title: Medical evacuations in the oil and gas industry: a retrospective review with implications for future evacuation and preventative strategies.
abstract: Businesses increasingly conduct operations in remote areas where medical evacuation [Medevac(s)] carries more risk. Royal Dutch Shell developed a remote healthcare strategy whereby enhanced remote healthcare is made available to the patient through use of telemedicine and telemetry. To evaluate that strategy, a review of Medevacs of Shell International employees [i.e. expatriate employees (EEs) and frequent business travellers (FBTs)] was undertaken.
  
  
  
  A retrospective review of Medevac data (period 2008-12) that were similar in operational constraints and population profile was conducted. Employee records and Human Resource data were used as a denominator for the population. Analogous Medevac data from specific locations were used to compare patterns of diagnoses.
  
  
  
  A total of 130 Medevacs were conducted during the study period, resulting in a Medevac rate of 4 per 1000 of population with 16 per 1000 for females and 3 per 1000 for males, respectively. The youngest and oldest age-groups required Medevacs in larger proportions. The evacuation rates were highest for countries classified as 'high' or 'extreme risk'. The most frequent diagnostic categories for Medevac were: trauma, digestive, musculoskeletal, cardiac and neurological. In 9% of the total, a strong to moderate link could be made between the pre-existing medical condition and diagnosis leading to Medevac.
  
  
  
  This study uniquely provides a benchmark Medevac rate (4 per 1000) for EEs and FBTs and demonstrates that Medevac rates are highest from countries identified as 'high risk'; there is an age and gender bias, and pre-existing medical conditions are of notable relevance. It confirms a change in the trend from injury to illness as a reason for Medevac in the oil and gas industry and demonstrates that diagnoses of a digestive and traumatic nature are the most frequent. A holistic approach to health (as opposed to a predominant focus on fitness to work), more attention to female travellers, and the application of modern technology and communication will reduce the need for Medevacs.
authors.affiliation: Shell Health, Shell International B.V., Carel van Bylandtlaan 16, 2596HR The Hague, The Netherlands.
authors.forename: Sharyn
authors.initials: S
authors.lastname: Toner
authors.affiliation: Shell Health, Shell International B.V., Carel van Bylandtlaan 16, 2596HR The Hague, The Netherlands.
authors.forename: Derkje H
authors.initials: DH
authors.lastname: Andrée Wiltens
authors.affiliation: Shell Health, Shell International B.V., Carel van Bylandtlaan 16, 2596HR The Hague, The Netherlands.
authors.forename: Johannes
authors.initials: J
authors.lastname: Berg
authors.affiliation: Aberdeen Centre for Trauma Research, Faculty of Health and Social Care, Robert Gordon University, Aberdeen, UK.
authors.forename: Hector
authors.initials: H
authors.lastname: Williams
authors.affiliation: Aberdeen Centre for Trauma Research, Faculty of Health and Social Care, Robert Gordon University, Aberdeen, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Klein
authors.affiliation: International SOS (Intl SOS), London, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Marshall
authors.affiliation: International SOS (Intl SOS), London, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Nerwich
authors.affiliation: International SOS (Intl SOS), London, UK.
authors.forename: Ryan
authors.initials: R
authors.lastname: Copeland
mesh_terms: D000062:Accidents, Occupational / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000368:Aged; D017732:Air Ambulances / Q000706:statistics & numerical data*; D005260:Female; D014943:Global Health; D006285:Health Planning; D006801:Humans; D008297:Male; D008875:Middle Aged; D009786:Occupational Health Services / Q000458:organization & administration*; D060051:Occupational Injuries / Q000453:epidemiology* / Q000517:prevention & control; D061329:Oil and Gas Fields; D055815:Young Adult
keywords: Medevac; Medevac rate; aeromedical evacuation; country risk; expatriates; female travellers; fitness to work; frequent business travellers; medical evacuation; offshore workers; oil and gas platforms; pre-existing conditions; remote healthcare; repatriation