remote area urgent care facilities

HEALTHCARE DEVELOPMENT ORGANIZATIONMedical Designated Facilities Department

Medical Consulting and Quality Assurance Division

Remote Area Clinic Group

Remote Area Urgent Care Facilities Minimum Medical Standards Requirements Manual

2009

© Copyright 2009, Saudi Aramco. All rights reserved. No part of this manual may be reproduced in any form or by any means without the express written consent of Saudi Aramco.

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 Saudi Aramco 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.

Healthcare Development OrganizationMedical Designated Facilities Department

Medical Consulting & Quality Assurance Division

Remote Area Urgent Care Facilities GroupBldg. 554, Room G10, Box 76

Dhahran Health Center

June 14, 2009

MINIMUM MEDICAL STANDARDS REQUIREMENTS MANUAL (MMSR)

To ensure safe practice and deliverance of quality health care to all patients receiving medical care at the work site, Medical Designated Facilities subject matter experts, have put together this Manual to be used as a reference to assist organizations setup, evaluate and monitor the standards of patient care mandatory at Remote Area Clinic health care system.

The requirements within this manual are based on the Ministry of Health (MOH) regulations, Saudi Labor Law and Saudi Aramco Standards (Saudi Aramco Safety Manual, section 28-Medical) and are therefore manda-tory for all SA Proponent Organization and/or Contractor Companies performing work at Saudi Aramco job sites in Saudi Aramco remote areas and/or industrial settings.

Should you require help with the technical aspects of using this manual, one of our advisors will be happy to meet with you. For further information please contact the Remote Area Urgent Care Facilities Group Leader. He can be contacted at 03-877-3459 or 03-877-3338.

This manual was collated by Janet R. Acevedo, Health Educator.

Improving the quality of health care to all patients is a very broad, comprehensive and ambitious undertak-ing, which can only be achieved by working together.

Thank you for your cooperation.

Jacques D. Cheong, Quality Assurance CoordinatorRemote Area Urgent Care Facilities Group

Dr. Moh’d Fawzy Younis, ChiefMedical Consulting and QA Division

Dr. Saad A. Missmar, Director Medical Designated Facilities Department

Dr. T.Q. Al-Daiel, General ManagerHealthcare Development Organization

Table of Contents Section 1 Introduction

How to Use the MMSR Manual ........................................................................................ 1

Definition ......................................................................................................................... 1

Section 2 Initial Category/Level Evaluation

Instructions of Usage ....................................................................................................... 2

Evaluation Form ............................................................................................................... 2

Final Category/Level Selection .......................................................................................... 3

Section 3 Survey and Compliance Review Report for Category ABC Facilities

Health Care Provisions at Remote locations ...................................................................... 4

Building Specifications ..................................................................................................... 7

Manpower Requirements/Hours of Operation .................................................................. 14

Staff Qualification, Experience, Competency, Continuing Education and

Education/Training Records ............................................................................................... 15

Safety Requirements ........................................................................................................ 21

Environmental Health and Infection Control Requirements ............................................... 27

Medical Equipment and Medical Supplies Requirements ................................................... 31

Pharmaceutical Services .................................................................................................... 44

Support Services:

Ambulance Services ......................................................................................................... 53

Communications .............................................................................................................. 57

Janitorial Services ............................................................................................................. 58

Medical Emergency and Disaster Response/Medivac Procedures ....................................... 62

Quality Improvement Requirements .................................................................................. 69

Patient Processing and Medical Records ........................................................................... 70

Health Care Policies, Procedures and Guidelines ............................................................... 71

General Regulations ......................................................................................................... 74

Section 4 Survey and Compliance Review Report for Category D Facilities

First Aid Provisions in Remote Areas – General Regulations ............................................... 76

First Aid Provisions in Remote Areas – First Aid Requirements ........................................... 77

Section 5 Attachments ............................................................................................. 83

Section 6 References .................................................................................................148

Section 7 Appreciation .............................................................................................149

This manual is for nonprofit, noncommercial use only, and may not be sold. It is being published by Saudi Aramco as part of a services enhancement program to improve Remote Area Medical Facilities standards of care.

Section 1 – Introduction

How to Use the MMSR Manual

The MMSR Manual is to be used by any Proponent Organization (Saudi Aramco and/or Contractor) to:

1. Select the Most Appropriate Level of Medical Facility - The Initial Category Evaluation Sheet specifies the criteria for each category/level and therefore allows the proponent organization to evaluate and determine the most appropriate level of first aid services and category of medical facility it must provide at the work site in remote areas and/or industrial settings.

2. Setup a Medical Facility - The Survey and Compliance Review Report specifies the required mandatory minimum medical standards for first aid services and medical facilities at the work site in remote areas and/or industrial settings.

3. Monitor Compliance at Medical Facility - The Survey and Compliance Review Report can be used as a tool to monitor and evaluate the mandatory minimum medical standard requirements for first aid services and medical facilities, including privately owned facilities, operating at Saudi Aramco work sites.

Definition

1. Minimum Medical Standard Requirements – Are the minimum acceptable standards for first aid services and medical facilities at the work site in remote areas and/or industrial settings as specified in the Saudi Labor and Workmen Law, Saudi Aramco Safety Manual, General Instructions and policies and in the Ministry of Health (MOH) mandatory regulations.

2. Remote Area Urgent Care Facilities - Are medical facilities operating at industrial work sites in a remote area, able to provide first aid, urgent care, pre-hospital care, stabilization and prompt transfer of sick and injured employees to the nearest definitive care facility. Also, they are able to provide medical assistance in the event of a disaster.

3. Remote Areas - Are areas of operation, which by distance or topography, are isolated from any medical facility capable of providing an opportunity and prompt response to an emergency situation. These include:

Areas accessed by tracks or dirt roads, such as pipeline corridors and skid roads.

Areas which are far from inhabited areas, developed roads or landing strips.

Areas over open water.

Areas accessed by off-road travel, even if it is near paved roads, towns or industrial facilities.

Examples include offshore locations and off-road locations (i.e., drilling rigs, deep desert exploration, and refining and distribution areas).

We hope the information provided facilitates your efforts in ensuring that medical facilities at the work site in remote areas and/or industrial settings meet the mandatory standards of practices so you are able to provide a safe patient care environment and quality care to all patients and employees.

We wish you the best of luck in this very important endeavor.

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Section 2 – Initial Category/Level Evaluation

Instruction of Usage

1. First: Fill in the required information on the Evaluation Form.

2. Second: Use the criteria listed on the checklist below to evaluate and select the category/level of medical facility your organization requires to provide safe and quality health care to all employees at the work site. The determining factors must be looked at collectively before a final category is selected. Complete the “Final Category/Level Selection ( )” section at the end of page 3.

3. Third: Go to the appropriate section of the survey and compliance review report as indicated in the Final Category /Level Selection ( ) to identify the minimum standard requirements for your selected category.

Evaluation Form

Name of Project: __________________________ Name of Medical Facility: ____________________

Name of Company: __________________________________________________

Contact Details: Tel. No.:________ Fax No.:_______ Mobile No.:________ e-mail Address:

Category of Medical Facilities

Criteria: The following factors are used to determine the category (level) of medical facility required to meet the health needs of your employees at the work site.

Tick Here

CATEGORY/LEVEL A Physician operated facility, large size with laboratory and radiology services

1. Employee population exceeds 50 workers in a single location or within a radius of 15 kilometers.

2. Access to medical care: The company operates at a remote area/location where inpatient medical facilities are not available in the area to refer patients for definitive care or/and timely transfer of patients for definitive care is not possible.

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 operation, providing on-site specialized medical procedures, diagnostic or otherwise, will be cost-effective and benefit company operation.

CATEGORY/LEVEL B Physician operated facility, small size without laboratory and radiology services

1. Employee population exceeds 50 workers in a single location or within a radius of 15 kilometers.

2. Access to medical care: The Company operates at a remote area/location where only a limited number of inpatient medical facilities are available in the area to refer patients for definitive care and/or timely transfer of patients for definitive care may be difficult.

3. Risk factors: The work site is potentially high risk for accidents, disasters or explosions with possibility of mass casualties.

4. Specialized services: Providing on-site specialized medical procedures, diagnostic or otherwise, will be cost-effective and benefit company operation.

CATEGORY/LEVEL C Nurse operated facility

1. Employee population amounts 50 workers in a single location or within a radius of 15 kilometers.

2. Access to medical care: The Company operates at a remote area/location where inpatient medical facilities are available in the area 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 and the capability to arrange an immediate transfer or medivac.

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Category of Medical Facilities

Criteria: The following factors are used to determine the category (level) of medical facility required to meet the health needs of your employees at the work site.

Tick Here

CATEGORY/LEVEL C Nurse operated facility (Cont.)

3. Risk factors: The work site is potentially high risk for accidents, disasters or explosions with low possibility of mass casualties.

4. Specialized services: Specialized procedures can be provided at a company designated hospital. It will not be cost-effective or benefit company operation to have this service provided on-site.

CATEGORY/LEVEL D First Aid Kits/ Cabinets

1. Employer who employs less than fifty (50) workmen shall provide at the work site a first aid cabinet. And shall assign an appropriate number of his workmen to receive first aid training. (Saudi Arab Government Decision No. 404, Articles I-VI dated 17 Jamada 11, 1494 (July 7, 1974 and Saudi Aramco GI-150.002.)

Specialized Services include Radiology, Laboratory, physicals, and other tests/procedures preformed as part of the company’s health conservation program, e.g., hearing test and pulmonary function test.

Final Category/Level Selection ( ):

A Complete Section 1 of the Survey and Compliance Review Report

B Complete Section 2 of the Survey and Compliance Review Report

C Complete Section 3 of the Survey and Compliance Review Report

G Complete Section 4 of the Survey and Compliance Review Report

Remarks:

Name of Assessor: __________________________________________________________

Signature: _____________________________________________ Date: ______________________

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D

Section 3

Section 3

Section 3 – Survey and Compliance Review Report for Category ABC Facilities

SURVEY AND COMPLIANCE REVIEW REPORT

General and Specific Minimum Standards Requirements Category/Level “A, B and C” Facilities (Physician and Nurse Operated Facilities)

Instructions: Tick ( ) Yes or No or Write “NA” Where not Applicable

Item Code

Standards Review – I

Date: Review – II Date: Comments

Yes No Yes No

1.0 HEALTH CARE PROVISIONS AT REMOTE LOCATIONS

GENERAL REGULATIONS – References: Saudi Labor Law, Section 28 of Saudi Aramco Safety Manual and Ministry of Health (MOH) Regulations.

1.1

Every contracting company which operates within Saudi Aramco remote areas work sites shall provide medical care to all employees in accordance with Section 28 of the Saudi Aramco Safety Manual, which incorporates the relevant elements of Chapter 7 of Saudi Labor Law. At a minimum: For more information, see Attachment 1-2, pages 84-86.

1.1-1 An employer who employs less than fifty (50) workmen shall provide at the work site a first aid cabinet. For more information, see section 4, pages 76.

1.1-2 An employer who employs fifty (50) or more laborers at a minimum shall provide its employees with the following:

1.1-2-1 A first aid room at the work site. Depending on needs, the first aid room can range from a single room portable facility to a multi-room facility.

1.1-2-2 A Saudi MOH licensed nurse shall be on duty 24 hours a day, seven days a week (24/7).

1.2 Every proponent organization shall have a copy of the MMSR manual at the work site medical facility for implementation, compliance and reference purposes.

1.3 Every proponent organization shall provide healthcare as per the mandatory insurance laws in the Kingdom of Saudi Arabia implemented in 1999 and 2003:

1.3-1 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.

SCORE: YES = Meet Standards NO = Does not Meet Standards NA = Not Applicable

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Item Code



Yes No Yes No

1.0 HEALTH CARE PROVISIONS AT REMOTE LOCATIONS (Cont.)

GENERAL REGULATIONS

1.3-2

There is evidence that all employees and subcontractor employees are provided with health insurance coverage for emergency and inpatient care including appropriate investigations.

1.3-3

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.

1.3-4

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.

1.4 Every proponent organization shall have a database system that at a minimum includes, but is not limited to the following information:

1.4-1 Employee’s name.

1.4-2 Employee’s ID number.

1.4-3 Employee’s medical registration (MR) number.

1.4-4 Name of Medical Facility.

1.4-5 Medical insurance card number and level of medical coverage.

1.4-6 Proponent organization head office contact number.

1.4-7 Proponent organization 24 hour on-site representative contact number.

1.4-8 Contact number of Saudi Aramco Supervisor overseeing the contractor work.

1.4-9 All information above is kept current at all times.


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Item Code



Yes No Yes No

1.0 HEALTH CARE PROVISIONS AT REMOTE LOCATIONS (Cont.)

GENERAL REGULATIONS

1.5 Every proponent organization at a minimum shall define their organizational values as follows:

1.5-1 A vision, a statement about what the organization wants to become.

1.5-1-1 Vision statement is posted.

1.5-2 A mission, an organization's vision translated into written form. It materializes the management's view of the direction and purpose of the organization.

1.5-2-1 Mission statement is posted.

1.6

Every proponent organization shall ensure that there is at least one (1) crew member per shift with basic level of medical care awarded by a recognized training program (Saudi Red Crescent Society or Saudi Aramco Health Promotion Unit as applicable). At a minimum training includes, but is not limited to: For more information see Saudi Aramco GI-150.002

1.6-1 Basic Life Support (BLS). 1.6-1-1 Current certificate available upon request. 1.6-2 First Aid (FA). 1.6-2-1 Current certificate available upon request.

1.7

Every proponent organization shall ensure that their medical facilities’ healthcare professionals have the required Government license to practice their profession in the Kingdom. At a minimum all professional staff is registered and licensed by the following government bodies: For more information, see Attachment 3, page 91.

1.7-1 Saudi Council for Health Specialties (SCFHS). 1.7-2 Ministry of Health (MOH).


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Item Code



Yes No Yes No

2.0 BUILDING SPECIFICATION

2.A General Standards

2.A.1 Every proponent organization shall ensure that their medical facilities have signage available as follows:

2.A.1-1 Writing/information is clear and concise.

2.A.1-2 At a minimum it contains the following information/details in both English and Arabic:

2.A.1-2-1 Hours of operation.

2.A.1-2-2 Staff availability including regular and emergency contact numbers.

2.A.1-3 Signage is posted at the entrance point to the facility.

2.A.2 Every contractor company shall ensure that their medical facilities’ buildings are provided with following necessities. At a minimum these include, but are not limited to:

2.A.2-1 Each room has air conditioning.

2.A.2-2 Floors are covered with sheets of seamless, non-slip vinyl flooring.

2.A.2-3 Walls are painted with washable paint.

2.A.2-4 All areas within the facility have sufficient electrical power.

2.A.2-5 All electrical power outlets are ground protected.

2.A.2-6 All doors are fire-rated.

2.A.2-7 Floor mounted base cupboard units with seamless laminated work top, as needed.

2.A.2-8 Wall mounted cupboards in quality laminate finish, as needed.


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Item Code



Yes No Yes No

2.0 BUILDING SPECIFICATION (Cont.)

2.A General Standards (Cont.)

2.A.2-9 Sinks (wash basins) are available in the following areas:

2.A.2-9-1 Patient care areas.

2.A.2-9-2 Bathrooms.

2.A.2-9-3 Physician’s examination room.

2.A.2-10 Sinks (wash basins) are available with the following:

2.A.2-10-1 Hot and cold water.

2.A.2-10-2 Liquid soap dispenser.

2.A.2-10-3 Disposable paper towel dispenser.

2.A.2-11 Trash bins are available in all patient care areas.

2.A.2-12 Facilities that have an ambulance bay, shall provide the following:

2.A.2-12-1 A double entrance door as follows:

2.A.2-12-1-1 With sufficient width to enable easy-access of ambulance stretcher.

2.A.2-12-2 An ambulance bay as follows:

2.A.2-12-2-1 Sheltered.

2.A.2-12-2-2

With wall mounted power outlet to connect the ambulance auxiliary air conditioner unit.

2.A.2-12-2-3 With water tap and hosepipe.

2.A.2-12-3 An ambulance ramp is available.

2.A.2-12-3-1 Ramp is correctly positioned and leveled.


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Item Code



Yes No Yes No


2.A General Standards (Cont.)

2.A.2-13 Telephone lines are available in the following areas: 2.A.2-13-1 Business office. 2.A.2-13-2 Nurse station. 2.A.2-13-3 Treatment area. 2.A.2-14 Facility has emergency exit(s) available as follows: 2.A.2-14-1 Exits are not obstructed, kept clear at all times.

2.A.2-14-2 Exit signs are available as follows:

2.A.2-14-2-1 Well illuminated.

2.A.2-14-2-2 Exit signs are not obstructed, kept clear at all times.

2.A.2-15 Internally facility is well illuminated with acceptable (30 foot-candles or 300 Lux) intensity light. Areas include but are not limited to:

2.A.2-15-1 Inpatient examination area. 2.A.2-15-2 Treatment areas.

2.A.2-15-3 There are emergency lights strategically placed for power failure.

2.A.2-16 Externally facility is well illuminated. 2.A.2-17 All facility fabrics internally and externally, are well maintained. 2.A.2-18 Evacuation map is available. 2.A.2-18-1 Map is displayed at all times.

2.A.3

Every contractor company shall ensure that all new buildings (fabric and contents) are inspected and certified as compliant to the required Saudi Aramco (SA) building specifications and Safety and Loss Prevention standards and Environmental Health standards prior to occupation.


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Item Code



Yes No Yes No


2.B Specific Standards

Category/Level “A” Facilities

2.B.1

All facilities in this category shall be a fixed land-based or a portable building with multiple rooms. Floor plan must satisfy traffic flow and functional needs (e.g., easy patient observation, Radiology and Laboratory facilities access and utilization).

2.B.2 Every contractor company in this category shall ensure that their medical facilities have the following areas of operation:

2.B.2-1 Business office with reception.

2.B.2-2 Patient waiting area.

2.B.2-3 Emergency treatment /observation room.

2.B.2-4 Separate bathrooms as follows:

2.B.2-4-1 Patients/visitors.

2.B.2-4-2 Staff, only.

2.B.2-5 Staff room.

2.B.2-6 Nurse station, screening and examination.

2.B.2-7 Store room with level shelving.

2.B.2-8 Janitor room with the following:

2.B.2-8-1 Floor sink.

2.B.2-8-2 Water tap.

2.B.2-8-3 Storage facility (shelving/steel cabinet).

2.B.2-9 Pharmacy area.

2.B.2-10 Laboratory area.

2.B.2-11 Radiology area.

2.B.2-12 Physician’s room.


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Item Code



Yes No Yes No



Laboratory Services

2.B.3 Must be in compliance with all the building specifications and standards in relation to Safety, Environmental Health and Infection Control as specified by MOH regulations.

Radiology Services

2.B.4 Must be in compliance with all the building specifications and standards in relation to Safety, Environmental Health and Infection Control as specified by MOH regulations.


Category/Level “B” Facilities

2.B.5 Every contractor company in this category shall ensure that their medical facilities have the following areas of operation:

2.B.5-1 Business office with reception.

2.B.5-2 Patient waiting area.


2.B.5-4 Pharmacy room (dispensing and storage).

2.B.5-5 Separate bathrooms as follows:



2.B.5-6 Staff room.

2.B.5-7 Nurse station, screening and examination.

2.B.5-8 Store room with level shelving.

2.B.5-9 Physician’s room.


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Item Code



Yes No Yes No



Category/Level “B” Facilities

2.B.5-10 Janitor room with the following:




Category/Level “C” Facilities

2.B.6

All facilities in this category have a fixed land-based or portable building with one or more rooms depending on the facility’s scope of service and functional requirements. Open floor plan is preferred for multi-rooms building. For floor plan sample, see Attachment 26-27, pages 146-147.

2.B.7

Every contractor company in this category shall ensure that their medical facilities have the following areas of operation: As indicated below, exempt are certain areas at single room portable building in onshore rigs or at single assigned room in offshore operations.

2.B.7-1 Patient waiting area. Not applicable to single room portables.

2.B.7-2 Nurse screening and examination area.


2.B.7-4 Separate bathrooms as follows: Not applicable to single room portables.




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Item Code



Yes No Yes No



Category/Level “C” Facilities

2.B.7-5 Store room with level shelving. Not applicable to single room portables.

2.B.7-6 Staff room. Not applicable to single room portables.

2.B.7-7 Janitor room with the following: Not applicable to single room portables.




Staff on-site/Camp Accommodation

2.B.8 Every contractor company shall ensure that their employees are provided with appropriate accommodation, either as an integral part of the facility or in the camp.

2.B.9 If accommodation is provided in the camp, contractor company shall ensure that the location is very near to the medical facility building to enable prompt emergency or disaster response.

2.B.10 Every contractor company shall ensure that their staff accommodation facilities are provided with following necessities/standards. At a minimum these include, but are not limited to:

2.B.10-1 Room size shall be no less than 4.6 sq. meter (50 sq. feet) per individual occupancy, excluding bathroom and shower.

2.B.10-2 Air conditioning.


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Item Code



Yes No Yes No



Staff on-site/Camp Accommodation

2.B.10-3 Bathroom with the following:

2.B.10-3-1 Toilet.

2.B.10-3-2 Sinks (washbasin).

2.B.10-4 Shower with hot and cold running water.

2.B.10-5 Smoke detector.

2.B.10-6 Refrigerator.

2.B.10-7 Linen supplies.

2.B.10-8 Access to laundry facilities.

3.0 MANPOWER REQUIREMENTS/HOURS OF OPERATION

General Standards

3.1 Every proponent organization has a backup plan in place to provide coverage for unplanned emergencies, holidays, sickness, off-duty days, absences and other unplanned events.

3.2

Every contractor company shall ensure that for all matters pertaining to clinic operation, all registered nurses (RN) are under the direct supervision of a senior RN or physician. Distant supervision is acceptable and contact for advice/consultation shall be available 24 hours a day, seven days a week (24/7).

3.3 A work schedule detailing staff’s duty hours to cover a 24/7 operation is available and posted.

3.4 An on-call schedule for off-duty hours must be available and posted with respective contact numbers.


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Item Code



Yes No Yes No

4.0 STAFF QUALIFICATIONS, EXPERIENCE, COMPETENCY, CONTINUING EDUCATION AND EDUCATION/TRAINING RECORDS

A. General standards

4.A.1 Each proponent organization shall ensure that there is an appropriate recruitment system to select medical staff.

4.A.2 There is evidence that the recruitment system has a process for reviewing and approving resumes/CVs and carrying out pre-hire interviews as required.

4.A.3

There is evidence that resumes/CVs of healthcare candidates are reviewed by relevant experienced healthcare professionals (physician, registered nurse, pharmacist) noting experience, qualifications and clinical competency.

B. Staff Education and Competency

4.B.1 There is an employee New Hire Orientation (NHO) program in place.

4.B.2 There is a mechanism in place to provide all staff with continuing education.

4.B.3 There is a mechanism in place to provide all staff with periodic mandatory education. At a minimum this includes, but is not limited to:

4.B.3-1 Basic Life Support (BLS), every two (2) years.

4.B.3-2 Fire safety, yearly.

4.B.3-3 Infection control, yearly.

4.B.4 All mandatory education shall remain current and completion of all courses shall be documented and made available upon request.

4.B.5 Where special clinical tests and procedures are approved as part of the scope of service, a list of these tests and procedures is available.

4.B.6

Where special clinical tests and procedures are carried out, staff shall receive appropriate training and certified competent to perform these and/or competent to use associated equipment including performing manufacturer’s required calibration.


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Item Code



Yes No Yes No

4.0 STAFF QUALIFICATIONS, EXPERIENCE, COMPETENCY, CONTINUING EDUCATION AND EDUCATION/TRAINING RECORDS (Cont.)

B. Staff Education and Competency

4.B.7

Each proponent organization shall ensure that their staff has access to reference/education materials to keep them current with clinical standards and practices and with their professional/education requirements. A minimum of one (1) book (latest edition) for each of the following category shall be made available:

4.B.7-1 Nursing Practice.

4.B.7-2 Emergency Care.

4.B.7-3 Anatomy and Physiology.

4.B.7-4 EKG Interpretation.

4.B.7-5 Pharmacology.

4.B.7-6 Clinical Practice.

4.B.7-7 Basic Life Support (BLS).

4.B.7-8 First Aid (FA).

4.B.7-9 Trauma Care.

4.B.7-10 Merck Manual.

4.B.7-11 Physician’s Desk Reference. Physician operated facilities only.

C. Staff Records

4.C.1 All documents (certified) relating to employees past experience, professional qualifications and references must be available for verification upon request.

4.C.2

Each employee has personnel file containing all documents related to his employment (i.e., personal details, professional licensing, certificates, education and training history, performance appraisals, disciplinary actions and communications).


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Item Code



Yes No Yes No


D. Staff Specific Qualifications

Nurses Requirements:

4.D.1 To practice his profession in the Kingdom, a nurse is registered and licensed by the following government bodies: For more information, see Attachment 3, page 91.

4.D.1-1 Registered with Saudi Council for Health Specialties (SCFHS), prior to work site assignment.

4.D.1-2 When registration is under process, nurse shall have a valid SCFHS registration card or a follow-up card with K number only until registration card is issued.

4.D.1-3 Has a valid Saudi MOH license within 6 months of hire.

4.D.2 Must be graduated from an approved nursing school, 3-4 years basic course and registered in their country of origin.

4.D.3 Able to operate emergency medical equipment. At a minimum equipment includes, but is not limited to:

4.D.3-1 Automatic Electronic Defibrillator (AED).

4.D.3-2 Intravenous (IV) pump.

4.D.3-3 Airway management adjuncts.

4.D.4

Nurse has basic level of medical care from a recognized training program/institution (Saudi Red Crescent Society (SRCS) or Saudi Aramco (SA) Health Promotion Unit (HPU)) prior to work assignment. At a minimum this includes, but is not limited to:

4.D.4-1 Basic Life Support (BLS), current certificate.

4.D.4-2 First Aid (FA), current certificate.

4.D.5 Must have minimum 2 years Emergency Room experience.

4.D.5-1 Evidence of recent practice, less than 2 years.


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Item Code



Yes No Yes No


Nurses Requirements:

4.D.6

Each proponent organization shall ensure that their staff completed an emergency skills competency assessment prior to being assigned to work independently. Competency assessment determines the employee’s readiness to practice independently. Program details and performance appraisal (assessment) is available upon request. At a minimum assessment includes, but is not limited to following skills: For more information, see Attachment 20, page 132.

4.D.6-1 Airway Management.

4.D.6-2 Ability to administer BLS.

4.D.6-3 Ability to use at least six (6) types of emergency equipment.

4.D.6-4 Ability to manage at least 10 kinds of first aid.

4.D.6-5 Ability to manage at least six (6) kinds of emergencies.

4.D.6-6 Ability to activate a disaster response.

4.D.6-7 Ability to complete a pharmaceutical, drug familiarization program.

4.D.7 Good written and verbal English language skills.

Physicians Requirements:

4.D.8 General practitioner with five (5) years experience in a hospital setting and a minimum of one (1) year emergency room experience.

4.D.8-1 Evidence of recent practice, less than 2 years.

4.D.9 To practice his profession in the Kingdom, physician is registered and licensed by the following government bodies: For more information, see Attachment 3, page 91.

4.D.9-1 Registered with Saudi Council for Health Specialties (SCFHS), prior to work site assignment.


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Item Code



Yes No Yes No


Physicians Requirements:

4.D.9-2 When registration is under process, the nurse shall have a valid SCFHS registration card or a follow-up card with K number only until registration card is issued.

4.D.9-3 Has a valid Saudi MOH license within 6 months of hire.

4.D.10 Physicians have the basic level of medical care from a recognized training program/institution (SRCS or SA - HPU) prior to work assignment. At a minimum this includes, but is not limited to:

4.D.10-1 Basic Life Support (BLS), current certificate.

4.D.10-2 First Aid (FA), current certificate.


Ambulance Drivers Requirements:

4.D.12 Ambulance driver at a minimum meets the following work requirements:

4.D.12-1 Saudi driving license with minimum of one (1) year driving experience.

4.D.12-2 A good driving record.

4.D.13 Secondary school certificate (L7-9), diploma or equivalent.

4.D.14 Ambulance driver has the basic level of medical care from a recognized training program/institution (SRCS or SA - HPU) prior to work assignment. At a minimum this includes, but is not limited to:

4.D.14-1 Basic Life Support (BLS), current certificate. Course in Arabic is acceptable.

4.D.14-2 First Aid (FA), current certificate. Course in Arabic is acceptable.

4.D.15 Good command of English language skills preferred.


19

7

19




Item Code



Yes No Yes No


Ambulance Drivers Requirements:

4.D.16

Within two (2) weeks of site assignment completed a specific orientation and on-the-job training (OJT) program, on the following: (Evidence of completion available upon request.) For more information, see Attachment 21, page 136.

4.D.16-1 Familiarization with ambulance equipment/devices and how to perform some basic functions.

4.D.16-2 Site location orientation.

4.D.16-3 Role and responsibilities in the event of an emergency and/or disaster response.

4.D.16-4 Ambulance routine checks and maintenance.

Pharmacists Requirements:

4.D.17 A degree in pharmacy (Bachelor of Science [B.S.] and/or Master of Science [M.S.] degree), recognized by the Saudi Arabian Government as eligible for licensing.

4.D.18 Valid pharmacist license to practice in Saudi Arabia.

4.D.19 Minimum of three (3) years experience in hospital or clinical pharmacy.


Laboratory Technicians Requirements:

4.D.21 Bachelor of Science degree in medical technology or equivalent.

4.D.22 Valid license to practice in Saudi Arabia.

4.D.23 Three (3) years practical experience in a medical laboratory.



20

20




Item Code



Yes No Yes No


Radiology Technicians Requirements:

4.D.25 Diploma in radiology technology.

4.D.26 Valid license to practice in Saudi Arabia.

4.D.27 Three (3) years general practical experience.


5.0 SAFETY REQUIREMENTS

5.1 Every proponent organization shall ensure that their medical facilities have fire safety equipment available. At a minimum this includes, but is not limited to:

5.1-1 Fire Extinguishers as follows:

5.1-1-1 Appropriate fire extinguishers (A, B, C).

5.1-1-2 Clearly identified.

5.1-1-3 Placed in strategic locations.

5.1-1-4 Labeled with proof of periodic inspection, usually quarterly.

5.1-2 Smoke detectors.

5.1-3 Scott Air Pak (At location where exposure to H2S is a risk).

5.2 Every proponent organization shall ensure that their medical facilities have eyewash station available as follows:

5.2-1 Unit is outside the facility building and in proper working order.

5.2-2 There is evidence that unit is regularly tested/inspected to ensure it is in proper working order.


21

21




Item Code



Yes No Yes No

5.0 SAFETY REQUIREMENTS (Cont.)

5.3 Every proponent organization shall ensure that their medical facilities have decontamination shower available as follows:

5.3-1 Unit is in proper working order.

5.3-2 There is evidence that unit is regularly tested/inspected to ensure it is in proper working order.

5.4

Every proponent organization shall ensure that their medical facilities properly manage their compressed gas cylinders. At a minimum, the following precautions and safety regulations shall be observed when storing, handling, and using compressed gas cylinders in order to keep the hazards to a minimum:

5.4-1 Pressure is checked and logged daily, log sheet available upon request.

5.4-2 Cylinders are replaced when content reaches 500 pressure per square inch (psi).

5.4-3 Cylinders are securely stored as follows:

5.4-3-1 Either on oxygen delivery carts, walls, or in a secure storage cage.

5.4-3-2 In an upright position (valve end up), on a level floor. 5.4-3-3 Well ventilated and dry storage area.

5.4-3-4 In a storage room free from flammable substances (i.e., oil and/or volatile liquids).

5.4-3-5 Away from direct sunlight and from other sources of heat as cylinder temperatures must not exceed 50 °C (122 °F).

5.4-3-6 All sources of ignition (i.e., motors, generators, communication systems, etc.) are removed from the storage room.


22

22




Item Code



Yes No Yes No


5.4-3-7 Empty cylinders are stored separate from full cylinders.

5.4-3-8 Empty cylinders are marked empty.

5.4-4 No smoking signs are available and posted in areas where gas cylinders are located and/or stored.

5.5 Microwave oven, if available, shall be managed by the medical facility as follows:

5.5-1 Have operating instructions posted nearby.

5.5-2 Maintained clean and in good working order.

5.6

ELECTRICAL EQUIPMENT SAFETY - Every proponent organization shall ensure that their medical facilities properly manage their electrical equipment. At a minimum, the following precautions and safety regulations are observed when using electrical equipment in order to prevent injuries and keep hazards to a minimum:

5.6-1 All electrical equipment is in proper working order and safe for use, does not tingle, shock, spark or get overheated.

5.6-2 Case or body of the item is not cracked, chipped or broken.

5.6-3 There are no exposed internal parts.

5.6-4 The controls (buttons) are complete and functional.

5.6-5 There is an off switch, when used, equipment turns off.

5.6-6 Unit’s cord is intact (not damaged), has no cracks and/or breaks.

5.6-7 Cord is not taped or covered.

5.6-8 Unit’s plug is not damaged, has no cracks and/or breaks.

5.6-9 Plug is directly secured to wall socket.

5.6-10 There is an extension unit secured to the wall.

5.6-11 There is evidence that equipment is periodically checked for obvious defects or hazards.


23 23




Item Code



Yes No Yes No


5.6-12 There is evidence that defective equipment is removed from service, has tags so that no other staff will attempt to use it.

5.6-13 All electrical equipment is ground protected.

5.7

MEDICAL EQUIPMENT SAFETY - Every proponent organization shall ensure that their medical facilities have a system in place for the management of their medical equipment. At a minimum, the following precautions and safety regulations shall be implemented to ensure that the medical devices meet appropriate standards of safety, quality and performance:

5.7-1

There is a process in place for the maintenance/service of medical equipment performed either by the company that supplied the equipment or through an agent able to arrange timely and reliable service.

5.7-2

There is an established process for medical equipment to go through an initial acceptance test performed by a Clinical Engineer prior to being put into service. A record of this test is available upon request.

5.7-3

All patient care equipment must undergo periodic preventive maintenance (PM) checks. This includes testing and calibration as per manufacturer and local policy. PM stickers or log are placed to indicate PM completion and next due date.

5.7-4 There is evidence that there is a backup system in place for repairing medical equipment.

5.7-5 All equipment shall be checked daily for normal function and findings are recorded in a log. Log is available upon request.

5.8

Every proponent organization shall ensure that their medical facilities have a system in place for reporting on-the-job/off-the-job of injuries. Injuries shall be documented and reported to the MOH and Saudi Aramco Loss Prevention. For more information, see Attachment 5, page 93.


24 24




Item Code



Yes No Yes No


5.9 HAZARDOUS SUBSTANCES SAFETY - Every proponent organization shall ensure that their medical facilities have a system in place for the safe management/storage of hazardous substances as follows:

5.9-1 There is a Material Safety Data Sheet (MSDS) Manual available.

5.9-2 There is a current MSDS for each hazardous substances/ products used.

5.9-3 Manual is placed on a strategic location, easy to see and reach.

5.9-4 Staff is able to quickly locate manual, shows/verbalizes location.

5.9-5 Facility has appropriate antidotes for handling chemical exposure.

5.10

FIRE SAFETY - Every proponent organization shall ensure that their medical facilities have approved fire safety protocols in place. At a minimum, the following safety requirements shall be implemented to ensure the safety of patients/family, staff and visitors.

5.10-1 There is evidence that all staff is oriented on fire safety (R.A.C.E. and P.A.S.S.).

5.10-2

Staff verbalizes what to do in the event of a fire: Rescue injured person(s) from immediate danger, Activate nearest fire alarm pull station, Confine the fire by closing all doors/windows, Extinguish if fire is small/Evacuate if instructed (R.A.C.E.).

5.10-3 Staff shows/verbalizes location of the nearest fire alarm.

5.10-4 Staff is able to operate fire alarm, in theory.

5.10-5 Staff shows/verbalizes location of the nearest fire extinguisher.


25

25




Item Code



Yes No Yes No


5.10-6 Staff demonstrates/verbalizes knowledge of the types of fire extinguishers (A, B, C).

5.10-7

Staff is able to verbalize how to properly operate fire extinguisher: Pull the pin at the top of the fire extinguisher. Aim the nozzle at the base of the fire. Squeeze the handle of the fire extinguisher together. Sweep the nozzle from side to side (P.A.S.S.).

5.10-8 In the event of a fire staff knows/verbalizes the proper fire evacuation procedures. Able to put into action, in theory.

5.10-9 Fire evacuation procedures are posted in appropriate/ strategic locations, at all times.

5.10-10 Staff shows/verbalizes location of the nearest fire exit and evacuation protocol.

5.11

EMERGENCY RESPONSE - Every proponent organization shall ensure that their medical facilities have approved emergency response protocol in place. At a minimum, the following emergency response requirements shall be implemented to ensure timely emergency response in the event of a disaster.

5.11-1 There is a disaster response plan in place and it is implemented.

5.11-2 There is evidence that all staff is oriented on disaster response procedures.

5.11-3 Disaster response plan is posted in a strategic location, at all times.

5.11-4 Staff shows/verbalizes location of disaster response plan. 5.11-5 There is a current disaster call-out list of key personnel.

5.11-6 Disaster call-out list is posted in a strategic location, at all times.

5.11-7 Staff shows/verbalizes location of the disaster call-out list.


26 26




Item Code



Yes No Yes No

6.0 ENVIRONMENTAL HEALTH AND INFECTION CONTROL REQUIREMENTS

6.1 VACCINATION PROGRAM - Every proponent organization shall ensure that their medical facilities have a vaccination program in place as follows:

6.1-1 There is a vaccination program for all open wound injuries and is implemented.

6.1-2 Administered vaccines are appropriately logged in a book or database.

For more information, see Attachment 6, page 94.

6.1-3 As per MOH regulations, all staff before site assignment, shall be screened and immunized as follows:

6.1-3-1 Chest X-ray.

6.1-3-2 Tuberculosis skin test (tuberculin or PPD test).

6.1-3-3 Hepatitis B (HBV) and Hepatitis C (HCV).

6.1-3-4 Human Immunodeficiency Virus (HIV).

6.1-3-5 There is evidence that screening and immunization were completed.

6.2 Every proponent organization shall ensure that staff knows and complies with the following standard precautions:

6.2-1 Hand washing.

6.2-2 Gloves.

6.2-3 Mask.

6.2-4 Handling sharps.

6.2-5 Cleaning of spills.

6.2-6 Patient placement (isolation).


27

27




Item Code



Yes No Yes No

6.0 ENVIRONMENTAL HEALTH AND INFECTION CONTROL REQUIREMENTS (Cont.)

6.3 Every proponent organization shall ensure that personal protective equipment (PPE) is always available. At a minimum this includes, but is not limited to:

6.3-1 Disposable masks.

6.3-2 Gloves.

6.3-3 Goggles.

6.3-4 Gowns.

6.3-5 Plastic aprons.

6.3-6 Safety shoes.

6.4 Facility ensures that sterilization is not performed by soaking in liquids, boiling and/or steaming. This is NOT an acceptable practice.

6.5 Every proponent organization shall ensure that all CSS supplies (instruments and packs) in their medical facilities are disposable. At a minimum these include, but are not limited to:

6.5-1 Dressing packs.

6.5-2 Forceps.

6.5-3 Tongue depressors.

6.5-4 Dressing scissors (individual pack).

6.5-5 Suture pack.

6.6 All clinical areas have sinks (wash basins) available with the following:

6.6-1 Hot and cold water.

6.6-2 Antiseptic liquid soap.

6.6-3 Wall mounted paper towel dispensers.

6.6-4 Trash bins.


28

28




Item Code



Yes No Yes No


6.7 Every proponent organization shall ensure that their medical facilities have approved alcohol-based hand-rub, if sink(s) are not available.

6.8 Staff knows and is able to demonstrate appropriate hand sanitizing/ hand washing technique as per established hand washing policy.

6.9 Examination tables are protected with disposable cover sheets or paper rolls.

6.10 Every proponent organization shall ensure that their medical facilities have appropriate bactericidal available and that it is used to disinfect hard surfaces.

6.11 Clean linen is stored in a protected clean area.

6.12 Soiled linen is placed (deposited) into covered, leak proof bags, as per established criteria.

6.13 There are adequate puncture resistant, leak-proof sharp containers in all clinical areas, as follows:

6.13-1 All clinical areas have sharp containers.

6.13-2 Sharp containers are wall-mounted.

6.13-3 Replaced when they are three quarters (¾) full.

6.14 There is no recapping of needles. If used needles are recapped, the scoop method is used.

6.15 Healthcare providers are able to verbalize what to do in the event of a needle stick/sharps injury.

6.16 Housekeepers are able to verbalize what to do in the event of a needle stick/sharps injury.

6.17

Every proponent organization shall ensure that their medical facilities have a system in place for the safe management (identification, segregation, collection, storage, transportation, treatment and disposal) of infectious wastes/biomedical waste, as follows:

6.17-1 System is in compliance with Infection Control (IC) guidelines and is in accordance with MOH regulations.


29 29




Item Code



Yes No Yes No


6.17-2 Staff is familiar with and is able to verbalize the disposal protocol (i.e., all sharps boxes are securely taped shut, double boxed and transported to an approved agent for disposal).

6.18 Every proponent organization shall ensure that their medical facilities have two (2) dedicated refrigerators available, as follows:

6.18-1 Medication refrigerator is used for medications only. 6.18-2 Refrigerator is used for staff’s food only.

6.18-3 Temperature is maintained between 2-8 degrees Celsius (36-46 degrees Fahrenheit).

6.18-4 There is a thermometer available in each refrigerator.

6.18-5 Refrigerator’s temperature is recorded twice a day in a log sheet. Log is available upon request.

6.18-6 Refrigerators are cleaned inside and out on a regular basis, and when applicable, defrosted as needed.

6.19 Every proponent organization shall ensure that their medical facilities have adequate color-coded foot-operated waste bins, as follows:

6.19-1 For regular waste. 6.19-2 For infectious waste. 6.19-3 Bins are labeled.

6.20 Every proponent organization shall ensure that their medical facilities have blood spill kits available. For more information, see Attachment 7, page 95.

6.21 There is evidence that personnel responsible for cleaning and disinfecting blood and body fluids spills are adequate trained.

Laboratory Services

6.22 Laboratory specimens are handled, stored and transported in accordance with established policy/protocol.


30

30




Item Code



Yes No Yes No

7.0 MEDICAL EQUIPMENT AND MEDICAL SUPPLIES REQUIREMENTS

7.1

Every proponent organization shall ensure that their medical facilities depending on their category and operational needs have adequate quantity of medical and hospital equipment. At a minimum equipment includes, but is not limited to: For more information, see Attachment 8, page 98.

7.1-1 Bag valve mask (BVM) with built-in CO2 detection device, (e.g., AMBU), adult, disposable.

7.1-2 Backboard, long with straps.

7.1-3 Dressing cart stainless steel (trolley). Not applicable to single room portables.

7.1-4 Drug cupboard, lockable.

7.1-5 Wheel chair. Not for single portable facility.

7.1-6 Automated external defibrillator (AED), portable with the following monitoring capabilities:

7.1-6-1 Continuous cardiac monitoring.

7.1-6-2 Able to print strip.

7.1-6-3 Blood pressure measurement.

7.1-6-4 Oxygen saturation measurement. Separate pulse oximeter is acceptable if the above is not available on the AED.

7.1-7 Emergency response bag. For more information see Attachment 15, page 120.

7.1-8 Exam/emergency stretcher with lockable wheels. Stretcher without wheels acceptable at single room portable facilities.


31 31




Item Code



Yes No Yes No

7.0 MEDICAL EQUIPMENT AND MEDICAL SUPPLIES REQUIREMENTS (Cont.)

7.1-9 Observation bed. Not applicable to single room portables.

7.1-10 Entonox/nitronox unit, portable.

7.1-11 Examination light, wall mounted.

7.1-12 Refrigerators dedicated as follows:

7.1-12-1 For staff, small, medium or large.

7.1-12-2 For chilled items/drugs, small, medium or large.

7.1-13 Hare traction unit.

7.1-14 Infusion pump.

7.1-15 Intravenous (IV) pole/stand, mobile. Due to space limitation in single room portables, any device which facilitates the hook up of IV bag/bottle is acceptable.

7.1-16 Ophthalmoscope/otoscope, wall mounted and/or desk top.

7.1-17 Oxygen cylinder D size, wall secured or cart.

7.1-18 Oxygen cylinder E size, wall secured or cart.

7.1-19 Oxygen Resuscitation unit (e.g., Robert Shaw or Oxy-Viva Resuscitator).

7.1-20 Portable emergency eye irrigation unit.

7.1-21 Stretcher emergency, disposable (e.g., Life lite emergency), five (5) per box.

7.1-22 Stretcher, basket. In single room facility, to be part of operation emergency response supplies.

7.1-23 Weight/height scale.

7.1-24 Ring cutter.


32 32




Item Code



Yes No Yes No


7.1-25 Scissors bandage.

7.1-26 Sharps disposable box for disposal of contaminated sharp.

7.1-27 Sphygmomanometer, aneroid type, desk top or wall mounted.

7.1-28 Stethoscope.

7.1-29 Suction: portable suction, Laerdal, with rechargeable batteries.

7.1-30 Thermometer: electronic thermometer.

7.1-31 Visual acuity chart.

7.1-32 Scoop stretcher with straps.

7.1-33 Glucometer machine, calibration safe.

7.1-34 Pocket mask with oxygen nipple/inlet.

7.2

Every proponent organization shall ensure that their medical facilities depending on their category and operational needs have adequate quantity of standard medical supplies. At a minimum supplies include, but are not limited to:


7.2-1 Abdominal pads.

7.2-2 Adhesive tapes, sizes include, but are not limited to:

7.2-2-1 ½ inch.

7.2-2-2 1 inch.

7.2-2-3 2 inch.

7.2-3 AED - electrodes and other accessories.


33 33




Item Code



Yes No Yes No


7.2-4 Airways oral, guedal, disposable, sizes include, but are not limited to:

7.2-4-1 Small.

7.2-4-2 Medium.

7.2-4-3 Large.

7.2-5 Alcohol preps.

7.2-6 Aluminum foil, roll.

7.2-7 Anal scope, disposable. Not for Cat. C facilities.

7.2-8 Applicators sterile, 6 inch.

7.2-9 Applicators non-sterile, 3 inch.

7.2-10 Apron, plastic.

7.2-11 Bag: paper bag, preferable waxed.

7.2-12 Band aids.

7.2-13 Bandages stockinet, sizes include, but are not limited to:

7.2-13-1 2 inch.

7.2-13-2 4 inch.

7.2-14 Bandages ace, sizes include, but are not limited to:

7.2-14-1 2 inch.

7.2-14-2 3 inch.

7.2-14-3 4 inch.

7.2-14-4 6 inch.


34 34




Item Code



Yes No Yes No


7.2-15 Bandages, triangular.

7.2-16 Basins, kidney shape, disposable.

7.2-17 Batteries at a minimum include, but are not limited to:

7.2-17-1 1.5 volts, D cell.

7.2-17-2 1.5 volts, AA.

7.2-17-3 1.5 volts, AAA.

7.2-17-4 Spare for AED.

7.2-17-5 Chargeable for EKG machine, spare.

7.2-18 Bandage scissors.

7.2-19 Betadine swabs and/or solution sticks.

7.2-20 Blood spill kit. For details and contents, see Attachment 7, page 95.

7.2-21 Body bags.

7.2-22 Burn dressing, sterile burn sheet 60 x 90 cm.

7.2-23 Burn pad 55 x 75 cm.

7.2-24 Butterfly cannulas, sizes include, but are not limited to:

7.2-24-1 19 gauge.

7.2-24-2 21 gauge.

7.2-24-3 23 gauge.

7.2-25 Catheters nasal, sizes include, but are not limited to:

7.2-25-1 18 french.

7.2-25-2 16 french.


35 35




Item Code



Yes No Yes No


7.2-26 Suction catheters, sizes include, but are not limited to:

7.2-26-1 14 french.

7.2-26-2 16 french.

7.2-27 Catheterizations set urethral, size 14 french, disposable.

7.2-28 Cervical collars, hard, stiff neck brand only, sizes include, but are not limited to:

7.2-28-1 No neck adult.

7.2-28-2 Small adult.

7.2-28-3 Regular adult.

7.2-29 Cold packs.

7.2-30 Cotton balls, sterile, 10 packs.

7.2-31 Cardio Pulmonary Resuscitation (CPR) board.

7.2-32 Glue, derma bond. Not for Category C facilities.

7.2-33 Drain Penrose, sizes include, but are not limited to:

7.2-33-1 ½ inch.

7.2-33-2 1 inch.

7.2-34 Dressings include but are not limited to:

7.2-34-1 Non-adhering.

7.2-34-2 Disposable dressing pack.

7.2-34-3 Tegaderm, 6 centimeter x 7 centimeter (cm).

7.2-34-4 Multi-trauma dressing, sterile.

7.2-35 Ear speculum dispenser.


36 36




Item Code



Yes No Yes No


7.2-36 Ear speculum.

7.2-37 Ear wash syringe.

7.2-38 Electrocardiogram recording paper.

7.2-39 EKG adaptor clips/pads or suction bulbs.

7.2-40 EKG electrodes, disposable if applicable.

7.2-41 Elastoplasts, sizes include, but are not limited to:

7.2-41-1 ½ inch.

7.2-41-2 1 inch.

7.2-41-3 3 inch.

7.2-42 Emergency blankets at a minimum include, but are not limited to:

7.2-42-1 Aluminum polymer, body heat retainer.

7.2-42-2 Disposable emergency blankets, size 58 inch x 90 inch.

7.2-43 Emergency eye wash solution, 16 ounce bottle.

7.2-44 Eye pads, sterile.

7.2-45 Filter, pocket mask.

7.2-46 Splinter forceps, fine tip disposable.

7.2-47 Roller gauze, non-sterile, sizes include, but are not limited to:

7.2-47-1 1 inch.

7.2-47-2 2 inch.

7.2-47-3 3 inch.

7.2-47-4 4 inch.


37 37




Item Code



Yes No Yes No


7.2-48 Gauze sponges, non-sterile, sizes include, but are not limited to:

7.2-48-1 2 x 2. 7.2-48-2 3 x 3. 7.2-48-3 4 x 4. 7.2-49 Gauze sponges, sterile, sizes include, but are not limited to: 7.2-49-1 2 x 2. 7.2-49-2 3 x 3. 7.2-49-3 4 x 4. 7.2-50 Gloves examination, non-sterile, latex.

7.2-51 Gloves examination, sterile, latex. sizes include, but are not limited to:

7.2-51-1 7. 7.2-51-2 7 ½. 7.2-51-3 8. 7.2-52 Glucometer control solutions, as applicable. 7.2-53 Safety goggles. 7.2-54 Head immobilizer.

7.2-55 Humidifier disposable with adapter, Aquapak, 500 milliliters (ml).

7.2-56 Portable emergency eye wash set.

7.2-57 Intravenous (IV) catheters Jelco, sizes include, but are not limited to:

7.2-57-1 14 gauge. 7.2-57-2 16 gauge. 7.2-57-3 18 gauge. 7.2-57-4 20 gauge. 7.2-57-5 22 gauge.


38 38




Item Code



Yes No Yes No


7.2-58 IV set, primary and piggyback pump set for pump type.

7.2-59 IV tubing (nitroglycerin set) for IV pump. Not for Category C facilities.

7.2-60 IV tubing, 15 drops set. 7.2-61 IV tubing, 60 drops set. 7.2-62 IV tubing, metriset. 7.2-63 Kerlix rolls. 7.2-64 Kleenex tissue. 7.2-65 Lancets.

7.2-66 Laryngeal Mask Airways (LMA), disposable, sizes include, but are not limited to:

7.2-66-1 3. 7.2-66-2 4. 7.2-66-3 5. 7.2-67 Laryngeal mask airway holder. 7.2-68 Face mask, disposable. 7.2-69 Medicine cups. 7.2-70 Micropore tape, sizes include, but are not limited to:

7.2-70-1 ½ inch.

7.2-70-2 1 inch. 7.2-70-3 2 inch. 7.2-71 Nebulizer sets. 7.2-72 Needles, sizes include, but are not limited to:

7.2-72-1 18 gauge, 1-1½ inch.

7.2-72-2 20 gauge, 1 inch.

7.2-72-3 22 gauge, 1-½ inch.


39 39




Item Code



Yes No Yes No


7.2-73 Optivisor.

7.2-74 Oxygen connecting tubes.

7.2-75 Oxygen flow meter, to fit various size cylinders.

7.2-76 Oxygen masks adult, simple.

7.2-77 Oxygen masks, non-breathing, adult.

7.2-78 Oxygen nasal cannulas, adult.

7.2-79 Paper roll for examination table (e.g., Vanco).

7.2-80 Paper cups.

7.2-81 Paramedic scissor/sheer.

7.2-82 Penlight torch/flashlight.

7.2-83 Percussion hammer.

7.2-84 Pleur evac drainage. Not for Category C facilities.

7.2-85 Red dot monitoring electrodes.

7.2-86 Safety pins, large.

7.2-87 Safety hard hat, size to fit.

7.2-88 Scalpel handle, disposable with the following:

7.2-88-1 Blades number 11.

7.2-88-2 Blades number 20.

7.2-89 Shroud Kit.

7.2-90 Sharps boxes (SB) at a minimum include, but are not limited to:

7.2-90-1 SB with wall brackets, large.

7.2-90-2 SB with wall brackets, small.

7.2-90-3 SB small, ambulance.


40 40




Item Code



Yes No Yes No


7.2-91 Spandages at a minimum include, but are not limited to:

7.2-91-1 S-01, small, child's finger, toes, with applicator.

7.2-91-2 S-02, adult finger, toes, with applicator.

7.2-91-3 S-03, hand, lower arm, wrist, ankle.

7.2-91-4 S-04, large hand, foot, upper arm, elbow.

7.2-91-5 S-05, large arm, small leg, knee, amputations.

7.2-91-6 S-06, large leg, knee, amputations, IV / armboard.

7.2-91-7 S-07, wound trauma bandaging system.

7.2.92 Splints cardboard, sizes as follow:

7.2.92-1 Arm, 12 inch.

7.2.92-2 Leg, 12 inch.

7.2.92-3 Arm, 18 inch.

7.2.92-4 Leg, 18 inch.

7.2.92-5 Leg, 24 inch.

7.2-93 Saline, irrigation, 1,000 cc, sterile.

7.2-94 Steri-strip at a minimum include, but are not limited to:

7.2-94-1 ¼ inch.

7.2-94-2 1/8 inch.

7.2-95 Sutures at a minimum include, but are not limited to: Not for Category C facilities.

7.2-95-1 Ethilon 4/0 W 1612T NDL.

7.2-95-2 Ethilon 5/0 W 1616T NDL.

7.2-95-3 Mersilk 4/0 W 329 NDL.

7.2-95-4 Vicryl 5/0 W 9106 NDL.


41 41




Item Code



Yes No Yes No


7.2-96 Suture tray, disposable.

Not for Category C facilities.

7.2-97 Syringes with needles, disposable, sizes include, but are not limited to:

7.2-97-1 2½ cc 20 gauge, 1 inch.

7.2-97-2 2½ cc 22 gauge, 1 inch.

7.2-97-3 2½ cc 22 gauge, 1½ inch.

7.2-97-4 Insulin, 50 unit/cc.

7.2-98 Syringes disposable, sizes include, but are not limited to:

7.2-98-1 5 cc.

7.2-98-2 10 cc.

7.2-98-3 20 cc.

7.2-98-4 50 cc.

7.2-99 Tape measure.

7.2-100 Test strips at a minimum include, but are not limited to:

7.2-101 7.2-101-1 Strips for glucose in blood, 25’s

(HAEMOGLUKOTEST).

7.2-101-2 Multistix.

7.2-101-3 Strips for glucose in urine 25’s (KETODIABUR

TEST).

7.2-102 Thermometer, probe cover, disposable.

7.2-103 Thermometer/temperature gauge, fridge.

7.2-104 Tongue blades, non-sterile.

7.2-105 Towel, polyethylene, disposable.


42 42




Item Code



Yes No Yes No


7.2-106 Urinals.

7.2-107 Urinary drainage bag.

7.2-108 Paper rolls for stretcher, disposable (e.g., Vanco).

7.2-109 Vaseline gauze, sizes include, but are not limited to:

7.2-109-1 ½ inch x 72 inch.

7.2-109-2 3 inch x 18 inch.

7.2-110 Water for irrigation, 2,000 cc, sterile.

7.2-111 Wrench adjustable metal type to open all cylinder sizes.

7.2-112 Adhesive remover (e.g., Whisk).

7.3

Every proponent organization shall ensure that their medical facilities depending on their category and operational needs have adequate quantity of linen supplies (disposables are preferable where available). At a minimum supply includes, but is not limited to: For more information, see Attachment 10, page 108.

7.3-1 Bed sheets.

7.3-2 Blankets.

7.3-3 Pillows.

7.3-4 Pillow cases.

7.3-5 Plastic cover for pillows.

7.3-6 Face cloths.

7.3-7 Bath towels.

7.3-8 Patient gowns.

7.3-9 Linen hamper/container.

7.3-10 Linen hamper/container bags.


43 43




Item Code



Yes No Yes No


7.4

Every proponent organization shall ensure that their medical facilities have adequate storage facilities available (steel cabinet, cupboards and shelves) to properly/safely store materials and supplies and free the floor from clutter.

7.5 Where shelves are used, they are off floor level and 18 inches clear of the ceiling.

7.6 There is evidence that an inventory system is in place.

7.7 There are no expiry items on the shelves.

8.0 PHARMACEUTICAL SERVICES

8.1

Every proponent organization shall ensure that their medical facilities have a drug formulary. This formulary shall contain a wide spectrum of drugs enabling patients to be treated for minor ailments, emergencies, and stabilization prior to transfer to definitive medical care facility. The selection of drugs and quantity for each drug category depends on the facility’s operational needs and it is determined by the responsible physician. At a minimum drugs include, but are not limited to: For more information, see Attachment 11, page 109.

8.1-1 Analgesic (non-narcotic) agents at a minimum include, but

are not limited to:

8.1-1-1 Oral analgesic/antipyretic tablets (e.g., acetaminophen).

8.1-1-2 Oral analgesic/anti-inflammatory, non-steroidal anti-inflammatory drug (NSAID), tablets/capsules.

8.1-1-3 Injectable analgesic/anti-inflammatory, NSAID.

8.1-1-4 Analgesic topical cream and/or ointment.

8.1-2 Muscle relaxant, tablets.


44 44




Item Code



Yes No Yes No

8.0 PHARMACEUTICAL SERVICES (Cont.)

8.1-3 Urinary tract infection (UTI), analgesic/anesthetic agents, oral

tablets/capsules.

8.1-4 Antibiotic agents at a minimum include, but are not limited

to:

8.1-4-1 Oral antibiotic agent tablets/capsules.

8.1-4-2 Topical antibiotic ointment for cuts, scrapes, abrasions, insect bites, scratches, etc.

8.1-4-3 Topical antibiotic ointment for burns.

8.1-5 Antacid oral agents at a minimum include, but are not limited

to:

8.1-5-1 Antacid chewable tablets.

8.1-5-2 Antacid suspension.

8.1-6 Gastric (stomach) acid control agents at a minimum include,

but are not limited to: Not applicable for category “C” facility.

8.1-6-1 Oral H2 blocker, tablets.

8.1-5-2 Injectable H2 blocker (IV and/or IM use).

8.1-7 Antispasmodic agents at a minimum include, but are not

limited to:

8.1-7-1 Oral antispasmodic, tablets.

8.1-7-2 Injectable antispasmodic, IM, IV.

8.1-8 Antiemetics (treat nausea and vomiting) agents at a minimum

include, but are not limited to:

8.1-8-1 Oral antiemetic, tablets.

8.1-8-2 Injectable antiemetic, vial.


45 45




Item Code



Yes No Yes No


8.1-9 Antidiarrheal oral agent, capsules.

8.1-10 Antiparasitic chewable tablets.

Not applicable for category “C” facility.

8.1-11 Laxative oral tablets/liquid.

8.1-12 Bronchodilators agents at a minimum include, but are not

limited to:

8.1-12-1 Nebulizer aerosol delivery solution.

8.1-12-2 Inhalers.

8.1-13 Stimulant (crushable ampule, respiratory stimulant for inhalation only).

8.1-14 Beclomethasone disproportionate, oral inhalation agent. Not

applicable for category “C” facility.

8.1-15 Nasal agents at a minimum include, but are not limited to:

8.1-15-1 Antihistamine nose drops and/or spray.

8.1-15-2 Anti-infective steroid combination drops.

8.1-16 Nasal decongestant tablets/capsules.

8.1-17 Beta Blocker agent, tablets.


8.1-18 Antitussive (cough suppressant) agent, syrup, bottle.

8.1-19 Antihistamine agents at a minimum include, but are not

limited to:

8.1-19-1 Oral, tablets/capsules.

8.1-19-2 Injectable to relieve severe allergic reaction(s).


46 46




Item Code



Yes No Yes No


8.1-20 Steroidal anti-inflammatory agents at a minimum include, but

are not limited to:

8.1-20-1 Oral steroid, tablets.

8.1-20-2 Injectable steroid, IV and/or IM use.

8.1-21 Anticonvulsants (no-ncontrolled) agent, IV and/or IM use;


8.1-22 Anticoagulant, vial.


8.1-23 Vasodilator (Nitrate) agent, sublingual, tablets.

8.1-24 Antidiabetic (diabetes control) agents at a minimum include,

but are not limited to:

8.1-24-1 Oral glucose powder.

8.1-24-2 Injectable dextrose 50%, prefilled syringe.

8.1-24-3 Injectable antihypoglycemic agent (glucagon).

8.1-24-4 Injectable hyperglycemic agents (insulin).

8.1-24-4-1 Insulin Regular 100 U/ml 10 ml vials.

8.1-24-4-2 Insulin Human Isophane suspension.


8.1-24-5 Oral hypoglycemic tablets (glucophage).



47

7

47




Item Code



Yes No Yes No


8.1-25 Ophthalmic agents at a minimum include, but are not limited

to:

8.1-25-1 Antibiotic ophthalmic agents at a minimum

include, but are not limited to:

8.1-25-1-1 Eye drops.

8.1-25-1-2 Eye ointment.

8.1-25-2 Antihistamine eye drops.

8.1-25-3 Anesthetic eye drops.

8.1-25-4 Diagnostic agents eye drops, Myotic/Mydriatic

(e.g., Pilocarpine HCL-2%).


8.1-25-5 Other eye drops (i.e., irrigation, dry eye, eye wash).

8.1-26 Anesthetic agents at a minimum include, but are not limited

to:

8.1-26-1 Injectable local anesthetic solution.

8.1-26-2 Topical local anesthetic ointment, tube.

8.1-26-3 Oral (gel) local anesthetic, bottle.

8.1-27 Vaccination agents at a minimum include, but are not limited

to:

8.1-27-1 Tetanus immunoglobulin, IM use.

8.1-27-2 Tetanus toxoid, IM use.


48

48




Item Code



Yes No Yes No


8.1-28 Intravenous (IV) fluids at a minimum include, but are not

limited to:

8.1-28-1 Dextrose infusion, bag.

8.1-28-2 Lactate Ringer (LR) infusion.

8.1-28-3 Sodium Chloride (NS) infusion.

8.1-29 Rehydration oral agent, sachet.

8.1-30 Diuretics (treat water retention) agents at a minimum

include, but are not limited to: Not applicable for category “C” facility.

8.1-30-1 Oral diuretic, tablets.

8.1-30-2 Injectable diuretics.

8.1-30-3 Infusable diuretic solution, bag.

8.1-31 External/topical agents at a minimum include, but are not

limited to:

8.1-31-1 Antibiotic-anesthetic-steroid, hemorrhoidal, ointment/cream.

8.1-31-2 Corticosteroid topical cream, tube.

8.1-31-3 Antipruritic topical cream and/or lotion, tube and/or bottle, as applicable.

8.1-31-4 Antifungal topical cream, solution and/or powder.

8.1-31-5 Antiseptic cleanse/scrub topical solution, bottle.

8.1-31-6 Antiseptic cleanser/scrub (i.e., surgical hand scrub, antiseptic skin cleanser).


49 49




Item Code



Yes No Yes No


8.1-31-7 Antiseptic topical solution (i.e., isopropyl alcohol, betadine, povidone-iodine, etc.).

8.1-31-8 Antiseptic swab (alcohol sachet).

8.1-31-9 Emollient/lubricant, white petroleum KY jelly, tube.

8.1-31-10 Otic drops (cleanser ear drops).

8.1-32 Diluents agents at a minimum include, but are not limited to:

8.1-32-1 Sodium Chloride (NS), 10/20 ml ampules.

8.1-32-2 Sterile water for injection, 10/20 ml ampules.

8.1-33 Miscellaneous agents at a minimum include, but are not

limited to:

8.1-33-1 Adhesive remover for surgical/regular tape or dressing removal.

8.1-33-2 Silver nitrate applicators.

8.1-33-3 Throat lozenges.

8.1-33-4 Glycerin bottle.

8.2

DRUG ADMINISTRATION - Every proponent organization shall ensure that their medical facilities have a drug dispensing guideline s (written in a clear format) for nurses who are authorized to administer and dispense certain drugs in the absence of a physician and at a minimum it include the following:

8.2-1 A list of all medications/drugs that clearly stipulate which medications can be administered by the nurse as standing order (SO) or routine order (RO), and which ones require a physician’s consultation telephone order (TO).


50 50




Item Code



Yes No Yes No


8.2-2 Standing order guidelines for nurses.


8.2-3 Specific procedures to be followed for all TOs including documentation process.

8.2-4 Specific criteria for privileging nurses to administer and dispense

medications listed in the drug formulary and to administer the drugs in the emergency response bag. At a minimum:

8.2-4-1 There is evidence that the nurse successfully completed a drug familiarization competency program.

8.2-4-2

There is a drug information reference system available on-site or remotely (e.g., physician/ pharmacist consultation/online drug information site/drug inserts file/pharmacology book).

8.3

DRUG STORAGE - Every proponent organization shall ensure that their medical facilities have an adequate storage and inventory control system with appropriate checklists in place to facilitate the dispensing and inventory control of all medications/drugs in stock, as follows:

8-3-1 Ensure that all drugs/medications listed are:

8.3-1-1 Available.

8.3-1-2 Current.

8.3-1-3 Within the minimum stock level.

8.3-1-4 Rotated (arrange the shorter expiry date in front).

8.3-2 Inventory/expiration check date is conducted on monthly basis. Log is available upon request.


51 51




Item Code



Yes No Yes No


8.3-3 All medications/drugs shall be stored according to

manufacturer's recommendations, as follows:

8.3-3-1 In an air conditioned room.

8.3-3-2 On shelves above floor level or in a lockable cupboard.

8.3-3-3 Appropriately organized and identified in a systematic way (alphabetic order or drug group).

8.3-3-4 Medications for external use are stored separately from oral medications.

8.3-3-5 Narcotics/controlled substances, if available, are stored under double lock.

8.3-3-6 Temperature sensitive drugs are stored in a dedicated fridge as fallows:

8.3-3-6-1 Temperature is maintained at 2 to 8 Celsius (C) [36-45 Fahrenheit (F)].

8.3-3-6-2 Temperature is monitored and recorded twice daily.

8.3-3-6-3 Fridge is cleaned twice a month.

8.4 DRUG DISPENSING - Every proponent organization shall ensure that their medical facilities dispense all medications/drugs as follows:

8.4-1 In a suitable container.

8.4-2 At a minimum, labeled with the following information:

8.4-2-1 Patient’s name and ID number.

8.4-2-2 Date.


52 52




Item Code



Yes No Yes No


8.4-2-3 Drug’s name and strength.

8.4-2-4 Dispensing instructions (e.g., one (1) tablet three times a day after meals).

8.5 DRUG DISPOSAL - Every proponent organization shall ensure that their medical facilities have a system in place for the safe disposal of expired drugs and it is implemented as follows:

8.5-1 Expired medications/drugs are handled as follows:

8.5-1-1 Placed into a box.

8.5-1-2 Box is labeled “expired.”

8.5-1-3 Stored separately from other medications/drugs.

8.5-2 There is evidence that expired medications/drugs were sent to

supplier for proper disposal or other disposal system that meets MOH regulations. Documentation is available upon request.

8.6

Every proponent organization shall ensure that their medical facilities’ staff is familiar with and adhere to MOH regulations in regards to transportation, dispensing, administration and disposal of Narcotics/Controlled substances, where applicable.

9.0 SUPPORT SERVICES

Ambulance Service

9.1

Every proponent organization shall ensure that their medical facilities provide, or make arrangements to provide, a dedicated emergency vehicle (ambulance) to transport the sick and injured to a hospital facility for further management.


53 53




Item Code



Yes No Yes No

9.0 SUPPORT SERVICES (Cont.)

Ambulance Service

9.2 Every proponent organization shall ensure that their ambulance is a two-wheel or four-wheel (2WD/4WD) drive vehicle depending on location and terrain condition (e.g., tracks, dirt roads, etc.).

9.3

Every proponent organization shall ensure that every ambulance is fully equipped with adequate supplies and other necessities. At a minimum these include, but are not limited to: For more information, see Attachment 12, page 116.

9.3-1 Proper warning flashlights.

9.3-2 Purpose markings as follows:

9.3-2-1 Red Crescent Insignia.

9.3-2-2 Ambulance signs painted on the outside.

9.3-3 Air conditioning unit in the patient compartment.

9.3-4 Fire extinguisher ABC, small type.

9.3-5 Appropriate communication device (radio, cellular and/or satellite phone) with available network and appropriate frequency.

9.3-6 Ambulance essential medical emergency and resuscitation supplies at a minimum include, but are not limited to: Some items have been included as additional in order to backup the emergency response bag supplies. The items marked with an *asterisk, are loaded-up at the time of dispatch. For more information, see Attachment 12, page 116.

9.3-6-1 *Emergency Response Bag.

9.3-6-2 *Automated External Defibrillator (AED).


54 54




Item Code



Yes No Yes No


Ambulance Service

9.3-6-3 *Suction machine (portable) with the following accessories:

9.3-6-3-1 Suction catheters.

9.3-6-3-2 Tubing.

9.3-6-4 Stretcher collapsible (Ferno or other).

9.3-6-5 Backboard short with straps.

9.3-6-6 Long board short with straps (van type only).

9.3-6-7 Kendrick Extrication Device (KED).

9.3-6-8 Hare traction.

9.3-6-9 Oxygen cylinder, large size (modular and van type only).

9.3-6-10 Portable oxygen resuscitation unit (e.g., Robert Shaw unit or other).

9.3-6-11 At a minimum, the following oxygen supplies accessories are available:

9.3-6-11-1 Rebreathing mask.

9.3-6-11-2 Nasal cannulas.

9.3-6-11-3 Tubing.

9.3-6-12 Oxygen cylinder key.

9.3-6-13 Rigid cervical collar, sizes as follow:

9.3-6-13-1 Small.

9.3-6-13-2 Medium.

9.3-6-13-3 Large.


55

55




Item Code



Yes No Yes No


Ambulance Service

9.3-6-14 First aid supplies as follows:

9.3-6-14-1 First aid kit - unit size 36. For more information, see Attachment 23, page 140.

9.3-6-14-2 Ace bandages.

9.3-6-14-3 Kerlix.

9.3-6-14-4 Cold packs.

9.3-6-14-5 Scissors.

9.3-6-15 Infection/Environmental control items and Personal Protective Equipment (PPE) include, but are not limited to:

9.3-6-15-1 Goggles.

9.3-6-15-2 Surgical mask.

9.3-6-15-3 Plastic apron.

9.3-6-15-4 Examination gloves (sterile).

9.3-6-15-5 Examination gloves (unsterile).

9.3-6-15-6 Small sharps container.

9.3-6-15-7 Infectious waste plastic bag.

9.3-6-15-8 Plastic trash bag.

9.3-6-15-9 Heavy duty gloves.

9.3-6-15-10 Safety hard hat.

9.3-6-15-11 Safety shoes.


56 56




Item Code



Yes No Yes No


Ambulance Service

9.3-6-16 Miscellaneous items include, but are not limited to: 9.3-6-16-1 Notepad. 9.3-6-16-2 Pen. 9.3-6-16-3 Flash light, 9 volt. 9.3-6-16-4 Tire gauge. 9.3-6-16-5 Kleenex tissue. 9.3-6-16-6 Safety triangle.

9.4 Every proponent organization shall ensure that their ambulance’s equipment and supplies are checked daily, weekly or after each patient trip. Inspections are recorded and available upon request.

9.5

Every proponent organization shall ensure that their ambulance(s) is taken for a test run on a daily basis. The vehicle condition is checked and recorded and available upon request. For more information, see Attachment 13, page 118.

9.6 Every proponent organization shall ensure that their ambulance(s) is thoroughly cleaned inside and washed outside on a weekly basis or after a patient run, if necessary.

9.7 Every proponent organization shall ensure that their ambulance(s) have periodic maintenance (quarterly) and required Government road test. Documentation evidence is available upon request.

Communications

9.8 Every proponent organization shall ensure that their medical facilities have a communication book/file available to staff to maintain effective internal and external communication.

9.9 Every proponent organization shall ensure that their medical facilities have a notice board(s) available and that it contain current relevant information, e.g., safety, infection control, etc.


57 57




Item Code



Yes No Yes No


Communications

9.10 Every contractor company shall ensure that their medical facilities have the following communication devices available:

9.10-1 A landline phone with internal and external access, including direct access to emergency services.

9.10-2 Global system for mobile communications (GSM) and/or other communication devices with available network and appropriate frequency for field communication.

9.11

Every proponent organization shall ensure that their medical facilities have a dedicated telephone available for internal communication and with appropriate dial access to communicate directly with Medical Designated Facilities (MDFs) or other agencies to request external medical assistance and advice.

9.12 Every proponent organization shall ensure that their medical facilities have a fax machine available either in the medical facility or in a nearby administrative office.

9.13

Every proponent organization shall ensure that their medical facilities have a dedicated emergency communication device (110 or similar), for receiving expedient information/instructions regarding fire and/or other disaster in the camp and/or surrounding construction area.

9.14 Every proponent organization shall ensure that their medical facilities where applicable, have all their communication equipment checked per shift. Findings must be documented and available upon request.

Janitorial Services

9.15 Every proponent organization shall ensure that their medical facilities have a dedicated part-time or full-time janitor on the day shift.

9.16 Every proponent organization shall ensure that their medical facilities are cleaned inside and outside to acceptable healthcare standards.


58 58




Item Code



Yes No Yes No


Janitorial Services

9.17

Every proponent organization shall ensure that their medical facilities’ janitor receives training/orientation in medical housekeeping. On-site orientation performed by a nurse and/or a senior janitor is acceptable. Evidence of completion, which lists all the items covered during the orientation, is available upon request.

9.18

Every proponent organization shall ensure that their medical facilities’ janitor attended an infection control class. On-site orientation performed by a nurse, is acceptable. Evidence of completion, which lists all the items covered during the orientation, is available upon request.

9.19 Every proponent organization shall ensure that their medical facilities’ janitor is appropriately immunized prior to medical facility assignment. Evidence of immunization is available upon request.

9.20

Every proponent organization shall ensure that their medical facilities according to their size and needs have sufficient housekeeping equipment and supplies. At a minimum these include, but are not limited to: For more information, see Attachment 14, page 119.

9.20-1 Mops of two (2) different color.

9.20-2 J Cloth.

9.20-3 Trolley with dual mop bucket and wringer or portable, bucket with wringer for small clinic.

9.20-4 Sodium Hypochlorite (Clorox bleach).

9.20-5 Liquid soap.

9.20-6 Trigger spray bottle.

9.20-7 Detergent upgrade or similar, e.g., Beaucoup for patient area.


59 59




Item Code



Yes No Yes No


Janitorial Services

9.20-8 Plastic bags for rubbish (color coded for infectious waste).

9.20-9 Paper towels for sinks and spills.

9.20-10 Paper towel dispenser.

9.20-11 Wet floor sign.

9.20-12 Blood Spill Kit.

9.20-13 Floor polish.

9.20-14 Window cleaner.

9.20-15 Furniture polish.

9.20-16 General multi-cleaner with bleach for sinks, etc.

9.20-17 Toilet bowl and urinal cleaner.

9.20-18 Waste bin, pedal type with lid for clinical waste.

9.20-19 Waste basket, general purpose.

9.20-20 Hand brush and dust pan.

9.20-21 Heavy duty rubber gloves.

9.20-22 Hand sanitizer, ethyl alcohol 70% base (Santi-gel or Septogel).

9.21 Every proponent organization shall ensure that their medical facilities’ janitor closet is clean and tidy. Not applicable for single portable facility.

9.22 Every proponent organization shall ensure that their medical facilities’ cleaning agents and disinfectants are appropriately labeled and stored.


60 60




Item Code



Yes No Yes No


Janitorial Services

9.23 Every proponent organization shall ensure that their medical facilities’ color coded mops are cleaned and disinfected on a daily basis. Evidence is available upon request.

9.24 Every proponent organization shall ensure that their medical facilities’ are cleaned on a daily basis, cleaning is in evidence. At a minimum cleaning includes, but is not limited to:

9.24-1 Damp dusting.

9.24-2 Polishing floors and/or furniture as applicable.

9.24-3 Vacuuming.

9.24-4 Mopping of floor.

9.24-5 Cleaning toilet areas.

9.25 Every proponent organization shall ensure that their medical facilities’ janitors use separate cleaning equipment for toilet areas. This shall be in evidence.

9.26 Medical facilities shall ensure that there is a regular (twice daily and as necessary) removal of trash from all clinical areas.

9.27 Every proponent organization shall ensure that their medical facilities have a procedure for cleaning blood spills and that it is posted. This shall be in evidence.

9.28 Janitor and other staff know/verbalize the blood spill cleaning procedures and cleaning fluid dilution ratios, as per guidelines.


61 61




Item Code



Yes No Yes No

10.0 MEDICAL EMERGENCY, DISASTER RESPONSE AND MEDIVAC PROCEDURES

General Requirements

10.1 Every proponent organization shall ensure that their medical facilities have a quick reference Medical Emergency and Disaster Response plan available. At a minimum, plan outlines the following information:

10.1-1

Communication chain list of key personnel and various services (i.e., security, firefighting and support services) and show how chain is activated (e.g., ring-down-system flow chart). This is strategically posted (e.g., nursing station/ safety notice board).

10.1-2 Role of each medical personnel in the event of medical emergency and disaster response.

10.2

Every proponent organization shall ensure that their medical facilities have a 24 hour emergency and key personnel telephone numbers available and that it is properly displayed in the clinic to facilitate proper/timely response in the event of medical emergencies, disasters, transfers and Medivacs. At a minimum list includes the following telephone numbers:

10.2-1 Company Security Operations.

10.2-2 Saudi Aramco Security Operation.

10.2-3 Police.

10.2-4 Red Crescent.

10.2-5 Nearest healthcare facilities including MOH hospitals.

10.2-6 Company designated hospitals.

10.2-7 On-call company representative or alternate (construction Manager/Admin Manager/Health or Safety Advisor).

10.2-8 Trained first aiders in charge of first aid kits, available and displayed.

10.2-9 Evacuation group leader, where applicable.


62

62




Item Code



Yes No Yes No

10.0 MEDICAL EMERGENCY, DISASTER RESPONSE AND MEDIVAC PROCEDURES (Cont.)


10.3 Every proponent organization shall ensure that their medical facilities at a minimum have the following emergency response bag(s) available:

10.3-1 At least two (2) bags in Category “A and B” facilities.

10.3-2 At least one (1) bag in Category “C” facilities.

10.4

Every proponent organization shall ensure that their medical facilities emergency response bag(s) have the required medical supplies. The contents of each bag include, but are not limited to: For more information, see Attachment 15, page 120.

10.4-1 NURSE SUPPLIES at a minimum include, following items:

10.4-1-1 Sphygmomanometer. 10.4-1-2 Stethoscope. 10.4-1-3 Paramedic shears (scissors). 10.4-1-4 Penlight.

10.4-1-5 Disposable gloves at a minimum include, the following sizes:

10.4-1-5-1 Medium, unsterile. 10.4-1-5-2 Large, unsterile. 10.4-1-6 Masks. 10.4-1-7 Paper bag, waxed. 10.4-1-8 Sharps container, small.

10.4-2 INTRAVENOUS (IV) SUPPLIES at a minimum include, the following items:

10.4-2-1 Lactated ringers (LR), 1,000 cc, bag. 10.4-2-2 Normal saline (9NS), 1,000 cc, bag. 10.4-2-3 Dextrose 5%, 500 cc, bag. 10.4-2-4 Adhesive tape, 1 inch.


63 63




Item Code



Yes No Yes No



10.4-2-5 IV administration (giving) sets at a minimum includes, the following:

10.4-2-5-1 5 drop set.

10.4-2-5-2 6 drop set.

10.4-2-6 Alcohol swabs.

10.4-2-7 IV cannulas (catheters) at a minimum include but are not limited to, the following sizes:

10.4-2-7-1 14 gauge.

10.4-2-7-2 16 gauge.

10.4-2-7-3 18 gauge.

10.4-2-7-4 20 gauge.

10.4-2-7-5 22 gauge.

10.4-2-8 Band aids.

10.4-2-9 Tourniquets, 1 inch and/or ½ inch.

10.4-2-10 Tegaderm, 6 cm x 7cm.

10.4-2-11 Gauze sponges 2 x 2, sterile.

10.4-3 AIRWAY SUPPLIES (PATIENT SUPPLIES) at a minimum include, the following items:

10.4-3-1 Ambu bag (BVM), adult.

10.4-3-2 Oral airway adult, at a minimum includes, the following sizes:

10.4-3-2-1 Small (3).

10.4-3-2-2 Medium (4).

10.4-3-2-3 Large (5).


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Item Code



Yes No Yes No



10.4-3-3 Laryngeal masks at a minimum include, the following sizes:

10.4-3-3-1 Small.

10.4-3-3-2 Medium.

10.4-3-3-3 Large.

10.4-3-4 Bandage, 1 inch.

10.4-3-5 Syringe, 10 cc.

10.4-3-6 Pocket mask, adult.

10.4-3-7 Oxygen masks with reservoir (non-rebreather), adult.

10.4-3-8 Nasal cannula.

10.4-3-9 Suction connecting tubing.

10.4-3-10 Suction catheter, size 14 french/Yankauer.

10.4-4 DRESSINGS/BANDAGES SUPPLIES (PATIENT SUPPLIES) at a minimum include, the following items:

10.4-4-1 Multi-trauma dressing, sterile.

10.4-4-2 Abdominal pad, sterile.

10.4-4-3 Gauze sponges at a minimum include, the following sizes:

10.4-4-3-1 2 x 2, sterile.

10.4-4-3-2 4 x 4, sterile.

10.4-4-4 Vaseline gauze, 3 inch x 18 inch.

10.4-4-5 Triangular bandage.

10.4-4-6 Kerlix roll.


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Item Code



Yes No Yes No



10.4-4-7 Ace wraps at a minimum include, the following sizes:

10.4-4-7-1 4 inch.

10.4-4-7-2 6 inch.

10.4-4-8 Non-adhesive dressing.

10.4-4-9 Micropore roll, 1 inch.

10.4-4-10 Povidine iodine swabs.

10.4-4-11 Ice pack.

10.4-4-12 Bacitracin ointment, tube.

10.4-4-13 Band aids.

10.4-5 SPLINTS, DISPOSABLE (PATIENT SUPPLIES) at a minimum include, the following sizes:

10.4-5-1 Short.

10.4-5-2 Long.

10.4-6 BURN SUPPLIES(PATIENT SUPPLIES) at a minimum include, the following items:

10.4-6-1 Sterile burn sheets, disposable.

10.4-6-2 Burn pads sterile.

10.4-6-3 Surgical face masks, disposable.

10.4-6-4 Sterile gloves at a minimum include, the following sizes:

10.4-6-4-1 6.5.

10.4-6-4-2 7.0.

10.4-6-4-3 8.0.

10.4-6-5 Disposable gowns.


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Item Code



Yes No Yes No



10.4-7

EMERGENCY DRUGS FOR EMERGENCY RESPONSE BAG at a minimum include, the following drugs: Staff must be certified competent to administer these drugs. For more information, see Attachment 16, page 122.

10.4-7-1 Adenosine 6 mg/2 ml ampule. Not applicable for category “C” facility.

10.4-7-2 Amiodarone injection, 150 mg/3 ml ampule. Not applicable for category “C” facility.

10.4-7-3 Atropine sulphate 1 mg/0 ml pre-filled syringe. Not applicable for category “C” facility.

10.4-7-4 Albuterol inhaler, 200 inhalations inhaler.

10.4-7-5 Calcium chloride 10%, 1 gm/10 ml pre-filled syringe. Not applicable for category “C” facility.

10.4-7-6 Diphenhydramine 50 mg/1 ml vial.

10.4-7-7 Dopamine infusion 200 mg/5 ml vial. Not applicable for category “C” facility.

10.4-7-8 Dextrose 50% injection, 50 ml pre-filled syringe. Not applicable for category “C” facility.

10.4-7-9 Epinephrine 1: 1,000, 1 mg/1 ml.

10.4-7-10 Epinephrine 1: 10,000, 1 mg/10 ml pre-filled syringe. Not applicable for category “C” facility.

10.4-7-11 Glucose powder, oral, bottle.


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Item Code



Yes No Yes No



10.4-7-12 Glucagon injection.

10.4-7-13 Hydrocortisone injection, 100 mg/2 ml vial. Not applicable for category “C” facility.

10.4-7-14 Inderal (propanolol) ampule. Not applicable for category “C” facility.

10.4-7-15 Magnesium sulphate injection, 1 gm/2 ml ampule. Not applicable for category “C” facility.

10.4-7-16 Nitroglycerin tablets, 0.4 mg, bottle.

10.4-7-17 Nitroglycerin 50 mg vial. Not applicable for category “C” facility.

10.4-7-18 Normal saline, 10 ml, ampule.

10.4-7-19 Sodium bicarbonate 50 mEq/50 ml, pre-filled syringe. Not applicable for category “C” facility.

10.4-7-20 Vasopressin injection, 20 units/ml vial. Not applicable for category “C” facility.

10.4-7-21 Xylocard 2%, 20 mg/ml, abboject.

10.4-7-22 Xylocard 20%, 200 mg/ml, abboject (for dilution). Not applicable for category “C” facility.

10.4-7-23 Xylocaine spray 10%. Not applicable for category “C” facility.

10.4-7-24 Xylocaine injection (10 mg per 2 ml), 20 ml multidose vial.


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Item Code



Yes No Yes No



10.5 Every proponent organization shall ensure that their medical facilities emergency response bag(s) are appropriately checked as follows: Evidence of completion is available upon request.

10.5-1 On monthly basis and/or after use.

10.5-2 Quantity is checked and recorded.

10.5-3 Validity is checked and recorded.

10.6 Every proponent organization must ensure that staff has periodic disaster training as follows:

10.6-1

Training includes the application of a commonly used triage system (e.g., Simple Triage and Rapid Transport (S.T.A.R.T.); Move, Assess, Sort and Send (M.A.S.S.) in disaster management.

10.6-2 Training is conducted yearly. Evidence of completion is available upon request.

10.6-3 Staff takes part in at least two (2) disaster drills a year.

10.6-4 Completion of training both theoretical and practical is documented on the staff’s training record. Evidence is available upon request.

11.0 QUALITY IMPROVEMENT REQUIEMENTS

11.1 Every proponent organization shall ensure that their medical facilities have a quality improvement study in progress. Evidence is available upon request.


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Item Code



Yes No Yes No

12.0 PATIENT PROCESSING AND MEDICAL RECORDS

12.1 Every proponent organization shall ensure that their medical facilities have dedicated medical record/file available for the following individuals:

12.1-1 For every employee as stipulated in article 136 of the Saudi Labor and Workmen Law. For more information, see Attachment 1, page 84.

12.1-2 For every patient.

12.2 Every proponent organization shall ensure that their medical facilities document each and every encounter into the medical record. At a minimum, the following information is included:

12.2-1 Patient’s name and ID number.

12.2-2 Date of visit.

12.2-3 Time in and time out.

12.2-4 History.

12.2-5 Examination and assessment results.

12.2-6 Diagnosis or impression.

12.2-7 Treatment given, medications, etc.

12.2-8 Discharge status/sick leave/work restriction/referral.

12.2-9 Discharge instructions.

12.2-10 Significant Medical Data Sheet (SMDS), i.e., ordinary/occupational/work injuries.

12.3

Every proponent organization shall ensure that their medical facilities have a tetanus immunization record available in the patient’s medical record/file. For more information, see Attachment 6, page 94.

12.4 Every proponent organization shall ensure that their medical facilities record all injuries in a log book. Evidence is available upon request. For more information, see Attachment 5, page 93.


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Item Code



Yes No Yes No

12.0 PATIENT PROCESSING AND MEDICAL RECORDS (Cont.)

12.5

Every proponent organization shall ensure that their medical facilities have a process available (e.g., log book) for documenting patient’s attendance. Information listed is generally nonclinical and is kept for statistics purposes and for periodic report to management. For more information, see Attachment 17, page 123.

12.6 Every proponent organization shall ensure that their medical facilities have a process available for requesting medical aid and for reporting patient off-duty status.

13.0 HEALTH CARE POLICIES, PROCEDURES AND GUIDELINES - For more information, see Attachment 25, page 145.

General Guidelines

13.1 Every proponent organization shall ensure that their policies and procedures are accessible to all staff.

13.2 Staff knows/verbalize the location of their medical facility’s policies and procedures.

Scope of Service Policies and Procedures

13.3 Every proponent organization shall ensure that each of their medical facilities has a policy that defines their scope of service offered as follows: For more information, see Attachment 4, page 92.

13.3-1 Type of care and treatment offered at the facility. 13.3-2 Eligibility of service.

13.3-3 Investigations, specialized tests and clinical procedures (diagnostic or otherwise) performed in the facility.

13.3-4 Hours of operation.

Administrative - Manpower Requirements Policies and Procedures

13.4

MANPOWER REQUIREMENTS GUIDELINES - Every proponent organization shall have a policy stating the criteria (influencing factors) used by the organization to determine its manpower requirements to ensure that their medical facilities have adequate coverage at all times.


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Item Code



Yes No Yes No

13.0 HEALTH CARE POLICIES, PROCEDURES AND GUIDELINES (Cont.)

Infection Control Policies and Procedures

13.5 INFECTION CONTROL GUIDELINES at a minimum include, the following policies and procedures:

13.5-1 Infection Control in Medical Facility Personnel.

13.5-2 Blood and Infectious Fluid Exposure.

13.5-3 Employee Screening and Immunization Program.

13.5-4 Hand Hygiene.

13.5-5 Handling of Soiled and Clean Linen.

13.5-6 Specimen Collection and Transport, where applicable.

13.5-7 Cleaning of Spills.

13.5-8 Sharp Injuries, what to do in the event and reporting.

13.5-9 Reporting Occupational Illness/ Communicable diseases (i.e., Hepatitis B/C, Tuberculosis, Chicken pox, etc.).

13.6 GENERAL POLICIES AND PROCEDURES at a minimum include, the following policies and procedures:

13.6-1 Waste Management.

13.6-2

Every proponent organization has a patient consultation, referral and transfer policy to Saudi Aramco remote urgent care facilities. Contractor shall comply with RAC OM-10.

13.6-3 Every proponent organization shall ensure that their medical facilities have a policy that describes a reliable alternative system of transfer in place in the absence of an ambulance.

13.6-4

Every proponent organization shall ensure that a policy on Occupational Health Services (physicals and conservation program, i.e., hearing, pulmonary, etc.) is available for their employees.


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72




Item Code



Yes No Yes No


Patient care Policies and Procedures

13.7

PATIENT CARE GUIDELINES (Examination and Treatment Protocol for Nurses), at a minimum include, the following policies and procedures: For information in how to develop your own guidelines, see Attachment 18, page 124.

13.7-1 Protocols for the treatment of common illness and emergencies, from a common cold to chest pain, snake bites, burns, etc.

13.7-2 Protocols for (steps to follow) for consultation and for patient referral to the nearest hospital, or to an inpatient medical facility.

13.7-3 Nursing Procedures and Work Practice.

13.7-4 Management of Death.

13.7-5 Patient and Family Rights.

13.7-6 Confidentiality of Patient Information.

13.7-7 Medication guidelines at a minimum include, the following policies and procedures:

13.7-8 13.7-8-1 Medication Requisition.

13.7-8-2 Prescribing, administration and dispensing of drugs/medication in the absence of a physician or pharmacist, in accordance with MOH regulation.

13.7-8-3 Storing Drugs.

13.7-8-4 Shipping and Receiving of Drugs.

13.7-8-5 Disposal of Drugs.

13.7-8-6 Prescription storage and administration of narcotics and controlled drugs.


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73




Item Code



Yes No Yes No


Medical Emergency and Disaster Response/Medivac Guidelines

13.8 MEDICAL EMERGENCY AND DISASTER RESPONSE/MEDIVAC GUIDELINES at a minimum include, the following policies and procedures:

13.8-1 Medical Evacuation (Medivac) for medical/traumatic emergencies from Saudi Aramco Aviation. Compliance to Saudi Aramco GI-1321.015.

13.8-2 Medical Emergency(s) Response.

13.8-3 Disaster Response.

Safety Policies and Procedures

13.9 SAFETY GUIDELINES at a minimum include, the following policies and procedures:

13.9-1 Fire Drills and Fire Response.

13.9-2 Equipment Maintenance

13.9-3 Adherence to GI-150.002 (First Aid Training for Employees).

14.0 GENERAL REGULATIONS

14.1 Every proponent organization shall ensure that their medical facilities have printed education materials/posters available.


74 74

REMOTE AREA URGENT CARE FACILITIES


Level “A, B and C” Facilities

Final Remarks/Recommendations: Visit 1 Visit 2

Name of Reviewer: ___________________________________________________________________________________________________

Signature and Date: ___________________________________________________________________________________________________


75 75

Section 4 – Survey and Compliance Review Report for Category D Facilities


General and Specific Minimum Standards Requirements Category/Level “D” Facilities (First Aid Provisions, Supplies and Training)


Item Code


10/12/08 Review – II

10/12/08 Comments

Yes No Yes No

1.0 FIRST AID PROVISION IN REMOTE AREAS

A. General Regulations

1.A.1

Every proponent organization shall comply with the relevant articles and regulations specified in Chapter 7 of Saudi Labor and Workmen Law and the medical section of Saudi Aramco (SA) Safety Manual. At a minimum this includes, but is not limited to: For more information, see Attachment 1, page 84.

1.A.1-1

Every contractor company, which operates within Saudi Aramco remote area work sites and employs less than fifty (50) laborers, shall provide a first aid kit/cabinet at the worksite in strategic location(s). A first aid kit as described in Saudi Aramco GI 150.002 is acceptable.

1.A.1-2 Provide a first aid kit/cabinet at the work site in strategic locations.

1.A.1-3 Provide a certified first aid/BLS attendant on duty 24 hours a day, seven days a week (24/7) as custodian.

1.A.2

Every proponent organization shall ensure that at least one (1) crew member per shift has the basic level of medical care awarded by a recognized training program (Saudi Red Crescent Society or Saudi Aramco Health Promotion Unit as applicable). At a minimum training includes, but is not limited to: For more information, see Saudi Aramco GI-150.002.

1.A.2-1 Basic Life Support (BLS). 1.A.2-1-1 Current certificate available upon request. 1.A.2-2 First Aid (FA). 1.A.2-2-1 Current certificate available upon request.

1.A.3 Every proponent organization shall ensure that staff in their medical facilities attends a BLS/First Aid refresher class every two (2) years. Evidence is available upon request.


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Item Code



10/12/08 Comments

Yes No Yes No

1.0 FIRST AID PROVISION IN REMOTE AREAS (Cont.)

B. First Aid Requirements

1.B.1

Every proponent organization in this category shall ensure that where work is performed in multiple locations more than 300 meters (1,000 feet) apart, a separate first aid kit/first aid cabinet is available for every group of 10 (ten) workers.

1.B.2 Every proponent organization in this category shall ensure that their first aid cabinet where applicable, is as follows:

1.B.2-1 Made of hard wood or metal and be painted white.

1.B.2-2 Dimensions: no less than 85 cm long x 45 cm width x 30 cm diameter.

1.B.2-3 Fitted with a lock.

1.B.2-4 Have the Red Crescent insignia and the words “First Aid Cabinet” written on it.

1.B.2-5 Always be ready for use, restocked after each use.

1.B.2-6 Placed on a strategic location, accessible at all times.

1.B.3

Every proponent organization in this category shall ensure that their first aid kit at a minimum have the following supplies, as specified in Saudi Aramco GI-150.002: For more information see Attachment 23, page 140.

1.B.3-1 Bandage, compress, 5 cm.

1.B.3-2 Bandage, compress, 10 cm.

1.B.3-3 Bandage, gauze roller, 5 cm x 550 cm.

1.B.3-4 Bandage, plastic adhesive, 2.5 cm x 7.5 cm.

1.B.3-5 Bandage, triangular; sterile, 100 cm x 100 cm x 140 cm.

1.B.3-6 Cold pack.


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Item Code



10/12/08 Comments

Yes No Yes No



1.B.3-7 Compress gauze, 60 cm x 180 cm.

1.B.3-8 Forceps and scissors.

1.B.3-9 Iodine PVP (polyvinyl povidone) crushable ampules.

1.B.3-10 Green soap swab, crushable; 0.5 ml; width 2 mm x 51 mm (2 inches) gauze pad.

1.B.3-11 Tourniquet supplied with a separate card to note the time tourniquet was applied and the location of tourniquet.

1.B.3-12 First Aid Booklet, Arabic and/or English.

1.B.4 Every proponent organization in this category shall ensure that their first aid cabinet, if provided, at a minimum includes the following supplies: For more information see Attachment 24, page 144.

1.B.4-1 Oral airways, sizes include, but are not limited to:

1.B.4-1-1 Medium.

1.B.4-1-2 Large.

1.B.4-2 Non-sterile examination gloves.

1.B.4-3 Sterile gloves, sizes include, but are not limited to:

1.B.4-3-1 7.5.

1.B.4-3-2 8.

1.B.4-4 Band aids.

1.B.4-5 Alcohol swabs.

1.B.4-6 Iodine swabs.

1.B.4-7 Bacitracin ointment.


78 78




Item Code



10/12/08 Comments

Yes No Yes No



1.B.4-8 Sterile gauze, sizes include, but are not limited to:

1.B.4-8-1 2 x 2 or (5 cm x 5 cm).

1.B.4-8-2 4 x 4 or (10 cm x 10 cm).

1.B.4-9 Roller gauze, sizes include, but are not limited to:

1.B.4-9-1 2 inch.

1.B.4-9-2 3 inch.

1.B.4-9-3 4 inch.

1.B.4-10 Adhesive tape, 1 inch roll.

1.B.4-11 Eye pad.

1.B.4-12 Ace bandage, sizes include, but are not limited to:

1.B.4-12-1 2 inch.

1.B.4-12-2 3 inch.

1.B.4-12-3 4 inch.

1.B.4-12-4 6 inch.

1.B.4-13 Triangular bandage.

1.B.4-14 Safety pins.

1.B.4-15 Bandage scissors.

1.B.4-16 Burn sheet.

1.B.4-17 Abdominal dressing pad, 5 inch x 9 inch.

1.B.4-18 Multi-trauma dressing pad.


79 79




Item Code



10/12/08 Comments

Yes No Yes No



1.B.4-19 Cold pack.

1.B.4-20 Ammonia inhalant.

1.B.4-21 Padded arm board.

1.B.5 Every proponent organization in this category shall ensure that the following safety devices are available at work locations:

1.B.5-1 Fire blanket.

1.B.5-2 Limb splints, ready to use, various types: thigh, leg, arm, etc.

1.B.5-3 Rescue type stretcher (to move injured patients), folding, 72 inch long and 10 inch wide.

1.B.5-4 Splint Stretcher, basket type litter; 4 straps; to carry patient in any position without danger; 24 inch width 8.5 inch height.

1.B.6 Every proponent organization in this category shall ensure that signs indicating the location of the first aid kits/cabinets are posted.

1.B.7 Every proponent organization in this category shall ensure that there is an inventory system in place to replenish first aid kit supplies and to monitor expiry dates. Evidence is available upon request.

1.B.8 Every proponent organization in this category shall ensure that a patient log must be kept by the first aid attendant to register all injuries/illness treated.

1.B.9

Every proponent organization in this category shall ensure that personnel working in remote areas have one (1) vehicle equipped with a well stocked first aid kit. The vehicle must be marked to indicate it is carrying a first aid kit.


80 80




Item Code



10/12/08 Comments

Yes No Yes No



1.B.10 Every proponent organization in this category shall ensure that the designated vehicle is marked to indicate it is carrying a first aid kit.

1.B.11 Every proponent organization in this category shall ensure that the person in charge of first aid program have the following available and posted:

1.B.11-1 Contact number (24 hours) of all first aid attendants in his area of responsibility.

1.B.11-2 Name(s) and contact number of the nearest medical referral/ evacuation facility.

1.B.11-3 Other emergency telephone numbers to call for emergency medical assistance including Security and Red Crescent.


81 81

REMOTE AREA URGENT CARE FACILITIES


Final Remarks/Recommendations: Visit 1 Visit 2

Name of Reviewer: ___________________________________________________________________________________________________

Signature and Date: ____________________________________________________10/12/08__________________________________________


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Section 5 – Attachments and References Table 1: List of Attachments

Attachment Number

Title Page Number

1 Saudi Labor Law (2 pages). 84

2 Saudi Aramco Safety Manual, Medical Section (5 pages). 86

3 Government Licensure of Professional Medical Personnel (1 page). 91

4 Scope of Service (1 page). 92

5 Injury Summary (1 page). 93

6 Tetanus Vaccine Report (1 page). 94

7 Cleaning of Blood Spills (3 pages). 95

8 Medical Equipment Minimum Requirements (2 pages). 98

9 Medical Supplies Minimum Requirements (8 pages). 100

10 Linen Supplies Minimum Requirements (1 page). 108

11 Drug Formulary List Minimum Requirements (7 pages). 109

12 Ambulance Medical Equipment and Supplies Minimum Requirements (2 pages). 116

13 Vehicle (Ambulance) Condition Report/Daily Checks (1 page). 118

14 Housekeeping Equipment and Supplies Minimum Requirements (1 page). 119

15 Emergency Response Bag Minimum Requirements (2 pages). 120

16 Emergency Drugs for Emergency Response Bag Minimum Requirements (1 page).

122

17 Patient Treatment Daily Log (1 page). 123

18 Examination and Treatment Protocol (TP) for Nurses (2 pages). 124

19 Standing Orders Guidelines for Nurses (6 pages). 126

20 Staff Competency Assessment and Development (4 pages). 132

21 Employee Orientation (3 pages). 136

22 Continuing Education and Training (1 page). 139

23 First Aid Kit (4 pages). 140

24 First Aid Cabinet and Contents (1 page). 144

25 Policies and Procedures (1 page). 145

26 Floor Plan Specifications for Category “C” Medical Facility (1 page). 146

27 Floor Plan Specifications for Rig Medical Facility (1 page). 147

Note: Samples provided in this manual are intended to be used as a reference guide only. If implemented, it is important that you verify that the information is up-to-date with current standards and practices.

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83

Saudi Labor Law

Saudi Labor and Workmen Law

Chapter 7

Protection and Social Services

Labor and Workmen Law

Articles 134-6

Article 134

The employer shall provide first aid services for the workmen in accordance with the standards to be determined by the Minister of Labor in collaboration with the Minister of Health. If the number of his workmen in a single location or town, or within a radius of fifteen (15) kilometers, exceeds fifty, he shall employ a nurse who shall be familiar with first-aid services and shall be exclusively assigned to render such services; the employer shall assign a physician to examine and treat the workmen at the place to be provided by the employer for this purpose, and the employer shall provide them with the medicines necessary for their treatment. The aforementioned services shall be free of charge whether during work hours or otherwise. If in the cases mentioned above, the number of workmen exceeds one hundred (100), the employer shall, in addition, provide them with all other means of treatment in cases requiring treatment by specialists, or performance of surgical other operations. In case operations are performed, as well as in cases of incurable diseases, the expenses shall be taken from the Social Insurance Funds. The costs of treatment, medicines and hospitalizations in government or charitable hospitals, as well as the party, who will assume such costs, shall be determined pursuant to the decision to be made by the Minister of Labor in agreement with the Minister of Health, or to the rules laid down in the Social Insurance Law.

However, if the number of workmen is less than fifty (50), the employer must provide the workmen with a medical aid cabinet which shall be maintained in a good condition and shall contain the bandages, medicines, and antiseptics to be determined by the Minister of Labor in agreement with the Minister of Health, in order to provide the workmen with first aid.

Article 135

Every employer who employs more than fifty (50) workmen shall inform the appropriate Labor Office of the name of the physician who he has selected to treat his workmen. In case he employs more than one hundred (100) workmen, he shall inform the office of the names of the physicians and specialists whom he has selected to treat his workmen, and of the names of the hospitals which he has designated for that purpose. In both cases, he must notify the appropriate Labor Office of the minimum number of days fixed for the examination of workmen, provided that this minimum shall not be less than three (3) times a week.

Article 136

Every employer shall prepare for each workman a medical file showing the result of the medical examination performed on the workman upon his employment, a description of the cases of his illness, the stages of his treatment, and the periods of his absence from work, provided that mention shall be made in the file of the kinds of ordinary and occupational diseases and labor injuries. Saudi Labor Law

ATTACHMENT – 1 Page 1 of 2

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84

First Aid Facilities at Work

(Originally Published in Umm al-Qura, No. 2534 July 26, 1974)

Decision No. 404 Based on Article 245 of Labor Law

Article I

An employer who employs less than fifty (50) workmen shall provide at the work site a first aid cabinet containing bandages, medicines, and disinfectants.

Article II

The employer shall assign one or more persons to be responsible for administering first aid to the injured at all times during working hours, provided the person-in-charge shall be one of the establishments employees who will either be trained in first aid procedures in accordance with a program to be agreed upon with the Saudi Red Crescent Society, or who holds a certificate from a hospital attesting that he has practiced first aid and is qualified to administer it.

Article III

An employer who employs fifty (50) or more laborers shall provide at the work site a first aid room which meets the following standards:

Section (F) – “A licensed nurse shall be on duty at all times during working hours under the supervision of a physician.”

Article VI

An employer who employs less than fifty (50) workmen shall assign an appropriate number of his workmen to receive first aid in accordance with Article II. Saudi Labor Law


85

85

Saudi Aramco Safety Manual 28 Medical

28.1 Purpose

This chapter provides the minimum requirements for medical care to personnel performing work at Saudi Aramco (SA) work locations and shall include the following services:

First Aid and Urgent Care

Medical Emergency Response, Stabilization, and Transfer to Definitive Care

Disaster Response

28.2 Scope It covers all SA and contractor personnel operating within SA facilities, on SA job sites outside of operating facilities, off SA property under a SA contract, and in applicable SA domestic joint venture companies.

28.3 References

SA General Instructions:

GI 6.025, Control of Remote Area Travel and Search/Rescue Procedures

GI 1321.015, Request for Air Medical Evacuation

GI 150.002, First Aid/BLS Training and First Aid Kits

Schedule “D” SA Safety, Health, and Environmental Requirements -

Injury and Damage Reporting

First Aid Facilities

MMSR Manual - Medical Minimum Standards Requirements for Industrial Clinics Manual

28.4 Provision of First Aid/Medical Facilities

28.4.1 Saudi Aramco Proponent Organization (SAPO) and/or the contractor shall comply, in its entity, with the first aid/medical provisions described below prior to start of work activities. These provisions are applicable to all work activities within SA facilities, on SA jobsites outside of operating facilities, off SA property but under a SA contract, and in applicable SA domestic joint venture companies.

28.4.2 First aid is the immediate help that is provided at the work location to injured or seriously ill personnel prior to the arrival of professional medical assistance.

Saudi Aramco Safety Manual – Medical Section


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86

28.4 Provision of First Aid/Medical Facilities (Cont.)

28.4.3 Employers shall be responsible for ensuring that first aid/Basic Life Support (BLS) trained personnel and appropriate first aid facilities are available for their personnel at all work locations.

28.4.4 First aid facilities shall be kept in a sanitary condition and in strict compliance with the minimum requirements specified in the Medical Minimum Standards Requirements for Industrial Clinics Manual (MMSR) at all times.

28.4.5 First aid supplies shall be kept readily available in a first aid kit or a cabinet designated for those supplies only.

28.4.6 A first aid attendant shall be responsible for first aid kits or cabinet and shall ensure there is sufficient stock of all listed supplies at all times.

28.4.7 A suitable type of stretcher shall be available at all work locations.

28.4.8 Signs/notices shall be posted indicating the following:

a. The name of the person who is in charge of first aid kit or cabinet. b. The hospital where injured/ill personnel are to be transported. c. The telephone number(s) of the doctor(s) or first aid attendant(s). d. The emergency telephone number(s) to be called for assistance.

28.4.9 One (1) vehicle equipped with a well-stocked first aid kit for each crew shall be available for personnel performing pipeline and power line work or who are working in remote areas. Vehicles shall be marked to indicate that they carry a first aid kit. A minimum of one (1) man in every crew shall have a valid first aid/BLS certificate (See GI 150.002).

28.4.10 A medical logbook shall be maintained at every first aid station and medical facility by the first aid attendant/nurse who must log all injuries/illnesses treated. (Refer to MMSR Manual for sample log.)

28.5 First Aid Attendants/Medical Professional Personnel

28.5.1 Employers, employing less than fifty (50) personnel, shall have an appropriate number of personnel, including those in charge of the first aid kits or supply cabinets, trained in first aid/BLS (See GI 150.002).

28.5.2 When there are more than fifty (50) personnel employed within a radius of 15 kilometers (9.4 miles), employers shall provide a first aid facility at the work location, in accordance with the criteria set out in the MMSR Manual. As a minimum, a first aid/BLS certified nurse shall be assigned to and in charge of the medical/first aid facility.

28.5.3 Medical professional personnel (physicians/nurses) shall meet the licensing requirements of the Saudi Arab Government (SAG) Ministry of Health (MOH) and possess the necessary experience, and minimum qualifications, and required certifications specified in the MMSR Manual.

28.5.4 Medical professional personnel shall also be provided with continuing education by their employer as required by the MOH. This continuing education shall include, but not be limited to: First aid/BLS, safety and infection control, and fire and disaster training, etc.

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28.6 Medical Care at Work Site

28.6.1 First aid kits/Cabinet

A. Employers employing less than fifty (50) personnel shall provide a first aid kit or cabinet at the work location. Minimum requirements for first aid kits are specified in the MMSR Manual.

B. A separate first aid kit or cabinet shall be provided for every group consisting of more than 10 personnel if work is performed in multiple locations more than 300 meters (1,000 feet) apart.

28.6.2 Medical Facilities

A. Employers with more than fifty (50) personnel in a single location, or within a radius of 15 kilometers (9.4 miles) shall provide, at a central work location, a medical facility in accordance with the criteria set out in the MMSR Manual for each of the following categories:

Category – A (Physician operated, large). Category – B (Physician operated, small). Category – C (Nurse operated).

B. These facilities shall:

Have the capability to provide first aid urgent care, pre-hospital care and resuscitation, stabilization, and prompt transfer to the nearest definitive care facility.

Have an emergency response plan detailing their respective response capabilities specific to geographical location. A medical emergency and disaster call out list shall be posted in the facility.

28.7 Medical Facilities Requirements

28.7.1 Medical facilities are categorized according to the following criteria:

A. Number of personnel at the work location.

B. Remoteness of the work location and access to medical care.

C. Potential risk factors at the work location.

28.7.2 Regardless of the assigned category, employers shall strictly comply with all requirements set out in the MMSR Manual. These include:

A. Building specifications.

B. Scope of service.

C. Manpower requirements.

D. Staff qualifications and continuing education.

E. Equipment and supplies.

F. Medication supplies.

G. Support services (communications/ambulance services/janitorial services).

H. Medical emergency and disaster response procedures/Medivac procedures.

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28.8 Medical Transfer

28.8.1 Employers shall provide, or make arrangements to provide, a dedicated emergency vehicle (ambulance with purpose markings, configured safely, and equipped with emergency and resuscitation supplies to transport injured/ill personnel to the nearest designated health care facility. This vehicle shall be maintained in a safe, clean, sanitary, and roadworthy condition in compliance with SAG regulations and SA vehicle requirements.

28.8.2 Ambulances shall be equipped, as a minimum, with supplies as specified in the MMSR Manual.

28.8.3 A daily ambulance log and ambulance preventive maintenance work sheet shall be maintained.

28.8.4 Employers shall provide ambulance drivers with first aid and BLS training, orientation and safety training.

28.8.5 Ambulance drivers shall have a valid SAG driving license.

28.9 Medical Evacuation (Medivac)

28.9.1 Contractors shall ensure that Medivac procedures are incorporated into their emergency response procedures as a part of their Loss Prevention Program (LPP).

28.9.2 The procedures to initiate a Medivac are covered in GI 1321.015.

28.10 Worker and Workmen Law

Saudi Labor and Workmen Law, Chapter 7 - Protection and Social Services, Labor and Workmen Law, Articles 134-6.

Article 134

The employer shall provide first-aid services for the workmen in accordance with the standards to be determined by the Minister of Labor in collaboration with the Minister of Health. If the number of his workmen in a single location or town, or within a radius of fifteen (15) kilometers, exceeds fifty (50), he shall employ a nurse who shall be familiar with first aid services and shall be exclusively assigned to rendering such services; the employer shall assign a physician to examine and treat the workmen at the place to be provided by the employer for this purpose, and the employer shall provide them with the medicines necessary for their treatment. The aforementioned services shall be free of charge whether during work hours or otherwise. If in the cases mentioned above, the number of workmen exceeds one hundred (100), the employer shall, in addition, provide them with all other means of treatment in cases requiring treatment by specialists, or performance of surgical other operations. In case operations are performed, as well as in cases of incurable diseases, the expenses shall be taken from the Social Insurance Funds. The costs of treatment, medicines and hospitalizations in government or charitable hospitals, as well as the party, who will assume such costs, shall be determined pursuant to the decision to be made by the Minister of Labor in agreement with the Minister of Health, or to the rules laid down in the Social Insurance Law.

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However, if the number of workmen is less than fifty (50), the employer shall provide the workmen with a medical aid cabinet which shall be maintained in a good condition and shall contain the bandages, medicines, and antiseptics to be determined by the Minister of Labor in agreement with the Minister of Health, in order to provide workmen with first aid.

Article 135

Every employer who employs more than fifty (50) workmen shall inform the appropriate Labor Office of the name of the physician who he has selected to treat his workmen. In case he employs more than one hundred (100) workmen, he shall inform the Office of the names of the physicians and specialists whom he has selected to treat his workmen, and of the names of the hospitals which he has designated for that purpose. In both cases, he shall notify the appropriate Labor Office of the minimum number of days fixed for the examination of workmen, provided that this minimum shall not be less than three (3) times a week.

Article 136

Every employer shall prepare for each workman a medical file showing the result of the medical examination performed on the workman upon his employment, a description of the cases of his illness, the stages of his treatment, and the periods of his absence from work, provided that mention shall be made in the file of the kinds of ordinary and occupational diseases and labor injuries.

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Government Licensure of Professional Medical Personnel

Kingdom of Saudi Arabia Licensing Requirement Statement

Health profession practitioners must be licensed by the Ministry of Health (MOH)/Saudi Council for Health Specialties (SCFHS) of the Kingdom of Saudi Arabia (KSA) to practice their profession in the Kingdom.

Purpose

To ensure that health profession practitioners: 1. Meet the licensure requirements of the MOH/SCFHS of the KSA prior to employment. 2. Are properly licensed by the MOH of the KSA to practice their profession in the Kingdom.

Definitions

1. Health Profession Practitioners – A term used to describe Clinicians, Pharmacists, Nurses and Technicians.

2. Government Licensure – The issue of a license to practice the appropriate profession in the KSA, issued by the MOH/SCFHS of license from the Ministry of Health.

Registration Objectives 1. Verify the practitioner’s competency. 2. Evaluate and classify practitioner’s certificates and experiences. 3. Introduce practitioners to the standards and ethics of practicing health professions in the Kingdom. 4. Monitor the practice of health professions to detect any incompetence or malpractice and deal with

them. 5. Emphasize that practitioners pursue continuing medical education programs to improve their skills and

keep up with the latest developments in their filed of specialty. 6. Protect the society from incompetent practitioners.

Registration Procedures

1. Fill out and sign each page of the SCFHS “Application form for Accreditation and Professional Registration.”

2. Enclose originals of educational and experience certificates or authenticated copies. 3. Two (2) recent photos. 4. Sign the form of compliance with the standards with the standards and ethics of practicing health

professionals in Saudi Arabia.

SCFHS Contact Information

Telephone: Al-Khobar (03) 896-6760 Riyadh (01) 482-2415

Web page: www.scfhs.org.sa e-mail: [email protected]

Background History

In its session held on 14 Dhu al-Qa’dah 1416 (April 2, 1996), the Board of Trustees of the Saudi Council for Health Specialties (SCFHS) approved the registration list of health profession practitioners. On 30 Muharram 1417 (June 16, 1996), it approved the regulations governing the registration of physicians and dentists. HE, the Minister of Health and Chairman of SCFHS Board of Trustees, issued ministerial decision No. 1476/11, dated 5 Rajab 1418 (November 5, 1997), stipulating the registration at SCHS in order to approve the practice of health professions in both the public and private sectors in the Kingdom. This was circulated to all health areas by letter No. 298/6093/20, dated 12 Rajab 1418 (November 12, 1997).

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Scope of Service

Care Provided

Care includes triage, assessment, diagnosis, first aid, treatment, stabilization and transfer or Medivac to an inpatient hospital for definitive care and response to disaster situations.

Treatment

Includes treatment of encounters of varying complexities, such as acute trauma, medical emergencies and prescribing medicines.

Basic BLS and other first aid intervention. Use of AED, incorporating life saving measures with stabilization techniques.

Investigations

Investigations include any tests/procedures that can be undertaken, e.g.:

1. Dip stick urine test.

2. Test strip blood test.

3. Hearing test.

4. Pulmonary function test (PFT).

5. 12 Lead EKG/Chest lead monitoring.

6. Pulse Oximeter and SPO2.

7. Visual Acuity (Snellen chart).

8. Employees Physicals.

9. Radiology.

10. Laboratory.

Patient Eligibility

Clear policy statement regarding who is eligible for care and what are they eligible for, e.g.:

a. For all employees.

b. For general public or non-employee with potentially serious or life threatening condition. Scope of Service


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Injury Summary

Medical Facility: ________________________________ Project No.: _____________________ Page: _________ of _________

Proponent: ________________________________ File No.: _____________________ Date: _____________________

Injury No.

Name Injured Badge Number Craft Date of Accident

Carry Over

Yes/No

Days Lost this Month

Nature of Injury and Body Part

Affected

Brief Description of Accident. State

What, Where, How and Why.

# of Injuries this month: Total days lost

Report Prepared by: _______________________________

Signature: _______________________________

Title and Telephone: _______________________________

Injury Summary Report


93

7

93

Tetanus Vaccine Report

Medical Facility: ____________________________________

Date Given Patient Name Company ID Batch/Lot No. Nurse Signature ID No.

Tetanus Vaccine Record


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Cleaning of Blood Spills

Spills of blood can occur in your medical facility. So, it is essential to keep in mind that it is not possible to identify patients with Hepatitis B virus (HBV) and/or Human Immunodeficiency Virus (HIV). Therefore, all blood and blood borne pathogens “shall be considered infectious.”

A Blood Spill Kit shall be placed in all areas where blood spills are likely to occur, including medical facilities in remote areas.

Each Spill Kit shall have the following items and supplies:

One two-compartment plastic pail (dual bucket).

Disposable shoe covers.

Disposable safety glasses or plastic goggles.

Disposable mask.

Disposable gloves.

Two (2) trigger sprayers or peri-bottle, labeled #1 and #2.

One (1) measuring glass.

Container of detergent/disinfectant mixed to correct ratio.

Container of 5.25% sodium hypochlorite (Clorox).

One (1) roll paper towel or disposable cleaning cloths (J-cloths).

One (1) roll color-coded plastic bags for disposable of infectious waste.

One “WET FLOOR” sign.

One (1) laminated copy of these instructions.

Cleaning Procedure:

1. Place “WET FLOOR” sign near to the spill.

2. Wear disposable gloves and mask.

3. If splashing is anticipated, protective eye wear, such as disposable goggles should be worn. Wear disposable coverall/gown if soiling of clothes is likely.

4. If there is a chance that shoes could become contaminated, wear shoe covers.

5. Prepare the disinfectant/detergent solution according to the following prescribed ratio:

a. One 1 ounce of Beaucoup solution per one (1) gallon of sweet water.

b. One 1 ounce of Clorox solution per nine (9) ounces of sweet water.

Note: For other chemical dilution ratios, see page 97.

6. Arrange the required color coded (yellow) bio-hazardous plastic waste bags, so they are ready to receive contaminated waste.

7. Use disposable paper towels to soak up and remove all spilled blood or body fluid. Place soiled disposable paper towels in the color coded (yellow) bio-hazardous bag. Repeat until all spilled blood or body fluid has been removed.

8. Spray or apply adequate approved disinfectant solution (Beaucoup) on the spillage area. Clean the area with fresh paper towels, being sure to remove all visible blood or body fluid. Dry with fresh paper towels. Place soiled disposable paper towels in the color coded (yellow) bio-hazardous waste bag.



95

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Spray or apply adequate Clorox solution on the spill area, ensuring that the entire spillage area is covered with Clorox solution. Allow a two minute contact time and then wipe the area thoroughly with disposable paper towels. Dry with fresh paper towels. Place soiled disposable paper towels in the color coded (yellow) bio-hazardous bag.

9. Wait for the area to completely dry before removing the WET FLOOR sign.

10. Clean and disinfect the trigger spray bottles and other nondisposable items, as these items are considered potentially contaminated.

11. On completion of the task, place all disposable protective garments, such as gloves, shoe covers, goggles and mask in the yellow plastic bag. Wash hands thoroughly using antiseptic soap, such as Scrubstat.

12. Replenish all disposable items in the spill kit and ensure it is ready for future use.

Spills/Splashing of Walls:

1. Wear disposable gloves and mask.

2. If splashing is anticipated, protective eye wear (goggles) should be worn. Wear gown if soiling of clothes is likely.

3. Wear shoe covers if there is a chance of shoes becoming contaminated.

4. Prepare the disinfectant/detergent solution according to prescribed ratio.

a. One 1 ounce of Beaucoup solution per one (1) gallon of sweet water.

b. One 1 ounce of Clorox solution per nine (9) ounces of sweet water.

5. Arrange the required color coded (yellow) bio-hazardous plastic waste bags, so they are ready to receive contaminated waste.

6. Use disposable paper towels to soak up and remove all of the spilled blood or body fluid. Place soiled disposable paper towels in the color coded (yellow) bio-hazardous waste bag.

7. Spray or apply adequate SAMSO approved disinfectant solution (Beaucoup) on the spillage area. Clean the area with fresh paper towels, being sure to remove all visible blood or body fluid. Dry with fresh paper towels. Place soiled disposable paper towels in the color coded (yellow) bio-hazardous waste bag.

8. Spray or apply adequate Clorox solution on the spill area, ensuring that the entire spillage area is covered with Clorox solution. Allow a two minute contact time and then wipe the area thoroughly with disposable paper towels. Dry with fresh paper towels. Place soiled disposable paper towels in the color coded (yellow) bio-hazardous waste bag.

9. If it is found absolutely necessary to use a yellow scouring pad, this scouring pad should then be treated as infectious waste.

10. Double bag the scouring pad in yellow color plastic bag for disposal.

11. Clean and disinfect the trigger spray bottles and other nondisposable items, as these items are considered to be potentially contaminated.

12. On completion of the task, place all disposable protective garments, such as gloves, shoe covers, goggles and mask in the yellow plastic bag. Wash hands thoroughly using antiseptic soap, such as Scrubstat.

13. Replenish all disposable items in the spill kit and ensure it is ready for future use.



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Chemical Dilution Ratios

Beaucoup Phenolic Germicidal Detergent

One (1) ounce (30 milliliter) of Beaucoup per 1 gallon (3.7 liters) of sweet water.

Floor Maintainer Non-Ionic Surfactant Diethylene Glycol Mono Ethyl Ether

Three (3) ounce (30 milliliter) of Floor Maintainer per one (1) gallon (3.7 liters) of sweet water.

Six (6) ounce (60 milliliter) of Floor Maintainer per two (2) gallons (7.5 liters) of sweet water.

Upgrade Quarternary Ammonium Germicidal Detergent

One (1) ounce (30 milliliter) of Upgrade per three (3) gallons (11.3 liters) of sweet water.

Biotek Quarternary Ammonium Germicidal Detergent

One (1) ounce (30 milliliter) of Biotek per three (3) gallons (11.3 liters) of sweet water.

Deb Qac Based Aromatic Disinfectant Cleaner

One (1) ounce (30 milliliter) of Deb per one (1) gallon (3.7 Liters) of sweet water.

Clorox Liquid Bleach

One (1) ounce (30 milliliter) of Clorox per nine (9) ounces of sweet water.

Breaker Alkaline Detergent

One (1) ounce (30 milliliter) of Breaker per three (3) gallons (11.3 liters) of sweet water.

Cleaning of Blood Spills - Chemical Dilution Ratios


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Medical Equipment Minimum Requirements

The minimum quantity of medical equipment listed below is only a sample. The amount of equipment required to operate a Remote Area Clinic depends on the clinic’s category and utilization rates.

Description Category A Urgent Care

Facility

Minimum Quantity

Category B Urgent Care

Facility

Minimum Quantity

Category C Urgent Care Facility

Minimum Quantity

Bag Mask Valve (BMV) with built-in CO2 detection device (e.g., AMBU) adult, disposable. x 2 x 1 x 1

Backboard, long with straps. x 2 x 1 x 1

Dressing cart, stainless steel. x 1 x 1 x 1

Drug cupboard, lockable. x 2 x 1 x 1

Automated External Defibrillator (AED), portable with monitoring capabilities. x 1 x 1 x 1

Emergency response bag. See Attachment 15, page 120.

x 1 x 1 x 1

Exam/emergency stretcher with or without lockable wheels, as applicable. x 1 x 1 x 1

Bed observation. x 1 x 1 NA

Entonox/nitronox unit, portable. x 2 x 2 x 1

Examination light, wall mounted. x 2 x 1 x 1

Refrigerator for staff, small, medium or large. x 1 x 1 x 1

Refrigerator for chilled items/drugs, small, medium or large. x 1 x 1 x 1

Hare traction unit. x 1 x 1 x 1

Infusion pump. x 2 x 1 x 1

Intravenous (IV) stand, mobile. (Any device which facilitates the hook up of IV bag/bottle is acceptable at single room clinic).

x 2 x 1 x 1

Laryngeal mask (LMA), disposable sizes: 3, 4 and 5. x 2 x 2 x 2

Laryngeal mask airway holder. x 2 x 1 X 1

Ophthalmoscope/otoscope, desk top and/or wall mounted.

x 2 x 1 x 1



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Description Category A Urgent Care

Facility

Minimum Quantity

Category B Urgent Care

Facility

Minimum Quantity

Category C Urgent Care Facility

Minimum Quantity

Oxygen cylinders, D size, wall secured or cart. x 6 x 4 x 4

Oxygen cylinders, E size, wall secured or cart. x 6 x 4 x 2

Oxygen resuscitator unit (e.g., Robert Shaw or Oxy-Viva resuscitator). x 1 x 1 x 1

Portable emergency eye irrigation unit. x 2 x 2 x 1

Pulse Oximeter (If not part of AED). x 1 x 1 x 1

Ring cutter. x 1 x 1 x 1

Scissors bandage. x 2 x 2 x 1

Sharps contaminated disposable box. x 2 x 1 x 1

Sphygmomanometer, aneroid type, desk top or wall mounted. x 2 x 1 x 1

Stethoscope. x 2 X 2 x 2

Suction: Laerdal portable with rechargeable batteries. x 1 x 1 x 1

Thermometer, electronic. x 2 x 2 x 1

Visual acuity chart. x 1 x 1 x 1

Stretcher: Scoop stretcher with straps. x 1 x 1 x 1

Glucometer machine, calibration safe. x 1 x 1 x 1

Pocket mask with oxygen nipple/inlet. x 2 x 2 x 1

Wheel Chair. Not applicable for single room facilities.

x 1 x 1 x 1

Weight/Height scale. x 1 x 1 x 1

Stretcher emergency, disposable (e.g., Life lite emergency), 5 per box. x 2 x 2 x 1

Stretcher Basket. At single room facility, to be part of operation emergency response supplies.

x 2 x 2 x 1



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Medical Supplies Minimum Requirements

The minimum quantity of medical supplies listed below is only a sample. The amount of supplies required to safely operate a Remote Area Clinic depends on the clinic’s category and utilization rates.

Item Description Unit Category “A” and “B” Facility Category “C” Facility Quantity

Abdominal pads. Each

Adhesive tapes, sizes:

½ inch. Each

1 inch. Each

2 inch. Each

Automated External Defibrillator (AED) electrodes and other accessories. Each

Alcohol preps. Box

Aluminum foil, roll. Roll

Ambu bag and mask with CO2 indicator, adult, disposable. Each

Anal scope, disposable. Each

Applicators, sterile, 6 inch. Each

Applicators, non-sterile, 3 inch. Each

Apron plastic. Each

Bag: paper bag, preferable waxed. Each

Band aids. Box

Bandages: Stockinet bandages, sizes:

2 inch. Roll

4 inch. Roll

Bandages: Ace bandages, sizes:

2 inch. Roll

3 inch. Roll

4 inch. Roll

6 inch. Roll

Bandages: triangular bandages. Each



100

100


Basin, kidney, disposable. Each

Batteries, size:

1.5 volts (D cell). Each

1.5 volts (AA). Each

1.5 volts (AAA). Each

Battery: Chargeable battery for EKG machine, spare. Each

Bandage scissor. Each

Betadine swabs and/or solution sticks. Each

Blood spill kit. For details and contents, see Attachment 7, page 95.

Each

Body bags. Each

Burn dressing: Sterile burn sheet 60 x 90 cm. Each

Burn pad 55 x 75 cm. Each

Butterfly cannula, sizes:

19 gauge.

21 gauge.

23 gauge.

Catheter: Nasal catheter, sizes:

16 french. EA

18 french. EA

Catheter: Suction catheter, sizes:

14 french. EA

16 french. EA

Catheterization set: urethral catheterization set, #14 french, disposable. EA

Cervical collars, hard, stiff neck brand only, sizes:

No neck adult. Each

Small adult. Each

Regular adult. Each



101 101


Cold packs. Pack

Cotton balls, sterile, 10 packs. Pack

Cardiopulmonary resuscitation (CPR) board. Each

Glue, derma bond. Each

Drain: Penrose drain, sizes:

½ inch. Each

1 inch. Each

Dressing-release, non-adhering dressing. Pack

Dressing pack, disposable. Each

Dressing. Each

Dressing: Tegaderm, 6 cm x 7 cm. Each

Dressing: multi-trauma dressing, sterile. Each

EAR speculum, dispenser. Each

EAR speculum, box of 100. Each

Electrocardiogram (ECG), recording paper. Each

ECG adaptor clips/pads and/or suction bulbs. Pack

ECG electrodes, disposable. Pack

Elastoplasts, sizes:

½ inch. Each

1 inch. Each

3 inch. Each

Emergency blanket, aluminum polymer fire-retarded, body heat retainer.

Each

Emergency blanket, 58 inch x 90 inch, disposable. Each

Emergency eye wash solution, 16 ounce bottle. Bottle

Eye pads, sterile. Each

Filter, pocket mask. Each

Flash light, heavy duty. Pack

Forceps splinter, fine tip, disposable. Each



102 102


Gauze: Roller gauze, non-sterile, sizes: Roll

1 inch. Roll

2 inch. Roll

3 inch. Roll

4 inch. Roll

Gauze: Sponge gauze, non-sterile, sizes: Pack

2 x 2. Pack

3 x 3. Pack

4 x 4. Pack

Gauze: Sponge gauze, sterile, sizes: Pack

2 x 2. Pack

3 x 3. Pack

4 x 4. Pack

Gloves: exam gloves, non-sterile, latex. Box

Gloves: exam gloves, sterile, latex, sizes:

Size 7. Pair

Size 7½. Pair

Size 8. Pair

Glucometer control solutions, as applicable. Each

Goggles: safety goggles. Each

Head immobilizer. Each

Humidifier, disposable with adapter, “Aquapak” 500 ml. Each

Intravenous (IV): Jelco IV catheter, sizes:

14 gauge. Each

16 gauge. Each

18 gauge. Each

20 gauge. Each

22 gauge. Each Medical Supplies Minimum Requirements


103 103


IV set, primary piggy back pump set for pump type. Each

IV tubing, nitroglycerin set for IV pump. Each

IV tubing, 15 drop set. Each

IV tubing, 60 drops set. Each

IV tubing, metriset. Each

Kerlix rolls. Each

Kleenex tissue. Box

Lancets. Box

Laryngeal mask airway (LMA), disposable, sizes:

3. Each

4. Each

5. Each

Laryngeal mask airway holder. Each

Mask face, disposable. Box

Medicine cups. Each

Micropore tape, sizes:

½ inch. Roll

1 inch. Roll

2 inch. Roll

Nebulizer sets. Each

Needles, sizes:

18 gauge, 1-1½ inch. Each

20 gauge, 1 inch. Each

22 gauge, 1-½ inch. Each

Optivisor. Each



104

104


Oral airways, guedal, disposable, sizes:

Small. Each

Medium. Each

Large. Each

Ophthalmoscope with accessories and consumables. Pack

Oxygen connecting tubes. Each

Oxygen flow meter, to fit various size cylinders. Each

Oxygen masks adult, simple. Each

Oxygen masks, non-breathing, adult. Each

Oxygen nasal cannulas, adult. Each

Paper cups. Pack

Paper roll, vanco. Roll

Paramedic scissor (sheer). Each

Penlight (torch/flashlight). Each

Percussion hammer. Each

Pleur-evac chest drainage. Each

Pocket masks with oxygen nipple. Each

Probe cover for thermometer. Box

Red dots (monitoring electrodes). Pack

Safety pins, large. Each

Safety goggles, disposable. Each

Safety hard hat, size to fit. Each

Scalpel handle, disposable with blades number 11 and 20. Each

Shroud kit. Each

Sharps box with wall brackets, large. Each

Sharps box with large brackets, small. Each

Sharps box, small ambulance. Each

Shave prep kits. Pack Medical Supplies Minimum Requirements


105 105


Spandages, sizes 1 to 7. Each

Splint: cardboard Sam splint:

Leg splint 24 inch. Each

Leg splint 18 inch. Each

Leg splint 12 inch. Bottle

Arm splint 18 inch. Each

Arm splint 12 inch. Each

Stretcher straps. Each

Saline for irrigation, 1,000 cc, sterile. Bottle

Steri-strip, sizes:

¼ inch. Box

1/8 inch. Box

Suction machine with accessories and consumables. Each

Suture: Surgical suture, sizes:

Ethilon 4/0 W 1612T NDL. Box

Ethilon 5/0 W 1616T NDL. Box

Mersilk 4/0 W329 NDL. Box

Vicryl 5/0 W9106 NDL. Box

Suture tray, disposable. Each

Syringes with needles, disposable, sizes:

2½ cc 20 gauge, 1 inch. Each

2½ cc 22 gauge, 1 inch. Each

2½ cc 22 gauge, 1½ inch. Each

Insulin, 50 unit/cc.

Syringes, disposable, sizes:

5 cc. Each

10 cc. Each

20 cc. Each

50 cc. Each



106 106


Tape measure. Each

Test strips for glucose in blood, 25’s (Hemoglucotest). Bottle

Test strips for glucose in urine, 25’s (Ketodiabur-test). Bottle

Thermometer: temperature gauge for refrigerator. Each

Tongue blades, non-sterile. Box

Towel sterile. Each

Towel: Polyethylene, disposable. Box

Urinals. Each

Urinary drainage bag. Each

Vaseline gauze, sizes:

½ inch x 72 inch. Each

3 inch x 18 inch. Each

Water: Sterile irrigation water, 2,000 cc. Bottle

Wrench, adjustable metal type to open all cylinder sizes. Each

Adhesive remover (e.g., Whisk). Box

Yankauer suction. Each

Multistix, urine test strips. Bottle



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107

Linen Supplies Minimum Requirements

The minimum quantity of linen supplies listed below is only a sample. The quantity of each item required to supply a Remote Area medical facility will vary depending on the clinic’s category and utilization rate.

Note: Disposables, if available, are preferred.

Item Description Unit Quantity Check (•)

Bed sheets. Each

Blankets. Each

Pillows. Each

Pillow cases. Each

Plastic cover for pillows. Each

Face cloths. Each

Bath towels. Each

Patient gowns. Each

Linen hamper/container. Each

Linen hamper bags. Each

Linen Supplies Minimum Requirements


108 108

Drug Formulary List Minimum Requirement

Class

Minimum Quantity

Required per Class

Generic and Presentation (Example) Minimum Stock Level

Remarks

Analgesic/Antipyretic Tablets 2 Acetaminophen 500 milligram (mg) tablets

Acetaminophen with codeine

Analgesic/Anti-Inflammatory Tablets 2

Acetylsalicylic acid 325 or 500 mg tablets

Diclofenac 50 mg tablets

Ibuprofen 400 mg tablets

Indomethacin 25 mg capsules

Naproxen 250 mg tablets

Analgesic/Anti-Inflammatory Injection 1 Ketorolac tromethamine 15 mg/ml ampules

Antibiotic Tablets 4

Amoxicillin 250 mg capsules

Augmentin 375 mg

Ciprofloxacin 250 mg

Erythromycin 250mg

Doxycycline 100 mg

Azithromycin 250 mg tablets

Cefaclor 250 mg capsules

Penicillin VK 600 mg

Antibiotic Ointment 1 Bacitracin zinc 500 units/gram (gm)

Antibiotic Ointment for Burns 1 Bacitracin zinc ointment

Antacid Tablets 1 Antacid chewable tablets

Drug Formulary List Minimum Requirement


109

109

Class

Minimum Quantity

Required per Class

Generic and Presentation (Example) Minimum

Stock Level Remarks

Antacid Suspension 1 Maalox suspension

Adhesive Remover 1 Adhesive remover

Bronchodilator (Nebulizer) 1 Albuterol 20 ml solution/aerosol delivery

chamber

Atrovent inhalation solution

Bronchodilator (inhaler) 1 Albuterol sulfate inhaler

Antiseptic Solution 1 Alcohol isopropyl 70% solution

Antiseptic Swab 1 Alcohol sachet

Analgesic, Cream and/or Ointment 1

Algesal ointment, 40 mg tube

Diclofenac cream/ointment

Ibuprofen cream/ointment

Stimulant 1 Ammonia 0.3 ml crushable ampules

Anesthetic Rectal 1 Cinchocaine 1% ointment, 20 mg tube

**Beta Blocker 1 Atenolol 50 mg tablets **Not for Category “C” Facility

Cough Medication, Syrup 2

Diphenhydramine hydrochloride

Dextromethorphan 100 ml bottle

Rinofed Drug Formulary List - Minimum Requirement


110

110

Class

Minimum Quantity

Required per Class


Stock Level Remarks

Corticosteroid Cream 1

Betamethasone valerate 0.1% cream, 30 gm tube

Kenacomb (nystatin/gramicidin/triamcinolone) cream

Laxative Tablets 1 Bisacodyl 5 mg tablets

Antipruritic 1 Calamine lotion

Otic Drops, Cleanser 1 Carbamide peroxide 6.5%

Antihistamine Tablets/Capsules 2

Cetirizine 10 mg tablets

Diphenhydramine 25 mg capsules

Promethazine hydrochloride (HCL) 25 mg tablets

Antihistamine Injection 2 Diphenhydramine 50 mg/m injection

Antiseptic Cleanser/Scrub 1 Chlorhexidine gluconate 4% scrub,

500 ml

Ophthalmic Drops, Antibiotic 2 Chloramphenicol 0.5%, 10 ml dispenser

Erythromycin ointment

Tears naturale solution, 15 ml dropper

**Ophthalmic Drops, Myotic 1 Pilocarpine HCL 2% ophthalmic solution, 15 ml dropper **Not for Category “C” Facility

Ophthalmic, Antihistamine 1 Cromolyn sodium 2%, 10 ml bottle

Prefrin-A, 15 ml dropper

Drug Formulary List - Minimum Requirement


111 111

Class

Minimum Quantity

Required per Class


Stock Level Remarks

Ophthalmic Drops, Anesthetic 1 Oxybuprocaine HCL, 0.4% solution,

10 ml dropper

Ophthalmic Drops, Diagnostic Agent 1 Fluorescein sodium, single use applicator

Ophthalmic, Irrigation/Dry Eye/Eyewash 1 Sodium chloride, 0.9% eye drops, 15 ml

dispenser

Antifungal 2

Clotrimazole 1% cream, 20 gm tube

Clotrimazole 1% solution, 20 ml bottle

Daktacort cream, 2% miconazole, 1% hydrocortisone, 15 ml tube

Miconazole nitrate 2% powder, 20 gm

Nasal Drops, Antihistamine 1

Cromolyn sodium 2% solution, 30 ml spray

Oxymetazoline HCL - 0.05% solution, 10 ml dropper

Nasal Drops, Anti-Infective Steroidal Anti-Inflammatory 1 Otosporin otic drops, polymyxin, neomycin,

hydrocortisone, 5 ml bottle

Nasal Decongestant 1 Pseudoephedrine HCL - 120 mg sustained

release tab

**Gastric - H2 Blocker 1 **Famotidine 40 mg tablets **Not for Category “C” Facility

**Ranitidine 150 mg tablets **Not for Category “C” Facility



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112

Class

Minimum Quantity

Required per Class


Stock Level Remarks

**Gastric - H2 Blocker Injection 1 Ranitidine 25mg/mL, 2 ml for IV or intramuscular (IM) use **Not for Category “C” Facility

Antiemetic Tablets 1 Metoclopramide HCL - 10 mg tablets

Antiemetics Injection 1 Metoclopramide HCL - 5 mg/ml injection

**Diuretic Tablets 1 Furosemide 40 mg tablets **Not for Category “C” Facility

Diuretic Injection 1 Furosemide 10 mg/ml vial, 2 ml **Not for Category “C” Facility

Diuretic Infusion 1 Mannitol 20% solution, 500 ml bag

for IV **Not for Category “C” Facility

Antispasmodic Tablets 1 Hyoscine N-butylbromide 10 mg tablets

Antispasmodic Injection 1 Hyoscine-N-butylbromide 20 mg/ml,

1 ml Ampule for IM, IV or SC use

Antidiabetic - Miscellaneous 1 1 Glucose powder

Antidiabetic - Miscellaneous 2 1 Glucose 50% IV solution, 50 ml prefilled syringe

Antidiabetic Hyperglycemic Agent, Injection 1 Glucagon 1 mg (1U) with 1.5 ml solvent

Antidiabetic Hyperglycemic Agent, Injection 2

Insulin regular 100 U/ml 10 ml vial

**Insulin human isophane 100 U/ml isophane suspension, 10 ml vial **Not for Category “C” Facility



113 113

Class

Minimum Quantity

Required per Class


Stock Level Remarks

Antidiabetic Hypoglycemic Agent, Tablets 1 **Glucophage 500 mg tablets **Not for Category “C” Facility

Miscellaneous 1 1 Silver nitrate applicators

Miscellaneous 2 1 Throat lozenges

Miscellaneous 3 1 Glycerin 4 ounce bottle

Anti-Diarrhea 1 Loperamide HCL 2 mg capsules

Anesthetic, Local Injection 2

Lidocaine HCL 1% solution, 20 ml multi-dose vial

Lidocaine HCL 2% solution, 20 ml multi-dose vial

Anesthetic Local, Other 1 Lidocaine 2% Jelly - 20 gm tube

Oral viscous 2%, 122 ml bottle

**Beclomethasone Disproportionate, Bronchodilator 1 Oral inhaler, 50 microgram (mcg) per

inhalation **Not for Category “C” Facility

IV Fluids, Dextrose 1 Dextrose 5% bottle/bag, 1 liter

IV Fluids, Lactated Ringers (LR) 1 Lactated ringers solution 1,000 ml

IV Fluids, Sodium Chloride (Na) 1 Sodium chloride 0.9% 1,000 ml

Emollient (Lubricant) 1 KY Jelly 5 mg tube/petrolatum white

**Antiparasitic 1 Mebendazole 100 mg chewable tablets

Muscle Relaxant 1 Methocarbamol 500 mg tablets Drug Formulary List - Minimum Requirement


114 114

Class

Minimum Quantity

Required per Class


Stock Level Remarks

Diluent 1 Sodium chloride 10 or 20 ml ampule

Water for injection 10 ml ampule

Rehydration Agent 1 Oral rehydration salts 14 gm sachet

Tetanus Vaccine Immunoglobulin 1 Tetanus immune globulin 250 IU per ml 1 ml vial/syringe for intra muscular (IM) use

Tetanus Toxoid 1 Tetanus Toxoid 0.5 ml dose for IM

Urinary Anesthetic 1 Phenazopyridine HCL 100 mg tablets

Cleanser (Anti-Infective) 1 Povidone iodine 10% solution, 120 ml bottle

Steroid Anti-Inflammatory Tablet 1 Prednisone 5 mg tablets

Steroid Anti-Inflammatory Injection 1 Hydrocortisone injection 100 mg for IV or

IM

**Anticonvulsant Agent, Noncontrolled

1 Fosphenytoin sodium 50 mg/ml 10 ml ampule for IV or IM

**Not for Category “C” Facility

**Anticoagulant 1 5,000 units/ml vial **Not for Category “C” Facility

Vasodilator (Nitrate) 1 Isosorbide dinitrate 10 mg tablets

**Not to be supplied to Category “C” Medical Facility. Note 1: Generic and Presentation - Supply of generic alternatives from the local market is acceptable.

Note 2: Formulary list/crash cart and other emergency drugs supplies: Formulary list (a selection from each class of drug for category “A, B and C” Medical Facility) and crash cart contents is at the discretion of the company assigned

responsible physician who must comply with all Ministry of Health (MOH) drugs supply and administration regulations, and take into consideration the competency of the staff and required training before such drugs are administered.



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Ambulance Medical Equipment and Supplies Minimum Requirement

Description Quantity Week 1 Week 2 Week 3 Week 4

1. External:

a. Red Crescent insignia.

b. Ambulance sign painted on the outside.

2. Drivers Cabin:

a. Gloves, heavy duty.

b. Note pad and pen.

c. Fire extinguisher, ABC type - small.

d. Safety hard hat.

e. Flashlight, 9 volt.

f. Tire gauge.

g. Safety triangle.

h. Communication equipment (radio).

i. Safety vest, reflective with identity clearly labeled (e.g., medical).

3. Patient Compartment:

a. First aid kit (36 unit size) with the following items: ace bandages, kerlix, cold packs and scissors.

b. **Emergency response bag.

c. **Automated External Defibrillator (AED).

d. **Suction machine, portable with accessories, suction catheters and tubing.**

e. Stretcher collapsible (Ferno or other).

f. Backboard short with straps.

g. Long Board with straps, van type only.

h. Kendrick extrication device (KED).

Ambulance Medical Equipment and Supplies Minimum Requirement


116 116

Description Quantity Week 1 Week 2 Week 3 Week 4

3. Patient Compartment: (Cont.)

i. Hare traction.

j. Oxygen cylinder, large size, modular and van type only.

k. Portable oxygen (e.g., Robert Shaw unit).

l. Oxygen supplies accessories: rebreathing mask, nasal cannula and tubing.

m. Oxygen cylinder key.

n. Wrench adjustable, metal type to open all cylinder sizes.

o. Infection control supplies:

• Goggles.

• Mask, surgical.

• Plastic apron.

• Gloves, examination.

• Small sharps container.

• Infectious wastes plastic bag, yellow.

p. Cervical collar, rigid, size: small, medium and large.

q. Other items:

• Kleenex tissue.

• Trash bag, plastic.

• Gloves examination, unsterile.

**To be loaded upon dispatch of ambulance. Ambulance Medical Equipment and Supplies Minimum Requirement


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Vehicle (Ambulance) Condition Report – Daily Checks Medical Facility: ____________________ Vehicle No.: ____________________

Item Code Items Checked Day Checked and Initials

Remarks if Deficient 1 2 3 4 5 6 7

A.1 General cleaning inside and outside. A.2 Air conditioning. A.3 Directional lights. A.4 Fuel gauge. A.5 Horn. A.6 Siren. A.7 Mirrors. A.8 Steering wheel. A.9 Seat belts. A.10 Hand brake. A.11 Foot brake. A.12 Radio communication. A.13 Engine oil/Transmission oil. A.14 Fan belts. A.15 Radiator. A.16 Wiper water reservoir level. A.17 Battery. A.18 Flashers. A.19 Head lights, low and high beam. A.20 Tail lights. A.21 Stop lights and parking lights. A.22 Muffler. A.23 Tire condition and pressure. A.24 Spare tire and tire changing tools. A.25 Triangle. A.26 Fire extinguisher.

Daily Test Run Mileage Record (km) 1 2 3 4 5 6 7

Mileage - Out

Mileage - In Vehicle (Ambulance) Condition Report – Daily Checks


118 118

Housekeeping Equipment and Supplies Minimum Requirement

The quantity of each listed below depends on the medical facility category and utilization rate.

Description Check (•) Remarks

Mops, two (2) different colors.

Trolley with dual mop bucket and wringer/portable bucket with wringer for small clinic.

J cloth.

Sodium hypochlorite (Clorox bleach).

Antiseptic scrub for sinks (hibiscrub/hro-scrub 4).

Trigger spray bottle.

Detergent, upgrade or similar, e.g., beaucoup for patient area.

Plastic bags for rubbish, color coded for infectious waste.

Paper towels for sinks and spills.

Paper towel dispenser.

Wet Floor sign.

Blood Spill Kit. For details and contents, see Attachment 7, page 96.

Floor polish.

Window cleaner.

Furniture polish.

General multi-cleaner with bleach for sinks, etc.

Toilet bowl and urinal cleaner.

Soap, liquid and dispenser.

Waste bin, pedal type with lid for clinical waste.

Waste basket, general purpose.

Hand brush and dust pan.

Gloves rubber, heavy duty.

Hand sanitizer, ethyl alcohol 70% base, Sani-gel or Septogel.

Housekeeping Equipment and Supplies Minimum Requirement


119 119

Emergency Response Bag Minimum Requirement

At a minimum, each bag shall contain the supplies listed below. The contents of the emergency response bag shall be checked weekly or preferably after use to ensure quantity and validity.

Note:

The QUANTITY for each item varies from one facility to another.

At a minimum, the NUMBER of emergency response bag per facility, as follows: two (2) bags in Physician Operated Clinic (POC) and one (1) bag in Nurse Operated Clinic (NOC).

Emergency response bag is used when responding to medical emergencies and disasters, and in the medical facility.

Item Contents Quantity Check (•)

Nurse Supplies

Sphygmomanometer and stethoscope. One (1)

Paramedic scissors (shears). One (1)

Penlight. One (1)

Disposable gloves, medium and large. Three (3) each

Masks. Three (3)

Waxed paper bag. Three (3)

Small sharps container for sharps. One (1)

IV Supplies

Lactated ringers (LR), 1,000 cc. One (1)

Dextrose 5% solution, 1,000 cc. One (1)

Normal saline (9NS), 1,000 cc. One (1)

Adhesive tape, 1 inch. One (1)

Giving set. Two (2)

Alcohol swabs. Six (6)

IV Cannula: 14 gauge to 20 gauge. Two (2) each

22 gauge. Two (2)

Band aids. Six (6)

Tourniquets, 1 inch or ½ inch. One (1)

Tegaderm, 6 cm x 7cm. Three (3)

2 x 2 gauze sponge. Four (4)



120 120

Item Contents Quantity Check (•)

Patient Supplies - Airway Supplies

Ambu bag, adult. One (1)

Oral airway, sizes: small, medium and large (3, 4 and 5). One (1) each

Laryngeal mask, sizes: small, medium and large. One (1) each

Bandage, 1 Inch. One (1) roll

Syringe, 10 cc. Four (4)

Pocket mask, adult. One (1)

Oxygen masks/nasal cannula/non-rebreather. One (1) each

Suction connecting tubing. One (1)

Yankauer suction. One (1)

Suction catheters, size 14 french. One (1)

Patient Supplies - Dressings / Bandages

Multi-trauma dressing. One (1)

Abdominal pad. One (1)

Gauze sponges, sterile, 2 x 2 and 4 x 4. Six (6) each

Vaseline gauze, 3 inch x 18 inch. Six (6)

Triangular bandage. Two (2)

Kerlix roll. Two (2)

Ace wraps, 4 inch x 6 inch. Two (2) each

Non-adhesive dressing. One (1)

Micropore, 1 inch. One (1)

Povidine iodine swabs. Four (4)

Ice pack. Two (2)

Bacitracin ointment. One (1) tube

Band aids. Six (6)

Patient Supplies - Splints Splints, disposable, short and long. One (1) each

Patient Supplies - Burn Supplies

Sterile sheets, disposable. Five (5)

Blankets emergency, disposable. Two (2)

Surgical face masks, disposable. Five (5)

Sterile gloves, sizes: 6.5, 7 and 8. Two (2) pairs each

Disposable gowns. Two (2)

Sterile sheets, disposable. Five (5)



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Emergency Drugs for Emergency Response Bag Minimum Requirement

At a minimum, facilities in each category shall have the drugs listed below for each bag. The contents of the emergency response bags shall be checked weekly or preferably after use to ensure quantity and validity.

Note: Staff must be certified competent to administer these drugs. Other drugs can be added to this list provided that the staff is appropriately trained and certified competent to administer them.

Item Drug Name and Strength

Quantity

Check ( ) Physician Operated Facility Category A & B

Nurse Operated Facility

Category C

Emergency Drugs

Adenosine 6 mg/2 ml ampule. Five (5) Not applicable Amiodarone Injection, 150 mg/3 ml ampule. Three (3) Not applicable Atropine sulphate 1 mg/10 ml, pre-filled syringe. Three (3) Not applicable Albuterol inhaler, 200 inhalations, inhaler. One (1) One (1) Calcium Chloride 10%, 1gm/10 ml, pre-filled syringe. Two (2) Not applicable Diphenhydramine 50 mg/1 ml vial. One (1) One (1) Dopamine infusion, 200 mg/5 ml vial. Four (4) Not applicable Dextrose 50% injection, 50 ml pre-filled syringe. One (1) Not applicable Epinephrine 1: 1,000, 1 mg/1 ml. Six (6) Six (6) Epinephrine 1: 10,000, 1 mg/10 ml pre-filled syringe. Six (6) Not applicable Glucose powder, oral, bottle. One (1) One (1) Glucagon injection. Two (2) Two (2) Hydrocortisone injection, 100 mg/2 ml vial. One (1) Not applicable Inderal (propanolol) ampule. Three (3) Not applicable Magnesium sulphate injection, 1 gm/2 ml ampule. Four (4) Not applicable Nitroglycerin tablets, 0.4 mg bottle. One (1) One (1) Nitroglycerin 50 mg vial. Two (2) Not applicable Normal saline, 10 ml ampule. Five (5) Five (5) Sodium bicarbonate, 50 mEq/50 ml pre-filled syringe. One (1) Not applicable Vasopressin injection, 20 units/ml vial. Two (2) Not applicable Xylocard 2% (20 mg/ml), abboject. Two (2) Two (2) Xylocard 20% (200 mg/ml), abboject. Two (2) Not applicable Xylocaine spray 10%. One (1) Not applicable

Emergency Drugs for Emergency Response Bag Minimum Requirement


122 122

Patient Treatment Daily Log

Medical Facility: _______________________________________________________ Date: _______________________________

Date Name and Badge No. Time In Time Out Treatment Comments

Report prepared by:

Name: _____________________________________ Badge No.: ________________ Signature: _______________ Date: _____________

Patient Treatment Daily Log


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Examination and Treatment Protocol (TP) for Nurses

TP-xx

Backache

Body Parts Involved: Vertebrae, Spine ______________________________________________

Name: ___________________________ Badge No.: ________________ MR No.: ____________

Date: _____________________ Time in: ________________

History and Physical Examination

1. Is onset of pain sudden Yes No History trauma Yes No Is pain referred Yes No History of renal calculus Yes No Recent heavy lifting Yes No Movement restriction Yes No History of spondylosis Yes No History of disc prolapsed Yes No History of rheumatoid Yes No

History of arthritis Yes No

2. Is pain Mechanical: Made worse by prolonged sitting or standing, relieved by movement or inflammatory agent or prolonged early morning stiffness and is relieved by exercise _____________________________________

3. Are there any sensory or motor symptoms? Yes No If yes, describe: _________________ 4. Any change in bowel or bladder function? Yes No If yes, list: _____________________ 5.

Vital Signs: Temperature: _________ BP: _________ Pulse: _________ Respiration: ________

6. Urinalysis: Yes No If yes, list result: _____________________________________

Guidelines for Treating Nurse

1. Prior history of long standing backache and normally on prescribed medication, this should be given to the patient if available (with no other presenting symptoms) otherwise: In all cases of persistent backache the patient should be seen or referred to a clinician with the following instructions:

Used of proper body mechanics when moving or lifting heavy objects. Bend at the knees and hips when lifting and use the feet to pivot. Keeping the spine perfectly straight, do not

bend or twist the back. Keep loads close to the body when lifting. Avoid aggressive exercises when in pain. Note: Give patient education guidelines for safe lifting techniques. 2. If back pain is work-related, prepare and submit QI-30. History of work-related injury to company employee or contractor. History of injury to general public resulting directly from company operations or on company premises. Examination and Treatment Protocol for Nurses


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Examination and Treatment Protocol for Nurses

TP-xx

Headache

Body Parts Involved: Neurological System ______________________________________________

Name: ___________________________ Badge No.: ________________ MR No.: ____________

Date: _____________________ Time in: ________________

History and Physical Examination

1. History of recurrent headache Yes No Migraine Yes No 2. Trauma recent (within 24 hours) Yes No Within last 7 days Yes No 3. High velocity Yes No Blunt injury Yes No 4. Sudden onset Yes No Loss of consciousness Yes No 5. Fully alert and orientated Yes No Photophobia Yes No 6. Pyrexia Yes No Neck Rigidity Yes No 7. General Malaise Yes No Drowsiness Yes No 8. Nausea and vomiting Yes No Impaired vision Yes No 9. Sinusitis Yes No Flu like symptoms Yes No 10. Earache Yes No 11. Hypertension Yes No Hypotension Yes No 12. Epilepsy Yes No 13. Psychiatric illness Yes No Stress Yes No 14. History of alcohol abuse Yes No Drug or solvent abuse Yes No 15. Severe pain Yes No Localized pain Yes No 16. Trigeminal neuralgia Yes No

Guidelines for Treating Nurse In the event of sudden onset of severe headache with or without neurological symptoms, the patient must be seen by a clinician as soon as possible. 1. Where history of head trauma, baseline observations, such as: temperature, pulse, blood pressure, respirations, and

pulse oximeter must be performed and recorded. 2. If there is any loss of consciousness or disturbance of conscious level, ensure that the patient’s airway is protected at

all times. 3. A Glasgow coma scale and neurological status must be obtained and recorded. 4. If a patient presents with neck rigidity, photophobia, nausea, vomiting, and/or dizziness, he must be seen by a

clinician and referred to hospital as soon as possible. 5. If a patient presents with hypotension or hypertension, with no prior history, he must be seen by a clinician as soon

as possible. 6. Patients with prior history of migraine or longstanding headache, normally on prescribed medication; the patient

shall be asked when medications were last consumed/taken. 7. A patient presenting with associated common cold or influenza, treat as instructed by the clinician. 8. Prolonged history of recurrent headache, with no prior investigations should always be referred to a clinician for

evaluation. 9. If a patient presents with any neurological disturbance he shall immediately be examined by a clinician. Examination and Treatment Protocol for Nurses


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Standing Orders Guidelines for Nurses

In the event nurses are authorized to administer and dispense drugs in the absence of a physician or pharmacist, clear written administration and dispensing guidelines in line with MOH regulations must be in place. This could be in the form of a “standing order” or a “routine order” from the responsible physician. Note: The guidelines listed below are to be used as a reference to assist you in developing your own standing orders/protocols.

Standing Orders (SO) Treatment/Education

Refer to Physician

Headache

Refer to facility’s Nursing Protocol.

Always take patient’s blood pressure.

Refer if headache is associated with any of the following: high blood pressure, high fever, nausea, vomiting, history of injury and acute severe headache.

Headache of recent onset with normal vital signs and no other complaints, give panadol per schedule dosage. Refer if persistent headache.

Headache associated with sore throat or common cold, give panadol per schedule dosage. Refer if history of head trauma.

Headache with dizziness, give panadol per schedule dosage and 1 tablet of dramamine three times a day (tid).

Dramamine requires a physician’s order.

Chest Pain

Follow facility’s Nursing Protocol if chest pain is not associated with the typical symptoms of heartburn and/or indigestion.

ALWAYS REFER ALL CASES

IV fluids and morphine require a physician’s order.

Notify the physician.

Start IV to keep vein open.

Give Morphine sulfate per physician’s order.

Place patient in semi-fowler’s position.

Start oxygen 6 liters per minute.

Place on Life Pak monitor, if available.

Twelve lead EKG, if available.

Take vital signs as often as necessary and document.

Transport by the quickest method to the nearest medical facility.

Accompany patient during transportation.

Backache

Refer to facility’s Nursing Protocol.

Refer all other cases. Apply analgesic balm.

Mild or recent onset without any associated complaints, give panadol per schedule dosage. If no improvement in two days, refer to physician.

Common Cold Mild cold without any associated complaints (i.e., fever, productive cough, etc.), give panadol per schedule dosage.

Common cold associated with any of the following: Temperature over 38 Celsius (104.4 Fahrenheit), loose productive cough with purulent sputum, earache, sinus pain or rhinorrhea.



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Refer to Physician

Conjunctivitis (mild)

Give isopto cetamide eye drops every 4 hours.

Refer severe cases. Check G6PD status.

Give erythromycin eye ointment to be applied at bedtime. Erythromycin and isopto cetamide require a physician’s order. If no improvement in 48 hours, refer to physician.

Flash Burn of Eye Patch the affected eye with an eye pad. Refer all cases.

If indicated, apply analgesic. Analgesics require a physician’s order.

Foreign Body in Eye

Check vision on eye chart and record prior to eye examination.

Refer all cases Stat.

Novesine requires a physician’s order.

If simple foreign body, apply novesine 0.4%, 2 drops; remove foreign body with sterile cotton bud.

Use normal saline as eyewash after removal.

Other foreign objects: perform first aid treatment only, apply novesine 0.4%, 2 drops, cover eye with eye patch.

Reevaluate in two hours.

Itching Sensation in Eyes

If no evidence of acute irritation, recommend cold compress 3 times a day.

Prefrin-A requires a physician’s order.

Give prefrin-A 1-2 drops, every 6 hours.

Advise patient to return If no improvement in 48 hours, refer to physician.

Sties

Apply warm, moist compressed for 15 minutes four times a day (qid).

Give isopto cetamide eye drops every four hours and Erythromycin eye ointment at bedtime.

Check G6PD status.

Advise patient to return if condition worsens or persists longer than 3 days.

Trauma to Eyes

Give first aid treatment.

Refer all cases. Cover both eyes with normal saline pads.

Immobilize impaled object.

Check tetanus status.

Foreign Body in Ear If foreign body (such as fly) appears easy to remove, irrigate with warm normal saline solution using bulb syringe.

Refer if foreign body appears impacted (such as a bean or small stone) or is difficult to remove by irrigation.

Other Eye Complaints Refer all cases.

Ear Discharge, Ear Pain

Apply otosporin ear drops every (q) 6 hours.

Refer all cases. Never plug ears with cotton.

Give panadol per schedule dosage for pain.

Give Auralgan ear drops for earache.



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Refer to Physician

Impacted Cerumen

Irrigate with warm saline solution only if patient has no history of perforation of tympanic membrane or otitis media.

Refer all cases. If unable to remove, use murine ear drops (carbamide peroxide), 5-10 drops twice a day (bid). Examine ears for underlying infection.

Allergic Rhinitis If this is the first instance of allergy, give antihistamine and refer to a physician.

Refer if not previously diagnosed. Refer if no improvement after taking medication.

Epistaxis (minor)

Examine nasal passages.

Keep patient’s head erect, pinch side of nose against septum for five (5) minutes. May apply vaseline gauze nasal packing if necessary. Check and record blood pressure and pulse prior to physician referral.

Mild Throat Irritation with Normal Temperature

Recommend warm saline gargles or mouth spray.

Mild Sore Throat with Temperature of 38 °C

Give panadol per schedule dosage.

Recommend warm saline gargles or mouth spray.

Tonsillitis with Temperature of 38 °C

Recommend warm saline gargles or mouth spray. Refer all cases.


Cough Associated with Common Cold

Give romilar expectorant, 2 teaspoon (tsp) every 4-6 hours, as needed.

Refer if persistent or recurrent cough.

See nursing protocol for upper respiratory infection.

Refer if cough is associated with any of the following: weight loss, elevated temperature, purulent sputum or hemoptysis.

Heartburn/ Indigestion

Give liquid Maalox (antacid) 2 teaspoon every 4 hours or Maalox tablets, 2 tablets every 4 hours. Provide dietary advice: reduce spices, fried foods, etc.

Refer recurrent cases.

Refer if chest pain remains a possibility.

Vomiting

Nothing by mouth (NPO) till evaluated.

Refer all cases. Monitor vital signs. Give anti-emetic for severe cases. Close observation.

Abdominal Pain Refer to facility’s Nursing Protocol.

Refer in sickle cell disease and if severe cases associated with any of the following: nausea, vomiting, fever, tenderness and abdominal guarding.

Diarrhea

Refer to facility’s Nursing Protocol. Refer severe diarrhea.

Give imodium (Loperamide HCL), 2 capsules (4 mg) initially, then 1 capsule every bowel movement (qbm); maximum of 8 capsules (16 mg) in 24 hours.

Refer all severe cases associated with any of the following: nausea, vomiting, fever, blood in stool and dehydration.



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Standing Orders (SO) Treatment/Education Refer to Physician

Constipation

Give milk of magnesia 2 tablespoons (tbsp) (2 oz) or dulcolax 1-2 tablets at bed time. Refer constipation associated

with abdominal pain, nausea and/or vomiting. Advise patient to increase fluid intake, fruit and

vegetables in diet and moderate exercise.

Hemorrhoids Give anusol suppository and advise sitz baths, 20-25 minutes daily. Repeat process every day until relief is obtained.

Refer all cases.

Rectal Bleeding Refer all cases.

Burning and Frequency of Urination

Refer to facility’s Nursing Protocol on Urinary Tract Infection. Refer all cases.

Urethral Discharge Refer to facility’s Nursing Protocol on Urinary Tract Infection. Refer all cases.

Pain Suggestive of Renal colic

Refer all cases.

Gross Hematuria Refer all cases.

Acute Scrotal Swelling and Pain

Refer all cases.

Generalized Musculoskeletal Ache or Pain

Apply analgesic balm and give panadol per schedule dosage.

Refer if more than two days duration.

If associated with common cold or sore throat, treat as common cold or sore throat.

Refer if temperature is elevated over 38 °C.

Joint Pains

Localized with no redness or swelling, give panadol per schedule dosage and analgesic balm for local application.

Refer if associated with any of the following: redness, swelling, elevated temperature. Refer if condition worsens or persists.

Advice hot compresses or sitting in hot bath. If associated with common cold or sore throat, treat as common cold or sore throat.

Dry Skin Apply vaseline ointment.

Give lanolin, ½ ounce (oz).

Dry Lips Give vaseline ointment.

Heat Rash Apply calamine lotion locally.

Advise patient to keep skin dry, bathe only once a day, avoid bathing in hot water, wear lightweight clothing.

Boils

Advise warm water or saline compresses. Refer if boil is on nose or upper lip. Give bacitracin ointment four times a day (qid) if lesion

not ready for incision and discharge (I&D). Give panadol to relieve pain per schedule dosage. Refer if signs of cellulitis.

Change dressing daily. Refer if multiple boils, recurrent or with abscess formation.

Athlete’s Foot In chronic phase with scaling, give daktarin powder or canesten cream and advise good hygiene.

Refer if acute with maceration or infected. Medication requires physician’s order.

Corns

For removal of corns apply 1 drop of collomack solution in the morning and evening. After a few days of treatment, soak foot in hot bath to loosen the corn for removal.

Refer if diabetes or infection.

Lice (Head) Apply 1 ounce of kwell shampoo and rub vigorously for 4 minutes, then wet hair with warm water and rinse thoroughly. Repeat treatment in one week.

Kwell shampoo requires a physician’s order.



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Lice (Body)

Give Kwell cream or lotion.

Kwell shampoo requires a physician’s order.

Apply a thin layer to hairy infected areas and adjacent areas.

Leave on overnight (8-12 hours) then wash off.

Repeat application in one week.

Discuss hygiene/contagion.

Family members may need treatment.

Herpes Simplex Apply povidone-iodine 10% (clonidine) or 70% alcohol to the affected area. Requires a physician’s order.

Injuries

Report all on/off-the-job injuries as per your organization guidelines.

Refer all cases. Evaluate need for tetanus immunization and immunize as indicated.

Initiate immediate first aid treatment for all injuries.

Contusion(s)

Elevate affected part.

Refer if contusion(s) severe. Apply cold compresses to diminish edema.

Apply ace bandage as appropriate.

Sprains

Elevate and rest affected part.

Refer if severe, gross swelling, fracture and/or loss of function.

Apply cold compresses or ice bag for first 12 to 36 hours.

Give panadol for pain per schedule dosage.

Apply ace bandage.

Apply heat after 36 hours.

Abrasions and Superficial Punctures

Cleanse with soap and water or saline.

Irrigate thoroughly.

May apply antiseptic ointment or vaseline dressing.

Evaluate need for tetanus toxoid immunization and immunize as indicated.

Lacerations (if Minor)

If minor, such as nail wound: Refer if all other lacerations.

Clean and apply dry, sterile dressing.

Evaluate need for tetanus toxoid immunization and immunize as indicated. Refer if patient returns with

persistent pain or signs of infection. Advise patient to return if pain persists or signs of

infection appear. Standing Orders Guidelines for Nurses


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Minor Burns (first degree or small second degree burns)

Refer to minor burn treatment protocol.

Refer if more extensive or severe burns.

Refer if burns involving face, hands, soles of feet or perineum.

Refer if all circumferential burns.

Refer if any signs of sepsis.

Wash affected area gently with detergent soap (povidone-iodine detergent is recommended).

Rinse thoroughly.

Do not apply ice. Ice has the theoretical disadvantage of vasoconstriction and possible ischemia of tissue in and adjacent to the burn.

Apply bacitracin dressing and change every 48 hours.


Evaluate need for tetanus toxoid immunization and immunize as indicated.

Chemical Burns (except of eyes)

Refer to burns treatment protocol.

Refer if more extensive or severe burns.

Refer if burns involving face, hands, soles of feet or perineum.

Refer if all circumferential burns. Refer if any signs of sepsis.

Remove clothing.

Flush vigorously with several liters of water; shower if possible.

Do not waste time looking for s specific neutralizing agent.

Treat as thermal burns.

Monitor breathing closely for signs of pharyngeal swelling and airway occlusion.

Obtain name of chemical and MSDS instructions.



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Staff Competency Assessment and Development The provision of patient care in healthcare is a very challenging and dynamic profession. Therefore, each proponent organization shall ensure that their facilities’ employees have the knowledge, skills, ability and behavior required to perform task(s) correctly and skillfully in order to provide quality care to all patients. Since employees are required to demonstrate their competency levels, the facility must conduct competency assessment before the employee is assigned to the task(s) and on an annual basis. A training plan shall be developed based on individual assessment outcome(s). Assessing the knowledge, skills, and abilities of an employee requires more than the use of a checklist and a test. It entails the assessment, maintenance, demonstration, tracking, and improving/correcting the competence of the target staff. As an ongoing process, competency assessment must have the initial development, maintenance of knowledge and skills, educational/training sessions and correction of the deficiency. The Staff Competency program is a comprehensive program that begins with the hiring of competent staff and continues with a competency-based orientation. This is made up of general orientation competencies, specific competencies, mandatory and annual competencies. Continuing education and annual competency evaluation of healthcare providers provides a means of improving and reinforcing their abilities.

General Competencies – are competencies which are common to all medical positions in the remote area clinics (RACs) and which start at the education unit and continue in the assigned medical facility.

Specific Competencies – are competencies which are unique to the facility where the nurse and other healthcare providers are assigned. These include: Emergency skills competencies, ambulance equipment familiarization and basic operation for ambulance drivers. This involves teaching new skills required to perform the job safely and effectively.

Mandatory Competencies – are topics of high importance and for which periodic training is mandatory and without which employee cannot continue to practice, such as Basic Life Support (BLS) certification.

Annual Competencies – are competencies based on each clinic needs and are mandatory for each employee. These include fire safety, infection control, etc.

Competency Assessment and Development Guidelines

Proponent Organizations shall arrange for a qualified personnel to conduct staff competency assessments as follows:

1. Conduct a competency assessment by completing a performance appraisal checklist prior to on-site assignment. For more information, see pages 134-135.

2. Ensure new hires meet the minimum qualifications for clinical practice and that nurse demonstrates competency in all privilege areas. The assignment to specified areas of clinical practice and the type of frequency of clinical supervision is decided by the review of the employee’s background and experience.

3. Reevaluate the clinical competence factors, should a change in job function/assignment and/or a new/additional area of practice be added.

4. Develop a training and development plan based on the results of individual evaluation(s) with specific target dates for completion.

Competency Assessment and Development ATTACHMENT – 20

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Apply the following methods for correcting deficiencies, taking into account the extent and seriousness of the determined deficiency:

a. In-service education.

b. Consultation.

c. Change in type of supervision of employee.

d. Change in clinical practice area.

5. Incorporate additional activities to assist in ensuring continued competence. These include: review of approved nursing standards/practices, nurse's attendance of workshops/seminars for continuing education and in-service education programs.

6. Maintain records of the completed plans/training in the personnel file. Competency Assessment and Development


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Emergency Skills Competency Assessment

Competency Assessment

Employee’s Name: ______________________ Position: ________________ I.D. No.: ___________

NO.: Item to Assess - Nurse shows competency by demonstrating the following: YES NO

1 Airway Management: 1-1 Able to use naso and oropharyngeal airway. 1-2 Able to use pocket mask and bag-valve mask resuscitator/ambu. 1-3 Able to perform suctioning. 1-4 Able to perform laryngeal mask airway (LMA) insertion. 1-5 Able to administer oxygen with different type of masks. 2 Able to administer basic life support (BLS). 3 Able to use automated external defibrillator (AED). 4 Electrocardiogram (ECG) Management: 4-1 Able to use a 12 lead ECG machine. 4-2 Able to differentiate between normal and abnormal rhythms. 5 Able to use an infusion pump. 6 Able to apply immobilization techniques (neck/limbs/spine). 7 Able to apply hare traction. 8 Able to use a Kendrick extrication device. 9 Able to manage external bleeding.

10 Able to administer Entonox. 11 Able to manage anaphylactic shock. 12 Able to manage acute chest pain – chest pain protocol. 13 Able to manage the initial management of burns – burn protocol. 14 Able to activate a disaster response. 15 Able to complete the pharmaceutical, drug familiarization program.

Yes Scores 7.1 Points No Scores 0 Total Score

Note: Passing Score is 95%

Result: Pass Fail

Remarks: Action Plan:

Action in the event of failure is to enroll the employee into the appropriate competency development program and conduct a second competency assessment exactly one month from the initial assessment.

Employee’s Signature: ________________________________________ Date: ____________________

Supervisor’s Name: ___________________________________________ I.D. No.: __________________

Supervisor’s Signature: ________________________________________ Date: ____________________

Competency Assessment and Development ATTACHMENT – 20

Page 3 of 4 134

134

Ambulance Driver Competency Assessment

Competency Assessment

Employee’s Name: ______________________ Position: ________________ I.D. No.: ___________

NO.: Item to Assess - Driver shows competency by demonstrating the following: YES NO

1 Able to administer basic life support (BLS). 2 Able to administer first aid (FA). 3 Able to operate ambulance communication device(s). 4 Able to operate ambulance siren and flashing lights. 5 Able to perform basic operation of the following ambulance equipment: 5-1 Oxygen. 5-2 Suction machine. 5-3 Collapsible/other stretchers. 5-4 Kendrick extrication device (KED). 5-5 Hare traction. 6 Able to apply standard precautions. 7 Able to apply patient and scene safety. 8 Ambulance maintenance: 8-1 Able to properly clean the ambulance, interior and exterior. 8-2 Able to perform daily vehicle condition checks. 8-3 Able to conduct ambulance preventive maintenance. 9 Able to verbalize his role and responsibilities in the event of emergency/disaster response.

10 Safety: Management: 10-1 Able to apply general road safety/speed limits. 10-2 Able to appropriately use safety triangle.

Yes Scores 10 Points No Scores 0 Total Score

Note: Passing Score is 90%

Result: Pass Fail

Remarks:

Action Plan:

Action in the event of failure is to enroll the employee into the appropriate competency development program and conduct a second competency assessment exactly one month from the initial assessment.

Employee’s Signature: ________________________________________ Date: ____________________

Supervisor’s Name: ___________________________________________ I.D. No.: __________________

Supervisor’s Signature: ________________________________________ Date: ____________________

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Employee Orientation Orientation is a comprehensive process that introduces new hires to the organization and to their roles and responsibilities within the facility.

Types of Orientation 1. General Orientation 2. Unit/Area-Specific Orientation

General Orientation – Benefits: 1. Helps new hires adapt and perform well in their jobs by providing them with a general orientation to

their organization/facility and his/her role in it.

2. Welcomes new hires to facility and promotes a positive attitude at the start of their employment.

3. Helps new hires develop pride in the facility, by explaining the goals, responsibilities, mission and vision in providing excellent patient care.

4. Familiarizes new employees with the facility’s structure and lines and forms of communication within the system. Effective two-way communication is stressed so that participants will know where to go with questions, concerns and suggestions.

5. Provides new hires with information they should know from the start of their employment.

Core Elements of General Orientation include but are not limited to:

1. Infection Control.

2. Environment of Care Program (security, fire, Hazmat, disaster, etc.).

3. Confidentiality/privacy of health/patient information.

4. Patients’ Rights and Responsibilities.

5. Organization’s Mission and Vision, operation, organizational chart and chain of command.

6. Reporting occurrences/incident.

7. Official forms of communication (policies and procedures, operating manuals, etc.).

8. Prevention of injuries in the work place.

9. Familiarization of new employees with general work rules and contract agreement as applicable.

When Should New Hires Receive General Orientation? New hires shall be provided with general orientation during their first month of employment.

Unit/Area-Specific Orientation An “on-site” specific orientation designed to introduce the new nurses to their new work environment, area of medical response, local policies and procedures and the day-to-day specific activities of the facility they are assigned to.

Unit/Area-Specific – Benefits: 1. Introduces new employees to all aspects of the work.

2. Provides job-specific orientation to the individual’s specific job description, provided in his/her assigned area.

3. Helps new employees become acquainted with the correct way to perform their job and help him/her know what to expect and what is expected of him/her in their new job.

4. Acquaints new employees with individuals and resources available to help them perform their jobs more effectively.

Employee Orientation


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Core Elements of Unit/Area Specific Orientation include but are not limited to:

1. Job responsibilities and work practices.

2. Facility’s policies and procedures.

3. Necessary requirements to maintain professional status.

4. Work schedule and work distribution.

5. Environment of Care Program:

a. Disaster Plan.

b. Fire safety and fire plan.

c. Equipment handling safety.

d. Material Safety Data Sheets (MSDS).

e. Preventive maintenance.

f. Occurrence reporting.

6. Quality Improvement Activities:

a. QI/QA/QC programs.

b. Annual Competency requirements.

c. Performance appraisals.

7. General infection control practices:

a. Cleaning.

b. Waste management.

c. Personal protective equipment (PPE).

d. Standard precautions.

e. Hand washing. Employee Orientation


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Ambulance Driver Specific Orientation

All items listed below shall be completed within two (2) weeks of site assignment, except for items marked with an asterisk (*), which must be successfully completed prior to site assignment.

The company will implement and administer an ambulance driver orientation and competency program to include the following:

Item Minimum Requirements Date Completed Remarks

1. Facility orientation.

2. Work site orientation.

3. *First aid.

4. *Basic Life Support (BLS).

5.

Basic Ambulance operation:

a. Use of communication device.

b. Use of siren and flashing lights.

6.

Ambulance equipment familiarization and basic operation:

a. Oxygen.

b. Suction machine.

c. Collapsible/other stretchers.

d. Kendrick extrication device (KED).

e. Hare traction.

f. Other.

7. Standard precautions.

8. Patient and scene safety.

9.

Ambulance maintenance:

a. Cleaning.

b. Daily vehicle condition checks.

c. Preventing maintenance schedule.

10. Emergency/disaster response, role and responsibilities.

11.

Safety:

a. General road safety/speed limits.

b. Use of safety triangle.

12. Other.

Employee Orientation - Ambulance Driver


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Continuing Education and Training

Education and training provide employees with the knowledge and skills necessary to provide a high standard of patient care.

Types of Education and Training Programs

1. Ongoing Education and Training

2. Continuing Education (CE)

Ongoing Education and Training Ongoing orientation and training is a continuing periodic program, which provides educational and training activities necessary to meet the mandatory health and safety requirements, such as for fire safety and infection control. These training activities must be organized jointly with infection control and fire safety subject matter experts (SMEs) and/or other services as applicable. The following educational activities are required as specified:

1. Infection control and fire safety, annually.

2. Resuscitation techniques, Basic Life Support and first aid, every two years.

3. Environment of Care Program (security, Hazmat (Hazardous materials/waste), disaster, etc.), annually.

4. When applicable, staff shall be trained to ensure proper, efficient and safe use of equipment/tools.

Note: All educational activities shall be documented in the employee’s personnel record as applicable.

Continuing Education (CE) Continuing education refers to the provision of special education necessary to either obtain credits required to maintain a license, or as means to acquire additional certification(s). Continuous learning and education is required to stay abreast of new developments in the relevant field, enhance personal knowledge and skills, and to serve patients most effectively.

Purpose The CE program is intended to maintain and improve the knowledge and skills of certified healthcare providers (i.e., nurses, doctors), therefore enhancing the quality of service provided to patients. Therefore, it is necessary that every proponent organization establish a CE service design to provide administrative oversight and program coordination for continuing education.

Benefits of Establishing a Continuing Education Program

1. Promote professional development.

2. Enhance clinical skills and practice behaviors required for excellence in patient care.

3. Enrich knowledge.

4. Support the medical and nursing profession.

Channels Which Provide CE include: 1. In-Services Program: Designed to provide classes on general requirements.

2. Conferences and Symposiums are planned, publicized gatherings that provide professional staff with the opportunity to share information and to network.

3. Web-based programs.

4. Education brings this learning into the work area to facilitate learning at the staff’s own pace, at their own time and at their own convenience. With a wide range of courses, tests and exams offered online, staff can develop their skills and gain certifications quickly and easily. Visit the following Web sites for more information:

www.worldwidelearn.com/continuing-education/nursing-ce.htm

www.worldwidelearn.com/continuing-education/physicians-cme.htm Continuing Education (CE)


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First Aid Kit

First Aid Kit (36 unit size) shall be available with the following supplies.

SAP Material

No.:

Description Remarks

1000132516 Bandage: Compress, 5 cm.

1000132519 Bandage: Compress, 10 cm.

1000132543 Bandage: Gauze.

1000132547 Bandage: Plastic, adhesive.

1000132600 Bandage: Triangular.

1000132605 Cold pack.

1000132609 Compress: Gauze.

1000132612 Forceps and scissors.

1000132615 Iodine: PVP ampule.

1000132618 Green soap swab.

1000132641 Tourniquet.

1000132169 First aid booklet, Arabic.

1000132180 First aid booklet, English.

Safety Devices

At a minimum, the following safety devices shall be available:

SAP Material

No:

Description Remarks

1000128476 Rescue type stretcher.

1000128490 Splint stretcher.

1000124087 Fire blanket.

First Aid Kit


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First Aid Kit

SAP Material No: Description

1000128476 Rescue Type Stretcher

Rescue Type Stretcher

Folding; synthetic with nonferrous alloy supports; foam filled pad; capable of carrying patient in any position; 1,829 millimeter (72 inch) long and 245 millimeter (10 inch) wide.

Issue Restriction: None

Old Stock Number: 21-372-837

1000128490 Splint Stretcher

Splint Stretcher

Basket type litter; wire netting reinforced with iron braces; 4 straps; to carry patient in any position without danger; stokes pattern; 2.1 meter (6.75 feet) long; 610 millimeter (24 inch) width; 216 millimeter (8.5 inch) height.



1000124087 Fire Blanket

Fire Blanket

Fire Blanket: 1,574.8 millimeter (62 inch) width by 2,082.8 millimeter (82 inch) long; flame proofed wool, pleated and grommeted, with steel case, window in case and a fireproofed loop rope. Not suitable for use as a welding fire blanket. This roller mounted blanket is intended to protect the body from extreme heat while exiting a fire area. This blanket can also be used for self-extinguishment of clothing fires.



1000124087 First Aid Kit (10 unit size)

First Aid Kit (10 unit size)

First Aid Kit (10 unit size); white finish; includes the following components listed in the Aramco Material Stock (AMS) Catalog; complete in steel carrying case approximately 22 centimeter by 15 centimeter by 8.3 centimeter. Per ANSI Z308.1-1978. PKS description SAMS 1 bandage: compress, 5 cm S/N 21-586-505 one (1) bandage: compress, 10 cm S/N 21-586-507 three (3) bandage: Plastic adhesive S/N 21-586-511 two (2) bandage: Triangular S/N 21-586-513 one (1) compress: Gauze S/N 21-586-519 one (1) iodine: PVP ampules S/N 21-586-529 one (1) Soap S/N 21-586-533.



1000124087 First Aid Kit (36 unit size)

First Aid Kit (36 unit size)

First Aid Kit (36 unit size); white finish; includes the following components listed in the Aramco Material Stock (AMS) Catalog; complete in steel carrying case approximately 36 centimeter by 27 centimeter by 8.3 centimeter. Per ANSI Z308.1-1978. PKS description SAMS 3 bandage: compress, 5 cm 21-586-505 five (5) bandage: compress, 10 cm 21-586-507 three (3) bandage: Gauze 21-586-509 six (6) bandage: Plastic, adhesive 21-586-511 three (3) bandage: Triangular 21-586-513 four (4) cold pack 21-586-513 three (3) compress: Gauze 21-586-519 one (1) forceps and scissors 21-586-523 three (3) iodine: PVP ampules 21-586-529 one (1) Tourniquet 21-586-560.



First Aid Kit

ATTACHMENT –23 Page 2 of 4

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First Aid Kit


1000132516 Bandage: Compress, 5 cm

Bandage: Compress, 5 cm

Bandage: compress; per ANSI Z308.1-1978; 5 cm square non-adherent; packaged; in 1 unit size package; 4 per package.



1000132519 Bandage: Compress, 10 cm

Bandage: Compress, 10 cm

Bandage: compress; per ANSI Z308.1-1978; 10 cm square non-adherent; packaged; in 1 unit size package; 1 per package.



1000132543 Bandage: Gauze

Bandage: Gauze

Bandage: gauze roller; per ANSI Z308.1-1978; 5 cm x 550 cm; packaged in 1 unit size package; 2 per package.



1000132547 Bandage: Plastic, Adhesive

Bandage: Plastic, Adhesive

Bandage: plastic adhesive; per ANSI Z308.1-1978; 2.5 cm x 7.5 cm; packaged in 1 unit size package; 16 per package.



1000132600 Bandage: Triangular

Bandage: Triangular

Bandage: triangular; sterile; per ANSI Z308.1-1978; 100 cm x 100 cm x 140 cm; packaged in 1 unit size package; 1 per package.



1000132605 Cold Pack

Cold Pack

Cold Pack: in plastic pouch with chemicals in two sections that provide a cold chemical reaction when squeezed; packaged in 1 unit size package; 1 per package per ANSI Z308.1-1978; 1 per package.



1000132609 Compress: Gauze

Compress: Gauze

Compress: gauze per ANSI Z308.1-1978; 60 cm x 180 cm; packaged in 1 unit size package; 1 per package.


Old Stock Number: 21-586-519 First Aid Kit


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First Aid Kit


1000132612 Forceps and Scissors

Forceps and Scissors

Forceps and scissors: steel, sharp, pointed forceps; blunt nosed; steel scissors for cutting gauze; packaged in 1 unit size package; 1 per package per ANSI Z308.1-1978; 1 each per package.



1000132615 Iodine: PVP Ampules

Iodine: PVP Ampules

Iodine: PVP (Polyvinyl Povidone); crushable ampules filled with 0.5 cc PVP Iodine with cotton-tipped applicator at one end; packaged in 1 unit size package per ANSI Z308.1-1978; 10 per package.



1000132618 Green Soap Swabs

Green Soap Swabs

Swabs: Green Soap crushable; 0.5 ml; width 2 x 51 mm (2 inch) gauze pad.



1000132641 Tourniquet

Tourniquet

Tourniquet: per ANSI Z308.1-1978; supplied with a separate card to note the time tourniquet was applied and the location of tourniquet; packaged in 1 unit size package; 1 per package.



1000132600 First Aid Booklet (Arabic)

First Aid Booklet (Arabic)

Subjects: bleeding, bandaging, splinting, resuscitation, heat stroke, heat exhaustion and poisoning: Author - Asmund S. Laerdal, Stavanger.



1000132169 First Aid Booklet (English)

First Aid Booklet (English)

Subjects: bleeding, bandaging, splinting, resuscitation, heat stroke, heat exhaustion and poisoning: Author - Asmund S. Laerdal, Stavanger.



First Aid Kit


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First Aid Cabinet and Contents Specification: 1. Must be no less than 85 cm long x 45 cm width x 30 cm diameter. 2. Must be made of hard wood or metal and be provided with a lock and the Red Crescent insignia and the

words “First Aid Cabinet.” 3. Must be ready for use and accessible at all times. 4. Must be restocked up after each use.

Number List of Contents Unit Quantity

1 Oral Airways, medium and large. Each 2 of Each

2 Non-sterile exam gloves. 100 Box 1 Box

3 Sterile gloves, sizes: 7.5 and 8. Pair 2 of Each

4 Band aids. 100 Box 2 Box

5 Alcohol swabs. 100 Box 100 Box

6 Iodine swabs. 100 Box 1 Box

7 Bacitracin ointment. Tube 1 Tube

8 2” x 2” (5 cm x 5 cm) sterile gauze. 12 Packet Box 1 Box

9 4” x 4” (10 cm x 10 cm) sterile gauze. 12 Packet Box 1 Box

10 Roller gauze, sizes: 2, 3 and 4 inch. Roll 3 Rolls of Each

11 Adhesive tape roll, 1 inch. Roll 2 Rolls

12 Eye Pad. 6 Box 1 Box

13 Ace Bandage, sizes: 2, 3, 4 and 6 inch. Each 4 of Each

14 Triangular bandage. Each Six (6)

15 Safety pins. Each Twelve (12)

16 Bandage scissors. Each One (1)

17 Burn sheet. Each Four (4)

18 Abdominal dressing pad, 5 inch x 9 inch. 6 Box 1 Box

19 Multi-trauma dressing pad. Each Four (4)

20 Cold pack. Each 2 Packet

21 Ammonia inhalant. 6 Box 1 Box

22 Padded arm board. Each Four (4)

First Aid Cabinet and Contents


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Policies and Procedures

Policies and procedures are facility specific instructions and guidelines regarding the day-to-day activities/operation of the medical facility.

General Guidelines 1. Each organization is responsible for developing specific policies and procedures for its medical facility.

These policies must be updated and revised every three (3) years. Revisions are approved by an authorized medical representative, and dated to identify the review date.

2. Policies and procedures shall be available to all concern staff. These policies include but are not limited to:

General Guidelines

Required Policies and Procedures

1.

Organization: 1-1 Organization Chart. 1-2 Roles and Responsibilities. 1-3 Mission and Vision.

2.

Administrative: 2-1 Job descriptions. 2-2 Manpower Requirements. 2-3 Staff Qualifications. 2-4 Staff Recruitment Process. 2-5 Licensing.

3.

Staff Education Program: 3-1 New Hire Orientation. 3-2 Staff Competency. Safety and Loss Prevention: 2-1 Fire Safety. 2-2 HAZCOM. 2-3 Disaster Response Plan.

4. Infection Control and Environmental Health. 5. Quality Improvement Program.

6.

Operation: 6-1 Scope of Service. 6-2 Patient Eligibility of Care. 6-3 Patient Registration and Health Insurance. 6-4 Consultation. 6-5 Referral and Transfer.

7. Medical Records Patient, Documentation and Confidentiality of Information. 8. Patient Care/Nursing Practice. 9. Treatment Protocol. 10. Equipment Management and Supplies. 11. Drugs: prescription, ordering, storage, administration, dispensing, shipping and receiving of drugs. 12. Communication. 13. Transportation: Patient’s transfer and Medivac Procedures. 14. Laboratory specimens: handling, storage and transportation. Note: Should you require a sample of any of the above policies, please contact the Remote Area Urgent Care Facilities Group Leader. He can be contacted at 03-877-3459 or 03-877-3338. Policies and Procedures


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Floor Plan Specifications for Category “C” Facility Multiple rooms and integrated staff accommodation. With central or split-level filtered air conditioning unit (A/C), covered ambulance parking and ramp for stretcher. Floor Plan Specifications for Category “C” Facility


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Floor Plan Specifications for Rig Medical Facility Floor Plan Specifications for Rig Medical Facility


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Section 6 – References

1. Saudi Labor and Workmen Law, Chapter 7.

2. Saudi Aramco Safety Manual, Section 28.

3. Saudi Aramco GI 1321.015 and GI.150.002.

4. Saudi Aramco Medical Services Organization/Healthcare Development Organization, Infection Control Manual.

5. Saudi Aramco Medical Services Organization’s Medical Services Policies (MSPs) and Operating Manuals (OMs).

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Section 7 – Appreciation Our thanks and appreciation to the following subject matter experts (SMEs) for their valuable contribution to this manual:

Ali Hammoud, QI Advisor, Remote Area Clinics Group/Medical Consulting and Quality Assurance Division (MC&QAD)/Medical Designated Facilities Department (MDFD)/Healthcare Development Organization (HDO)/Saudi Aramco Medical Services Organization (SAMSO).

Curtis Roberts, QI Advisor, Remote Area Clinics Group/MC&QAD/ MDFD/ HDO/ SAMSO.

Eduarte B. Cocos, QI Advisor, Remote Area Clinics Group/MC&QAD/ MDFD/ HDO/ SAMSO.

George Williamson, QI Advisor, Remote Area Clinics Group/MC&QAD/ MDFD/ HDO/ SAMSO.

Hamed J. Said, Group Leader, Remote Area Clinics Group/MC&QAD/ MDFD/ HDO/ SAMSO.

Janet R. Acevedo, Health Educator, Medical Professional and Technical Support/MC&QAD/ MDFD/ HDO/ SAMSO, for collating this manual.

Dr. Hatem K. Herzallah, Unit Head, Medical Professional and Technical Support/MC&QAD/ MDFD/ HDO/ SAMSO, for allocating the time for the collation of this manual.

Russel Isaiah, QI Advisor, Remote Area Clinics Group/ Remote Area Clinics Group/MC&QAD/ MDFD/ HDO/ SAMSO.

Ramesh Swaminathan, Administrative Assistant, Remote Area Clinics Group/MC&QAD/ MDFD/ HDO/ SAMSO, for all the time and effort and for the countless hours spent typing the initial layout of this manual.

Terry Nihil, QI Advisor, Remote Area Clinics Group/MC&QAD/ MDFD/ HDO/ SAMSO.

William McDowall, many thanks for all the help in putting together the first draft of this manual and widely admired for his vast and unrivalled knowledge and experience in this field, for his valuable input and diligent proofreading.

And our special thanks and appreciation to our distinguished Management (Dr. T.Q. Al-Daiel, Dr. Saad A. Missmar and Dr. Moh’d Fawzy Younis), without whom this manual would not have been possible. Sincerely,

_______________________________________ Jacques D. Cheong, Quality Assurance Coordinator Remote Area Urgent Care Facilities Group

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remote area urgent care facilities

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