appendixto:aframeworkforremoteandisolatedhealthprofessionalpractice|revisedAugust2018 1

remoteandisolatedmininghealthservicesappendixto:aframeworkforremoteandisolatedprofessionalpractice

version2|revisedAugust2018

improvingremote health

2 CRANAplusremoteandisolatedmininghealthservices

RemoteandIsolatedMiningHealthServiceRevisedAugust2018

Appendixto:AFrameworkforRemoteandIsolatedProfessionalPracticeReviewedAugust2018

Authors:GeriMalone,JudyWhiteheadandChrisBelshaw

appendixto:aframeworkforremoteandisolatedhealthprofessionalpractice|revisedAugust2018 3

Contents

Introduction 4

Contextofremoteandisolatedminingsector 4

Aframeworkforremoteandisolatedmininghealthservices 6

Theprofessionalrole 6

Thehealthfacility 9

Relevantlinks 10

References 10

4 CRANAplusremoteandisolatedmininghealthservices

introduction

The‘AFrameworkforRemoteandIsolatedPractice’1describestheremotehealthworkforcebeinglocatedindiverselocationsandhealthsettings.TheminingindustryinAustraliahasbeenactiveintheremotesectoroveralongperiodoftime.IncreasingdemandsandcomplexitieshaverequiredtheMiningIndustrytoprovideabetterlevelofhealthservicetotheiremployeeswhilst,atwork,inremotelocations.

MiningcommunitiesacrossremoteAustraliaarediverseinnatureresultinginthehealthservicesevolvingwithgreatvariation.Therearesomewell-establishedhealthservicesinoperationformanyyears,forexample,MoombaOperationunderSANTOSintheCooperBasin.

Thisdocumentwillprovideaframeworkfortheestablishmentofhealthservicesinconsiderationoftheprofessionalneedsofhealthemployeesandbestpracticestandardsfortheminingcompany.

Forthepurposeofthisdocument,the‘miningcommunity’contextisreferredto,asbeingremotelylocated,non-permanentminingsites,withaFly-In,FlyOut(FIFO)orDriveIn,DriveOut(DIDO)workforce.Itisimportanttonoteremoteandisolatedconjuresgeographicalremoteness.However,healthprofessionalsworkingintheminingindustrymaybeisolatedintheirprofessionalpractice,astheindustryfocusismining,nothealth.

contextofremoteandisolatedminingsector

TheWorkforce

Theworkforceremainspredominantlymale,withtheassociatedco-morbidities,isolatedfromfamily,networks,andsocialsupports.Inspiteofthis,thereareanincreasingnumberofwomenintheminingworkforce,influencingthetypeofhealthservicesoffered,thuschangingthe‘traditional’typesofservicefromamalefocustobeinclusiveofbothgenders.

Theworkforceprofilehaschangedovertheyearsfrombeingyoung,activewhenjobswerephysical,tobeingolder,moresedentaryroles,withasignificantchangeintheexpectationsoftheworkforcebytheemployers.

LegislativechangessuchasenforcedDrugandAlcoholTestingProgram(DAMP)andconditionsofworkandrequirementsrelatedtoworkhealthandsafetyhaveimpactedandinfluencedtheemploymentexpectationswithintheminingindustry.

Theworkforceremainslocationdependent,andwhilstitisstillpredominantlymale,variancesdoexist,rangingfromyoungsingles,toyoungtomiddleagedwithpartnersandfamilieslocatedelsewhere.

ItisrecognisedtheMiningindustryworkforceismulti-cultural,andgenerallytheworkershaveahigh-incomestatus,withassociatedhighdisposableincome,whichimpactsonspendingpatternsandlifestyles,whilstonleave(rest).

appendixto:aframeworkforremoteandisolatedhealthprofessionalpractice|revisedAugust2018 5

Locations

Miningsitescanbelocated‘off-shore’or‘on-shore’sharingsomeofthesimilaritiesinregardtogeographicalisolation.Somearegeographicallyisolated;othersmaybelocatedclosertoregionalorruraltownships.

Theestablishingminingcompanydeterminestherangeoffacilitiesandservicesavailableinisolatedcommunities.Thesevariationsinfacilitiesrangefromsemi-permanent‘demountable’tomobile‘set-ups’withvariancesexistinginaccommodationstandards,andothercampfacilitiessuchassporting/recreation,cateringandtheavailabilityofalcoholonsite.Iftheminingsiteislocatedintheregionalorruralareasclosertotownships,otherservicesmaybemorereadilyaccessible.TheworkforceisFly-In,FlyOut(FIFO)orDriveIn,DriveOut(DIDO)andthelengthoftimeonsite,isvariable.

HealthServices

HealthServicesvarybroadly,basedontheroleofthecompany,thesizeofthesite,legislationandcontractualarrangementsalongwiththeminingcompany’sethos.

Thehealthservicesrangefromfirstaidservicestoamorecomprehensivehealthservicethatprovidesforgeneralhealthconsultations,alongwithemergencycare,workplaceaccidentmanagement,andworkplacehealthandsafetyservices,suchas,audiometry.

Staffingvariesfromsafetyofficers,firstaiders,advancedfirstaiders,toParamedics,Nurses,Doctors,whichisdependentonthelevelofservicerequired.Thehealthfacilityvariesfrom:acaravan;ademountable;afirstaidroom;toadesignatedhealthcenter(stand-alonefacility).

Criticallookatthechallengesforhealthprofessionals

Healthprofessionalsemployedinanon-healthindustryi.e.Miningareisolatedintheirpractice,astherearenoacknowledgedbenchmarksfortheestablishmentofhealthfacilitiesandservices.Thislimitationimpactsuponhealthcarestandardsandservicedelivery.

Healthprofessionals‘employed’toworkinfacilitiesoftenhavenohealthgovernancepolicytoassistinguidingandshapingtheirday-to-daypractice.Theminingindustrypersonnelmayhavelimitedlevelofunderstandingoftherequirementsforprofessionalpracticeofhealthprofessionals,employinghealthstafftofulfilla‘legislative’requirement.

Traditionallytheroleofhealthserviceprofessionalswastorespondtoworkplace‘accidents’andoccupationalhealthandsafetyrequirements.However,thereareacknowledgedbenefitsofprovidingacomprehensiveprimaryhealthcareservice,totheemployees,whilsttheyareawayfromhomebase.

Theprovisionofprimaryhealthcareservicehasbenefitsforboththeworkforce,andthecompany.Fortheworkforce,itprovidesamorecomprehensivelevelofcareonsite.Forthecompany,itreducestheimpactontherequirementforemployeestoleavethefieldfor(non-workrelated)healthconditions,astheycanbemanagedsafelyandcompetently,byhavingtheappropriatelevelofhealthstaff.

Acriticalchallengeforhealthprofessionalsinestablishingamininghealthserviceistopreventitfallingshortofthehealthcarestandardsthatare‘acceptable’tothehealthprofessional’sroleandresponsibilities.Failuretodothismayresultinconflictsbetweenthehealthprofessionalandtheemployeroversuchissuesascomprisingprofessionalconfidentialityandworkingoutsideoftheirscopeofpractice.Thisplacesthehealthprofessionalatprofessionalrisk.

6 CRANAplusremoteandisolatedmininghealthservices

aframeworkforremoteandisolatedmininghealthservices

TheremoteandisolatedmininghealthservicesframeworkalignswiththeAFrameworkforRemoteandIsolatedProfessionalPractice(RevisedAug2014)2withtheaimtoprovideguidanceintheinitiation,developmentandtheon-goingserviceprovisionofaremotemininghealthservice.

There are three key components of this framework:

● TheProfessionalRole

● TheHealthFacilityGuide

● RelevantLegislative

CRANAplus’‘AClinicalGovernanceGuideforremoteandisolatedhealthservicesinAustralia’3providesguidanceforestablishinganurse–ledhealthservicesasitisbasedontheNationalSafetyandQualityHealthServiceStandard#1:GovernanceforSafetyandQualityinHealthServiceOrganisations.

theprofessionalrole

Itiswellrecognisedthatremotehealthprofessionalsareguidedby‘health‘asbeingawhole-of-lifeconcept,encompassingphysical,spiritualandemotionalwell-beingofindividuals,family,communityandtheenvironment.

Remotehealthprofessionalsworkwithintheirscopeofpractice,arespecialistpractitionerswhoprovideand/orcoordinateadiverserangeofhealthcareservicesforadiversityofpopulationgroups4.

ScopeofPractice

CRANAplus supports the following definition of Scope of Practice:

Aprofession’sscopeofpracticeisthefullspectrumofroles,functions,responsibilities,activitiesanddecision-makingcapacitywhichindividualswithintheprofessionareeducated,competentandauthorisedtoperform.

Thescopeofprofessionalpracticeissetbylegislation–professionalstandardssuchascompetencystandards,codesofethics,conductandpracticeandpublicneed,demandandexpectation.Itmaythereforebebroaderthanthatofanyindividualwithintheprofession.

appendixto:aframeworkforremoteandisolatedhealthprofessionalpractice|revisedAugust2018 7

The actual scope of an individual’s practice is influenced by the:

● contextinwhichtheypractice

● consumers’healthneeds

● levelofcompetence

● education,qualificationsandexperienceoftheindividualserviceprovider’spolicy,qualityandriskmanagementframework

● organisationalculture5

CollaborativePractice

Whilsthealthprofessionalspractisinginaremotesettingmayfeelisolatedassolehealthprofessionals;collaborativepracticeisanessentialrequirement.Thismaytakemanyformswitharangeofotherindividualprofessionalsandorganisations.Inessence,nohealthprofessionalshouldworkinisolation.TheadvancesinTelehealthhavegreatlyassistedwiththecollaborationbetweenmultidisciplinaryteammembers.

Types of collaborative practices:

● Miningcompanyassignedmedicalpractitioner,healthserviceproviders;e.g.RoyalFlyingDoctorService(RFDS)orequivalent,workplacehealthspecialists

● Professionalnetworksaroundspecificareaofpracticei.e.CardiacNetworks,Dermatology.

● Miningstaff:SafetyOfficers,FirstAiders,SiteManagers,HumanResourcepersonnel,RehabilitationOfficersandCorporateOfficers.

PreparationforPractice–Education,QualificationsandExperience

The‘AFrameworkforRemoteandIsolatedProfessionalPractice’documentprovidesinformationaboutcareerpathways,coursesandexperiencesrequiredtoworkinremoteandisolatedcommunities.Inaddition,asanemployeeintheminingsectortheremaybevariouspathwaystogainingtherequirededucationandtrainingtoequiptherole,througheitherpost-graduateeducationand/orcontinuingprofessionaldevelopmentactivities.

These include:

● SpecificWorkplaceandHealthandSafetycourses

● Audiometry

● DrugandAlcoholtestingcourse

● Safetyauditcourses

● Disastermanagement

8 CRANAplusremoteandisolatedmininghealthservices

As a Health Professional, you need to consider the following questions, but limited not to, in preparation of your role:

● Whataretheconditionsofemployment?

● Whatistheemployers’expectationsofyourrole?

● Howwellistheroleandresponsibilitiesdescribed?

● Whataretheprofessionalandorganisationalreportingprocesses?

● Arethereclinicalgovernancestructuresandprocessesinplaceifso,aretheyclear?

● WhatGuidelinesareinplace?e.g.CARPAandPrimaryClinicalCareManual(PCCM)

● Isthereajobdescriptionavailable?

● Doyouhaveaclearunderstandingofyourprofessionalscopeofpractice?

ForfurtherinformationvisittheCRANAplus’website,‘PathwaytoRemotePractice’whichunpacksthepreparatorystageintofoursimplesteps:https://crana.org.au/uploads/pdfs/CRANAplus_RemotePractice_V1_1_webrescmp_Jan15-1_1.pdf

Your Role may contain some of the following elements:

● Emergencycare

• OccupationalandGeneralCare

● PrimaryHealthCareacrossthelifespan

• Chronicdisease,mentalhealth,men’sandwomen’shealth

● WorkplaceHealthandSafety

• DrugandAlcoholscreening

• Audiometryscreening(NoiseStandards)

• ConfinedSpaces

• Workingatheights

• Roperescue

• Undergroundmining

• Breathingapparatus

• Returntoworkrequirements

appendixto:aframeworkforremoteandisolatedhealthprofessionalpractice|revisedAugust2018 9

ContinuousProfessionalDevelopment

Itiswellrecognisedthattomaintaincompetenceintheworkplacehealthprofessionalsneedtoembracea‘lifelonglearning’approachtoenhancetheirknowledge,skills,attitudesandbehaviourstomeettheirobligationstoprovideethical,safe,andcompetentcare.Theongoingandmaintenanceorexpertisewillbeshapedbytheirscopeofpractice.

The knowledge and expertise expected will require depth and breadth of experience and may include areas such as:

● Emergencycare

● MentalHealth

● PrimaryHealthCare

● ChronicDisease

● WorkplaceHealthandSafetycourse/topics

thehealthfacility

Thefacilitywillvaryandisdependentupontheservicesrequired.InthecontextofthisdocumentdescribesafacilitybasedonaRegisteredNurselevelofpractice,deliveringaprimaryhealthcarealongwithemergencyandworkplacehealthandsafetyservices.

The standard requirements:

● Building–facility-basedontheNationalFirstAidintheWorkplace–CodeofPractice(2018)6

● Additionalconsiderationswillvaryaccordingto‘on-site’servicessuchas:

• Consultingrooms,forvisitingdoctor,alliedhealthprofessionalsorothers

• Drugstorage

• Equipment

● Resourcese.g.Ambulancevehicle(refertoAppendixlistasperRemoteHealthAtlas)

● Drugs/Licenses:jurisdictionalbased,requiresconsultationandplanning

● Supportingresources/personnel

10 CRANAplusremoteandisolatedmininghealthservices

relevantlinks

National Registration with links to the National Boards https://www.ahpra.gov.au/

National Law with links to each State and Territory National law https://www.ahpra.gov.au/About-AHPRA/What-We-Do/Legislation.aspx

State and Territory legislations DrugsandPoisonsorControlledSubstancesActsandotherLegislationsimpactingonpractice,areunderthejurisdictionofeachStateandTerritory.Thesedocumentsarefrequentlyupdated,youwillneedtosearchundertherelevantStateorTerritoryparliamentaryand/orDepartmentofHealthwebsites.

SafeWork Australia with links to each State & Territory https://www.safeworkaustralia.gov.au/

Australian Commission on Safety and Quality in Health Care http://nationalstandards.safetyandquality.gov.au/

Fact sheets on NSQHS Standards http://nationalstandards.safetyandquality.gov.au/resources

NOPSEMA – National Offshore Petroleum Safety and Environmental Management Authority https://www.nopsema.gov.au/

references

1. MaloneG,CliffeC:AFrameworkforRemotePractice:CRANAplusJune2012.

2. CRANAplus:AFrameworkforRemoteanIsolatedProfessionalPractice:RevisedAugust2018.https://crana.org.au/resources/practice/remote-practice/

3. CRANAplus:AClinicalGuydeforRemoteandIsolatedHealthServicesinAustralia;September2013.https://crana.org.au/resources/practice/standards/

4. CRANAplus:AFrameworkforRemoteanIsolatedProfessionalPractice:RevisedAugust2018:p6.

5. NursingandMidwiferyBoardofAustralia:National Framework for the development of decision-making tools for nursing and midwifery practice,September2007–rebranded.http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Frameworks.aspx

6. SafeWorkAustralia:FirstAidintheWorkplace–CodeofPractice:May2018.http://www.safeworkaustralia.gov.au/system/files/documents/1805/code_of_practice_-_first_aid_in_the_workplace_0.pdf

12 CRANAplusremoteandisolatedmininghealthservices

Cairns office

Street address: Lot 2, Wallamurra Towers, 189–191 Abbott Street, Cairns, QLD 4870

Mailing address: PO Box 7410, Cairns, QLD 4870

Phone: (07) 4047 6400 Fax: (07) 4041 2661

Alice Springs office

Street address: c/- Centre for Remote Health, cnr Simpson and Skinner Streets, Alice Springs, NT 0870

Mailing address: PMB 203, Alice Springs, NT 0871

Phone: (08) 8955 5675

Adelaide office

Mailing address: PO Box 127, Prospect, SA 5082

Phone: (08) 8408 8200 Fax: (08) 8408 8222