heliport then all rooms where the patient has been isolated should be cleaned and disinfected. The helicopter should be cleaned as per manufacturers’ instructions. Any PPE worn should be disposed of safely and hand hygiene measures followed by all on the helicopter.

9. Where no suspect case presents during the flight, on arrival at the heliport passengers and crew will disembark as usual. All people arriving from an OI should be given advice consistent with UK government advice on respiratory and hand hygiene measures, and on self-isolation.

22 The Taxi should be of suitable size to maintain 2m distance between the case and the driver and preferably have a bulkhead or screen. The taxi should be cleaned and disinfected after wards following guidance in Key resources

Health Protection Scotland

20

Algorithm C. Summary of decisions and actions for routine transport of persons from the OI to onshore