Minimum Medical Standards Requirements Manual 2021 PDF

Minimum Medical Standards Requirements Emergency Department Remote Area Clinics Administration Unit MMSR Manual Edition: 2021 Minimum Medical Standards Requirements MMSR Manual Emergency Medical Services Remote Area Clinics Administration Unit © Copyright 2021, JHAH. All rights reserved. No par...

Minimum Medical Standards Requirements Emergency Department Remote Area Clinics Administration Unit MMSR Manual Edition: 2021 Minimum Medical Standards Requirements MMSR Manual Emergency Medical Services Remote Area Clinics Administration Unit © Copyright 2021, JHAH. All rights reserved. No part of this manual may be reproduced in any form or by any means without the express written consent of JHAH. Disclaimer of Liability: The information enclosed in this manual is intended as a reference guide only, and if implemented, it should enhance the Remote Area Medical Facilities standard of care. Medical standards of care and practice are dynamic and it is therefore critical that facilities providing medical services keep up- to-date with current clinical and Industry Standards and Practices. Information provided in this manual is accurate at the time of publishing, but JHAH emphasizes that it does not assume any legal liability or responsibility for the accuracy, completeness, or usefulness of any information disclosed in herewith and that no guarantees, expressed or implied are made. Johns Hopkins Aramco Healthcare  MINIMUM MEDICAL STANDARDS REQUIREMENTS MANUAL (MMSR) Introduction To ensure safe practice and delivery of quality health care to all patients receiving medical care at the work site, RAC Administration Unit / MMSR Team, have assembled this Manual to be used as a reference to assist Aramco Proponents, Contractor Companies and JHAH approved Healthcare Providers to assess, plan, implement and evaluate the standards of patient care at all Saudi Aramco work sites. The requirements within this manual are based on the Ministry of Health (MOH) regulations, Ministry of Labor (MOL) / Saudi Labor Law and Saudi Aramco (SA) Standards including: Saudi Aramco’s Contractors Safety Administrative Requirements Manual (CSAR section 9). This MMSR manual is mandated to be followed by all SA Proponent Organizations (SAPO), Contractor Companies (CC), and Healthcare Providers (HCP) performing work at Saudi Aramco Remote, Industrial work sites. Should you require help with the technical aspects of this manual, please contact the RAC / MMSR Coordinator or the RAC Admin Supervisor. [email protected] 5  Table of Contents 1. Definitions 03-00 2. Category / Level of Medical Facilities 04-05 3. Healthcare Provisions / General Regulations 06-08 4. MMSR Standards. 9-162 6  Introduction Definitions Definitions: 1. Minimum Medical Standard Requirements – Are the minimum acceptable standards for first aid services and medical facilities at SA work sites as specified in the Ministry of Health (MOH) mandatory regulations, Cooperative Health Insurance Law, Saudi Aramco CSAR Manual, SA General Instructions and policies and the Saudi Labor Law. 2. Contractor Urgent Care Facilities - Are medical facilities operating at SA project sites, and able to provide first aid, urgent care, pre-hospital care, and stabilization including prompt transfer of sick and injured employees to the nearest definitive care facility and occupational medicine services. They are also able to provide medical assistance in the event of disaster. 3. Industrial / Remote Areas - Any area of Saudi Aramco operations, which by distance, topography or lack of prompt access to medical healthcare. These include but are not limited to the following examples: 1. Any SA project site where outside medical agencies are unable to respond in a timely manner due to limited access to healthcare and or because of a limited definitive system of communication and or dispatch of the emergency response is not available. 2. Oil and gas facilities such as Producing, Separation, Refining, Storage, Distribution plants, Offshore Exploration, Onshore active Drilling operations and Water injection facilities. 3. Construction sites, Support services and residential camps associated with the operations mentioned above. 4. Minimum Stock Level (MSL): 1. MSL will be the number specified for each clinic item (Equipment, medication, supplies). 2. Quantity will be determined for each Facility by utilization review to ensure compliance with Facility MSL at all times. 3. MSL stored at the Clinic must be adequate to cover at least 3 months’ supply requirements for the Facility. 4. There is no maximum stock level. 5. Records and analysis are required to support policies and procedures and justify the stock levels. 7  Category / Level of Medical Facilities: For selection of clinic category / level, refer to the following appendix: 1. It is recommended that all parties (SAPO, CC and HCP) are involved in the assessment, planning, selecting and implementation of the most appropriate level of Medical Facility. 2. The determining factors must be looked at collectively before a final category is selected. 3. Where there is uncertainty of the selected category of the clinic, the final decision must be decided by SAPO with the advice from JHAH/RAC staff as required. Medical Facility Criteria: The following factors are used to determine the category (level) of Medical Facility required to meet the health needs of the employees at the work site. 1. Employee population exceeds 2000 + workers in a single camp and associated work site Category/Level A location(s). Physician operated 2. Access to medical care: The Company operates in an area / location where inpatient medical facility, large size facilities are not available to refer patients for definitive care and / or timely transfer of with laboratory and patients for definitive care is not possible. radiology services 3. Risk factors: The work site is potentially high risk for accidents, disasters or explosions. Possibility of mass casualties is high. 4. *Specialized services: In view of the remoteness of company operations, providing on-site specialized medical procedures, diagnostic or otherwise, will be cost-effective and benefit the Company operations. 1. Employee population exceeds 1000-2000 workers in a single camp and associated work Category/Level B site location(s). Physician operated 2. Access to medical care: The Company operates in an area / location where only a limited facility, small size number of inpatient medical facilities are available to refer patients for definitive care and / without laboratory- or timely transfer of patients for definitive care may be difficult. and radiology 3. Risk factors: The work site is potentially high risk for accidents, disasters or Services explosions with the possibility of mass casualties. 4. Specialized services: Providing on-site specialized medical procedures, diagnostic or otherwise, will be cost-effective and benefit the Company operations. 8  Category / Level of Medical Facilities: Criteria: The following factors are used to determine the category (level) of Medical Facility required to meet the health needs of the employees at the Medical Facility work site. Category/Level C 1. Employee population amounts 50-1000 workers in a single camp and associated work site Nurse operated location(s). facility 2. Access to medical care: The Company operates in an area / location where inpatient medical facilities are available to refer patients for definitive care and timely transfer of patients for definitive care is possible. The company has an established medical support and logistic network, e.g., a referral system for the duty nurse to immediately consult a physician for advice and treatment as well as the capability to arrange an immediate transfer or MEDIVAC. 1. Employee population amounts 50 workers or more in a single camp and associated work Category/Level D site location(s). Nurse operated 2. Access to medical care: The Company operates in an area / location which is non-industrial and non-remote, where there is access to inpatient medical facilities and that facility it is possible to refer patients for definitive care and / or timely transfer of patients for definitive care. CIVIL 3. The clinic is operated by a JHAH approved Healthcare Provider or other MOH licensed medical facility Non-Industrial recommended in writing and as determined by JHAH / RAC Administration Unit Staff to establish Non-Remote the required range of services. 4. If approved in writing by the SAPO, the contractor for a non-construction contract is not required to provide a work site medical facility for office personnel (e.g., working in an office building within a major metropolitan area) if the contractor has contrac- tually arranged for emergency response and medical care with a nearby hospital that is operated 24-hours a day, seven days a week and is capable of responding to the office building within a maximum travel time of fifteen (15) minutes. Category/Level E 1. Employer with less than 50 workers, shall provide at work site a First Aid cabinet and assign an appropriate number of First Aid trained employees. *Specialized Services include Radiology, Laboratory, physicals, and other tests / procedures performed as part of the company’s health prevention screening program, e.g., fit to work, hearing screening and Pulmonary Function Tests etc. 9  Health Care Provisions General Regulations 1. Every CC which operates within Saudi Aramco remote area work sites shall provide medical care to all employees in accordance with Section 9 of the Saudi Aramco CSAR Manual and Schedule D of the contract. 2. Every CC who employs less than fifty (50) workmen shall provide at the work site a first aid cabinet. Refer to Level E category. 3. Any CC who employs fifty (50) or more laborers at a minimum shall provide its employees with the following: 1. A first aid clinic; this can range from a single room portable facility to a multi-room facility (depending on needs) 2. A ‘Full-Service’ Contract with an approved Healthcare Provider (HCP) to operate the clinic in accordance with CSAR and MMSR. 4. All Contractor’s medical facilities located at SA project sites shall be fully operated by a JHAH approved HCP or other MOH licensed medical facility recommended in writing and as determined by the JHAH / RAC Administration Unit to establish the required range of services needed to operate one or more work site medical facility. 5. Every SAPO, CC & HCP shall have a copy of the MMSR manual at the work site medical facility for implementation, compliance and reference purposes. 6. Every SAPO, CC & HCP shall provide healthcare as per the mandatory Cooperative Health Insurance Laws in the Kingdom of Saudi Arabia: 1. There is evidence that all employees, including subcontractor employees, are registered in a 24 hour a day, seven days a week (24/7), inpatient hospital. 2. There is evidence that all employees and subcontractor employees are provided with health insurance coverage for emergency and inpatient care including appropriate investigations. 3. There is evidence that the organization designated an inpatient hospital where a physician (specialist or otherwise) can be consulted by the work site medical facility staff for further advice, referral and/or transfer of patients as needed. 4. There is evidence that the organization maintains adequate funds at all times in the proposed inpatient hospital. Current documentation of advanced payment of agreed funds is available upon request. 1  7. SAPO to ensure that every CC and HCP has a database system that at a minimum includes, but is not limited to, the following information: 1. Employee’s name, employee’s ID number & medical registration (MR) number. 2. Medical insurance card number and level of medical coverage. 3. Contact number of Saudi Aramco Supervisor overseeing the contractor work. 4. SAPO 24 hour on-site representative and head office contact number. 5. Name, contact number / address of the operating HCP and nearest Medical Facility. 6. Input into file pre-employment screening and comprehensive medical exam every one-two years as indicated. 7. Ensuring that all information above is kept current at all times. 8. SAPO shall ensure that the CC has adequately trained crew members per shift with basic levels of medical care awarded by a recognized BLS training program such as Saudi Heart, American Heart Associations or Heart Saver (CPR/FA/AED) trained by JHAH / HS & E. Refer to Saudi Aramco GI-150.002 9. The HCP shall ensure that their medical facilities’ healthcare professionals have the required Government license to practice their profession in the Kingdom prior to assignment. At a minimum, all professional staff are registered and licensed by the following government bodies: 1. Saudi Commission for Health Specialties / SCHS Card. 2. Ministry of Health / MOH Licensing (within 3 months from the SCHS Registration). 10. Manpower Requirements / Hours of operation as per the following: 1. The HCP shall deploy an adequate number of medical staff at their clinic; the required number of medical staff depends on the operational needs and the level of clinic. 2. The HCP has a backup plan in place to provide coverage for education, unplanned emergencies, holidays, sickness, off-duty days, absences and all other planned / unplanned events. 3. The HCP shall have a policy stating the criteria to determine its manpower requirements to ensure that their medical facilities have adequate coverage at all times. 4. The HCP shall ensure that for all matters pertaining to clinic operation, all clinic staff are under the direct supervision of a senior RN or a physician. Distant supervision is acceptable. Contact for advice/consultation shall be available 24 hours a day, seven days a week (24/7). 5. A work schedule detailing staff duty hours to cover a 24/7 clinic operation is available and posted. 6. An on-call schedule for off-duty hours must be available and posted with respective contact numbers. 1  11. The HCP at a minimum shall define their organizational values as follows: 1. A vision, a statement about what the organization wants to become. 2. A mission, translated into written form. It materializes the management's view of the direction and purpose of the organization. 3. Both Vision and Mission statements are available and posted. 12. HCP other responsibility include but not limited to the followings; 1. Set up and commissioning of clinics. 2. Clinic supervision biannual compliance review audit by a senior clinical staff such as (Doctor, Nursing supervisor, Trainer/OJT). 3. Submit the completed audit report to SAPO. 13. The contractor company shall ensure that their staff medical accommodation facilities are provided with the following necessities/standards. At a minimum includes, but are not limit to: 1. Room size shall be no less than 4.6 meter2 (50 feet2) per individual occupancy. 2. Air conditioning 3. Refrigerator 4. Smoke detector 5. Bathroom provided with the following: 1. Shower with hot and cold running water 2. Sinks (washbasin) 3. Toilet with toilet paper 14. The Contractor Company shall ensure that the medical staff are provided with appropriate accommodation, located within close proximity of the facility or in the camp. If the accommodation is provided in camp, the CC shall ensure that the location is very near to the medical facility building to enable prompt emergency or disaster response. 15. Every HCP shall ensure that their medical facilities have a quality improvement (QI) study in progress. The purpose of a QI study is to achieve the following: 1. Improve patient outcomes and clinical process through continuous quality assessment. 2. Improve safety of patient delivery system processes. 3. Support the vision and optimally utilize resources. 4. Provide evidence upon request. 16. JHAH RAC-MMSR team has the below roles. At a minimum this includes, but are not limited to: 1. JHAH RAC-MMSR team will provide ADVISORY& CONSULTATION ROLE and support to SAPO, HCP and CC, where there is uncertainty of MMSR related issue. 2. RAC-MMSR team may conduct initial clinic audit inspection as applicable with follow up Compliance Review (Visits& reports) for Contractor Company clinics as required. 1  3. CV Reviews and approval is required for all clinical medical candidates by RAC-MMSR team prior to deployment. 4. RAC-MMSR team may conduct audit survey visits for the new HCP applicants (who has interest in adding their medical facilities to the JHAH approved HCP list). This is to evaluate their capabilities in operating remote industrial clinics at SA sites, by providing full medical service as per CSAR and MMSR manuals. RAC-MMSR team may conduct further Compliance Reviews (Follow up visits) & reports as required. 5. The performance of the listed approved HCP facilities is subject to continuous monitoring by RAC MMSR team with collaborations of SA proponent organization. Any decline in the provided medical services may result in removing the HCP name from the JHAH’s approved list for operating Contractor Company Clinics at SA remote industrial sites. For effective communications with RAC-MMSR team, send all your concerns, requests and CVS for approval to the following email address: [email protected] 1