LEIGHTON Iraq Crude Oil Export Expansion Project Phase -1 Project No. $397 Health Management Plan Document Ref.No.: $397-HSE-PLN-C1005 Copyright This documents the property of Leighton Intemational Limited an al rights are reserved in respect of t, This document may not be reproduced or discloved in any manner whatsoever in whale or ix part, without the prior writen ‘consent of Leighton ntemational Leighton International expressly disclaims any responsibil for or lability arising from the use ofthis document by any third party. Copies printed from KEYSTONE are UNCONTROLLED. Revision Status a Date Revision Description Prepared | Reviewed | Approved a | 2052011 For Approval VK SS ‘South Oi! Company ‘CONTRACT No. a) PO. No REG. REQ ITEM No, TAG No, ‘SUPP DOC Ne. ‘SUPPLIERREV ‘DOC TYPE CODEIDSN PRCREV, STATUS CODE PMCENGINEER | DEPT: | DATE ‘CORIMENT STATUS CODE 2- Comments 08 Noted: Minor Comments Acceptable; No CommentsIRAQ CRUDE OIL EXPORT EXPANSION PROJECT - PHASE 1 ONSHORE PIPELINE WORKS AND GENERAL SUPPORT SERVICES Health Management Plan Contractor Document Number: $397-HSE-PLN-C1005 Sa ieee a a le ta eee eels ‘Contract number: S397-COM-AGR-C1000 Srmoroyeny ese serene, mropvoaerecrdng ones a “UNAOILLTD. Registered Office: Skelton Builking Document number Page Main Street, P.O. Box3138, Road Town —_|§397-HSE-PLN-C1005 1 0f76 Tortola, British Virgin Islands —L IRGY 4 > RMSI -, ; MEDICAL SOLUTIONS RMSI HEALTH MANAGEMENT PLAN FOR GLOBAL ENERGY TECHNICAL RESOURCES, GL@BAL ENERGY a AL FAO, IRAQ 11 May 2011 - DRAFT -ERGY TABLE OF CONTENTS 1. BACKGROUND. 2. INTRODUCTION TO IRAQ. srr 24. 2.2. 2: 2s 25. 26. 27. COMPANIES OPERATING IN IRAQ. 3, RMSI CREDENTIALS & SUPPORT STRUCTURES. 3a. 3.2. 33. 34. 35. 3 4, RMSI SOLUTION 41. 42. 43. 44. 45. 46. CONTRACTED AGREEMENT) AND INTERNATIONAL AIR AMBULANCE EVACUATION, ANNEXURE A - BASIC SETUP WITH MONITORING CAPABILITIES. ANNEXURE B - RMSI CAPABILITY STATEMENT. GEOGRAPHY, POPULATION AND CLIMATE CURRENT COMMERCIAL SITUATION. SECURITY OVERVIEW... MEDICAL RISKS oeeaate OTHER MEDICAL OPERATING CHALLENGE: (MOST COMMON MEDICAL ISSUES FACED BY EMPLOYEES IN IRAQ. CHECKLIST OF MINIMUM RECOMMENDED MEDICAL SERVICES PROVISION FOR OVERVIEW. ‘COMPANY DETAILS RMSI - INTERNATIONAL SOS STRATEGIC ALLIANCI RMSI SUPPORT STRUCTURE FOR THE PROJECT .wsnsssssese QUALITY CONTROL. RMSI INSURANCES. (ON-SITE MEDICAL SUPPORT. REMOTE MEDICAL SUPPORT PROVIDED BY RMSI & INTERNATIONAL SOS MEDICAL EQUIPMENT, MEDICATION AND MEDICAL CONSUMABLES AMBULANCE oss.sesnseses RMSI HARDWARE, SOFTWARE, COMMUNICATIONS AND REPORTING. MEDICAL ASSISTANCE FOR SITE STAFF (PROJECT MEMBERSHIP VIA THE UNAOILBACKGROUND GETR has been awarded the contract for the mobilization and for the design, build, operations, catering and maintenance of a workers camp as part of Irag’s Crude Oil Export Programme in Fao, South East Iraq. ‘The project requires full medical support service for the personnel who will be engaged at the camp facility. The estimated Camp size is 400 personnel. ‘The Camp includes a dedicated facility to operate camp medical services. There are a number of different nationalities working on the project and accommodated in the ‘camp, including a large contingent of Iraqi workers. GETR have contracted RMSI to manage the medical service delivery allowing GETR to focus on its core business activity, leaving the medical service delivery in the hands of a professional medical services organization with hostile environment experience. 2. INTRODUCTION TO IRAQ. 2.1, GEOGRAPHY, POPULATION AND CLIMATE With an area of over 400,000 km2, Iraqis the S8th-largest country in the world. Bordered by Jordan to the west, Syria to the northwest, Turkey to the north, Iran to the east, and Kuwait and Saudi Arabia to the south, Iraq has narrow section of coastline measuring 58 km (35 miles) on the northern Arabian Gulf. The capital city, Baghdad, isin the center of the country. ‘The total population of Iraqis over 31 million (IMF, April 2008), with almost 75% living in the fat, alluvial plain stretching southeast from Baghdad to Basra and the Arabian Gulf. Over 90% of the population is Muslim, with Arabic the most commonly spoken language. Several other languages are also spoken within the courtry {including Kurdish, Armenian and Assyrian). English is the most. ‘common foreign language spoken, although it is not widespread throughout the national population ‘and language barriers should be anticipated. The majority of iraq has a hot and arid climate, with mild to cold winters and dry, hot, cloudless summers. Temperatures range from below 10 degrees Celsius in the winter, to above 40 degrees Celsius in the summer. Source: CIA world fact book hhttpsi//www.cia.gov/library/publications/the-world-factbook/geos/iz.html Iraq can be broadly divided into three main regions: ‘+ Northern iraq - primarily Kurdish Sunni majority, it includes the cities of Erbil and Kirkuk. © Central raq ~ primarily Sunni Arab majority. This area hosts the capital city of Baghdad, ‘which isthe country’s main commercial and diplomatic center. © Southern Iraq ~ primarily Shia Arab majority, it includes the city of Basra. This region is also home to a significant amount of Iraq's proven oil reserves, and is currently the main focus of the Saag eon ao ‘tnd ota Tinos st anata trp ny a mee yc ecSatenaies increasing activity by international oil and gas companies. Iraq's sea port, Umm Qasr, is located on the southeastern tip of the country at the mouth of the Euphrates River. 2.2, CURRENT COMMERCIAL SITUATION The situation in rags slowly improving. A decreased level of insurgent attacks ard an improved security environment are helping to spur economic activity, leading to a major increase in the level of foreign investment and commercial activity within the country — particularly within the Oil and Gas sector, where proven oil reserves stand at 112 billion barrels. However only a fraction of these reserves are currently being exploited and a large proportion of the country remains unexplored. This huge potential, coupled with the central government's strategy of rapidly increasing oil production in the near term, has resulted in a significant influx of investment, activity, resources and expertise since the latter half of 2010, particularly into Southern Iraq. 2.3, SECURITY OVERVIEW ‘A complex array of groups has waged an insurgency against US-led coalition forces and the Iraqi government since the end of the full scale military conflict in Iraq. Armed opposition groups and trans-national terrorist networks have also targeted diplomatic, commercial and humanitarian personnel and assets, as well as civilians. The security situation has improved since mid-2007; however, foreign personnel continue to face threats from suicide attacks, roadside bombings, shootings and kidnapping. Violent crime is widespread and includes carjacking, robbery, rape and murder. Although the majority of the multinational companies have strict security procedures and protocols in place to protect their employees from such risks, foreign nationals are still an attractive target for insurgents. Transferring personnel around the country continues to require significant. logistical planning and security resources. 2.4, MEDICAL RISKS In the 1970s and 1980s the Iraqi healthcare system was considered to be one of the best in the Middle East. The government placed a very strong focus on international training for its doctors and complemented this with significant investment in hospital and clinic facilities as well as state-of-the- art medical equipment from Europe and the US. This high level of care was universally provided free of charge to anyone who needed it. However, since the first Gulf War in 1991, and the subsequent commercial isolation of Iraq, the national healthcare system has deteriorated significantly. Hospital infrastructure was badly affected, but the most detrimental impact has been the shortage of trained and experienced medical staff of all disciplines, as many left the country with their families and relocated to other countries and. regions, particularly Europe, which welcomed their high level of skills and international accreditations. The healthcare system is now a mere shadow of its former self and the quality and capacity of care provided is well below the levels considered to be of international standard. In addition to the poor facilities and clinical standards available in local medical facilities, the security concerns regarding accessing such facilities add a further layer of complexity and risk, particularly for foreign nationals. rT ron ie a i ded yh py ybShiSRONATIE For several years during the height of the coalition military presence it was sometimes possible for certain companies, on a case by case basis, to access military medical services, particularly for incidents ofa life threatening nature. This is now however, a completely 10n-viable part of any company’s medical or security emergency response plan, as the US military consolidates its operations and plans for withdrawal from the country. There is now no guaranteed access to military medical treatment for any non-military staff. The resulting lack of reliable and high quality national medical infrastructure in Iraq, coupled with extreme travel security risks, requires companies to be as operationally self-sufficient as possible. ‘This includes the ability to adequately address the primary healthcare needs of its staff alongside robust contingency plans to deal with emergency medical incidents of both a life threatening and norlfe threatening nature. 2.5. OTHER MEDICAL OPERATING CHALLENGES In addition to the medical infrastructure challenges and security risks, companies employing staff in Iraq face a number of other medically related challenges: * Dust storms, sandstorms and floods are regular occurrences in many parts of the country, and can have a direct impact on both the health and safety of personnel, as well as adversely affecting the ability of emergency response plans to work as expected. © Language barriers are a significant limiting factor when dealing with most iraqi nationals. English is not widely spoken and the majority of staff in local medical faciities are unlikely to speak ‘any language other than Arabic or Kurdish. © The transportation, communications and IT infrastructures within Iraq are subject to frequent interruptions. Most roads are sub-standard and this can have an impact on patient care ‘and security during transport. ‘* Road Traffic Accidents (RTAs) are a very common occurrence due to poor roads, and limited law enforcement and, coupled with the lack of reliable local medical servces, present a major risk to personnel travelling within the country. ‘© The extreme remoteness of some areas of the country necessitates access to aircraft for both general transportation and emergency response. However, aircraft options are very limited and this can present a major challenge for organizations operating in remote locations. ‘© Strict controls imposed by the military authorities upon aircraft fight plans limit the ability to reach much of the country after dark, which can have a major implication for emergency response. ‘The medical and security challenges listed can frequently combine to create an extremely unpredictable operating environment, in which a minor incident can turn into a major emergency. Even with extensive planning and preparation, itis possible for situations to deteriorate quickly as contingency and response plans become unworkable in a lve field incident, requiring a high degree of operational flexibility and local experience. As is always the case better planning will yield more robust and consistent results, and companies should fully prepare their medical and security plans and contingencies before entering the country.GL QBALENERGY 2.6. MOST COMMON MEDICAL ISSUES FACED BY EMPLOYEES IN IRAQ The major medical focus of most companies planning to mobilize operations into Iraq is emergency treatment in response to hostile incidents. However, these incidents in reality make up only a very small percentage of the medical issues facing staff. The majority of medical issues are the same as those faced elsewhere in similar operating locations and are, most predominantly, the usual primary care issues (e.g.: coughs and colds). Companies operating in iraq should therefore ensure that they have access to a broad medical capability, and not rely on or plan solely for the basic trauma / emergency provision offered by the “security frst aider” type of role. Below is alist of the major medical risks that companies should expect to affect their employees operating in Iraq: © Primary care: coughs, colds, flu, aches & pains etc. © Upper-respiratory tract conditions, aggravated by dust and pollution. © Weather-related conditions: heat-stroke, dehydration (life threatening in severe cases). © Road traffic accidents. ‘© Slips, trips and falls which can lead to breaks and sprains. © Heart attacks & strokes. © Accidents in the industrial environment — falls, burns, crushings, amputations, extreme bodily trauma etc. © Gall stones (particularly in the Basra area, as a result of elevated calcium levels in the water system). ‘+ Snake bites, scorpion stings and other venomous animal bites. Violent and extreme trauma injury from insurgency activities, including IEDs and gunshot wounds. 2.7, CHECKLIST OF MINIMUM RECOMMENDED MEDICAL SERVICES PROVISION FOR, COMPANIES OPERATING IN IRAQ. Based on the above synopsis of the current operating situation in Iraq and its relevant challenges, it is strongly recommended that companies employing or planning to employ staff in Iraq ensure provision of, or access to, the following ALS-level medical services and contingencies: Apre-deployment Site Health Review to provide companies with a detailed medical gap analysis, highly specific to the project its exact location and its surroundings, including a detailed analysis of any existing nearby local medical facilities. ‘© Primary medical care. Emergency medical care. © Trauma and resuscitation response to a life threatening medical incident. aso ont hart hone cen et ne en oy ther ny a mei ea ch es.ShoRChARSESS ‘Access to an international medical air evacuation operator with proven experience of extracting patients from the nearest international airport to an international center of medical excellence. © __ Adedicated Medical Emergency Response Plan (MERP), detailing the specific processes and procedures that will be initiated in the event of a medical emergency. 3. RMSI CREDENTIALS & SUPPORT STRUCTURES 3.1, OVERVIEW ‘Operating since 2006 in Afghanistan and Iraq, RMS! is at the forefront of providing clients with medical services in hostile locations. These services range from staffing and equipping client site medical facilites with fully qualified, internationally trained RMSI medical staff and appropriate medical supplies, to emergency medical stabilization supported by rapid response domestic and international evacuation capabilities. With hundreds of life-saving Medevac missions successfully completed, RMSI is the only fully tegrated, international standard hostile environment medical company operating in Iraq, Afghanistan, and other hostile environments. Clients include the United Nations, the United States Department of Defense and a number of major Oil and Gas companies. MSI holds global insurance policies and operates with the back-up and support of a multi-layered clinical backbone. RMS! has been vetted by major global insurance and assistance providers as well as the US Department of Defense and United Nations. 3.2. COMPANY DETAILS Pertinent Company information is provided below: Rob Pullock, «: RMSI Commercial Director ‘Andre Hendrik, RMSI Chief Financial Officer RMS! Head Office Dubai ‘Suites 82901-2904, = Floor, Business Central Towers Sheikh Zayed Road, Dubai - UAE Phone + 971 4423 079 Fax _+971.4423 0778 3.3. _RMSI- INTERNATIONAL SOS STRATEGIC ALLIANCE RMSIis a Strategic Alliance partner of international SOS, the world’s largest integrated medical assistance company. Through this alliance, RMS! is the sole provider for International SOS when. delivering medical services in hostile environments globally. International SOS adds specificSenenainess components of the total solution including quality management and oversight services in order to further augment RMSI's capabilities. The partnership with International SOS also allows clients’ global quality standards :o be implemented at RMS sites. Clients operating in hostile environments benefit from the seamless integration of assistance and ‘medical evacuation capabilities, combining the resources and infrastructure of International SOS with the unique capabilities of RMSI. 3.4, _ RMSI SUPPORT STRUCTURE FOR THE PROJECT Below is the RMSI management oversight organization chart. The organisation chart demonstrates a series of escalating authorities, internal interfaces and key personnel for both medical, operational istrative matters right up through the RMSI organisation to the corporate office. The day to day medical requirements of the project medical services under this contract will be supervised and managed by key personnel in RMSI~ medical, operational, administrative and emergency (as shown on the organisation chart). eae Gace [overall management responsibility for RMSI and lauthorised representative for this bid entity. |As owner of RMSI overall accountability, responsibility land oversight of all business activities of RMSI. [Financial and contractual responsibility for AMSI including oversight, financial auditing and financial management. [Responsible for corporate governance and compliance. Robert amb —_—_|president & CEO Frank Ludick ——|cFo ean int itn cet rion mt edo oy eps. tm ea eee ee[Oversight of logistical chain and procurement process lwithin RMSI. ~ lAndre Hendrikz Operations Director [The primary role of the Operations Director is to manage [the day to day operations of the company through an. laction oriented approach aimed at focusing lorganizational energy and synergy on achieving RMSI lgoals and objectives. The Operations Director is responsible for a wide range of duties across RMSI. [Robert Pullock —_|commercial Director Responsible of commercial development activities pertaining to RMSI. Functions include client account management and commercial alignment for project medical services delivery to contract. Divisional Manager |William Sudelt [Rapid Response & IMedevac Responsible and accountable for medical evacuation |process and aero-medical capabilities. Oversight of RMSI '24/7 Operations Centre. Responsible for aviation assets availability and capability, {to respond to requests for activation of services. Dr. Marie Van Eck |chief Medical Officer [Responsible for all medical, clinical and evacuation Irelated services forall medical management of cases, Iconsultations, and services provided by RMSI clinical staff, [Direct clinical supervision of staff as referral point for |complicated or cases requiring additional assistance. Divisional Manager ~ [Dr. Tony Capps aah teat [Responsible for policy and procedure of RMSI Clinics loperating in region. Direct management and oversight of clinics management, services, and functions. ‘The diagram below gives a visual overview of the support structures in place to support GETR and Al Fao, Project Team: ren rth fren net ety ede nme ty res Say eaRMSI-Intl.SOS Ops Centro GETR Remote Site RMSIALS Paramedic, RMS! Doctor, ofc ALS Equipment, Project Membership (inc! MERP plan), de =Primary Medical Care Emergency Stablisaton and Medical Care Preparation br Medivac fo Basra “Remote Medcal Support GETRP1 Ambulance RMSIALS Paramedic + Responder Bag & Emergency Equipment + Pationt Hospitalisation In Ry ie AS ‘AlArangemont(retuing Gor} ors Orang ae, Pee eee RMS\/Intl.SOS ICU Medivac GETR will benefit from the seamless integration of assistance and medical evacuation capabilities, combining the unparalleled resources and infrastructure of International SOS with the unique capabilities of RMI. In addition, International SOS adds specific components of the total solution, Including detailed MERP planning, quality management and oversight services in order to further augment RMSI's capabilities. ‘The unique RMSI capabilities ensure specific in-country Iraq established procedures, processes and ‘experience are provided in the delivery of services. ‘The RMS! - International SOS alliance not only gives the client access to both RMSIand International 05‘ air evacuation capabilities, butt also provides 24/7 access to International S0S' global network (of 26 alarm centers (including the Dubai alarm center) for both the patient and the corporation. RMSI medical teams in the field are directly supported by the 24-hour RMSI Mission Response Center (MRC) in Dubai, which itself is able to draw on the global medical resources of International SOS where required {including the 24-hour Dubai Alarm Centre). Ta Teo ee Tea anon hefner ty ced mab nao ye pr hy mi chShreninneSS 3.5. QUALITY CONTROL MSI operates its medical services (personnel, clinics, facilites, services, supplies etc.) according to international medical standards. These standards are consistent with a set of Standard Operating Procedures (SOPs) and Quality Control & Assurance Guidelines forall services provided to client's remote site projects. Additionally, each facility is audited regularly with defined audit checklists and corrective action plans. RMS! will use these standards for the provision of services under a new agreement, MSI will implement a Quality Management Program for utilizing a set of developed internal quality control measures / operating standards and procedures in each area of its business to ensure consistent and high quality service delivery for contract performance. With respect to the delivery of site medical services in Iraq, the Quality Management Program to be implemented will comprise of (but shall not be limited to) the following areas: © Regional and Local Medical Management / Supervision; © Installation of Relevant Operating Standards & Standard Operating Procedures; © Installation of Standardized Reporting Tools (internally and to ‘© Medical Support Services; © Audits / Inspections / Procedures including Corrective and Preventive Actions; * Continuous Quality improvement. 3.6, RMSI INSURANCES RMI provides comprehensive personal accident insurance including medical and evacuation coverage for its staff and activities globally through Lloyds of London. RMSI's comprehensive insurance is extended to medical malpractice and public lability insurance. Certificates can be provided upon request. All insurances, including aircraft insurance for RMSI air ambulances, are war zone policies and remain permanertly in place. Summary of RMSI insurances: + Medical Malpractice of US$10,000,000 per event or in the aggregate amount will be provided forall staff and subcontracted medical personnel acting for RMSI on the project —all ‘medical malpractice insurance will be the responsibilty of RMSI. ‘+ General Liability Insurance of US$5,000,000. ‘+ Employers Liability Insurance of US$5,000,000. ‘© Products Liability Insurance of US$5,000,000.. ‘© Pollution Liability Insurance of US$5,000,000. ‘+ Auto Liability Insurance of US$5,000,000. © Personal Accident (including war risk) for RMSI employees of USS 500,000 per employee. ‘The above represents the highest evidence of RMSI’s commitment to its own employee personnel, subcontracted personnel as well asto client operations in hostile environments. Saag eon Ta ‘tar oe rn ns ae ya na tb oy hpi ty ka ed yah echRMSI SOLUTION 4.1. ON-SITE MEDICAL SUPPORT MSI is in the process of mobilizing assign an experienced hostile environment medical team comprising of: ‘Quantity ‘Medical Position | Rotation Experience/Qualification 1 ‘ALS Paramedic ‘Weeks On | The Paramedics will have at least 2 years’ pos / 3-4 Weeks Off | qualification (and will hold the ACLS ~ Advanced (Off Time Cardiac Life Support cualification) experience in, Staffed by and relevant training for providing medical Locum services in remote, challenging and hostile Paramedic) __| environments. 1 Iraqi Doctor ‘SDaysOn/2 | The Doctors will haveat least 2 years’ post- Days Off qualification (and will hold the ACLS ~ Advanced (off Time Cardiac Life Support qualification) experience in, Staffed by and relevant training for providing medical Locum Iraqi | services in a remote, challenging and hostile Doctor) environments. The Doctors will speak, read and write English, ‘The medical team wears clearly recognizable RMSI uniforms to ald recognition of the qualified medical team in emergency or stressful situations. ‘The medical team provides the following services on site: © Emergency stabilization of injured or seriously il patients. * Diagnosis and treatment of specific illness covered by RMSI Clinical Practice Manual (CPM) under guidance from the RMSI Chief Medical Officer where protocol dictates. NB: treatment does ‘not cover the management of chronic (long-term) illnesses. '* Medical triage in mass casualty situations (where there are more casualties than appropriately trained medical staff available on site). ‘* Work closely with GETR’s on-site security team to undertake secure transfers of injured or ill patients from the site to the nearest international airport. Coordination of evacuation if required, in conjunction with RMSI Country Manager, RMS! physicians and coordination team based remotely in the Dubai Mission Response Centre (MRC) and. International SOS alarm centers. © Use of RMSI Private Practice Software (PPS) to record all details of patients seen. This. proprietary software is loaded onto an RMS! laptop computer which is provided with the hostile ‘environment medical team.GLPEAL ENERGY * Provision of regular standard format reports to GETR based on information captured within RMSI PPS System. These reports can be provided weekly or monthly according to GETR requirements. ‘+ Organization of medical facility at GETR's site to ensure readiness for emergency or non- ‘emergency medical cases, including replenishment of medication and consumables (as per agreed re-supply procedure with GETR). ‘Some administrative tasks can be performed by the hostile environment medical team on site where these do not compromise the primary tasks of the provision of emergency care and the ‘maintenance of the clinic. Such tasks may include non-certified first-aid training etc. These tasks ‘must be approved in writing by the hostile environment medical team and his/her RMSI line manager and exclude HSE advisor tasks. AI RMSI hostile environment medical staff will maintain registration with the medical council of their home country (where applicable) and, depending on the nationality, have: * Advanced Cardiac Life Support qualifications (ACLS) from a recognized institution passed within the last 2 years. © Relevant experience and/or specific training to be able to operate in a location with physical security concerns. We select staff who will work well with your team and who understand the stress that your employees will feel when working in 2 hostile environment. © Atleast 2 years’ field experience operating in high-risk locations. 4.2, REMOTE MEDICAL SUPPORT PROVIDED BY RMSI & INTERNATIONAL SOS The RMSI medical teams in the field are directly supported by the RMSI Mission Response Center (MRC) in Dubai, which itself is able to draw on the global medical resources of International SOS where required (including the 24/7 Dubai alarm centre). The following activities are provided by this combined RMSI and International SOS infrastructure: ‘+ RMS! hostile environment medical teams are required to act in compliance with the field- proven RMSI Clinical Practice Manual (CPM) which provides clear protocols for most contingencies and treatment guidelines forall medical interventions that can be carried out by the hostile environment medical teams. The CPM also details when a medical case must be escalated toa remote physician for medical support. + RMS! hostile environment medical teams are trained to escalate to a physician in the RVI Mission Response Center in Dubai any medical cases that are not covered by the CPM, or any the hostile environment medical team’s previous training and experience, to make diagnosis confirmations, treatment decisions and a recommendation on whether to evacuate or not. Further escalation or specialist advice where required can be sought from a coordinating doctor at an International SOS alarm center. * Annual medical sis assessment is carried out by the RMSI Chief Medical Officer in Dubsi. Development and implementation ofa training plan to address any skills gaps identified and to ensure that medical competencies and qualifications are kept up to date. ‘* Setting and carrying out an annual review of site-specific quality objectives. The objectives are developed by RMSI and aligned with GETR’s medical standards where these exist. Quality is @ I cases not encountered du Sa Tea Teena anna hain Scent nad matt ic oy hn yh remy ah eekey attribute of RMSI and so each team member has set objectives an to provide a service that meets these quality assurance objectives, © Aspart of the continuing quality assurance process, RMS! will annually carry out an external or a self-performed site audit or inspection of the site clinic / ambulance operations, using International SOS’ proprietary audit tools, and will provide written feedback to client management for review. ‘© Logistical and administrative support such as organization of rot measured on their ability sand travel. 4,3, MEDICAL EQUIPMENT, MEDICATION AND MEDICAL CONSUMABLES The medical equipment as per Annexure A has been provided by RMSI. Replenishment of medications and consumables will be quoted for separately, supplied (subject to local import regulations) replaced and billed for as and when requested. 4.4. AMBULANCE MSI is finalising on behalf of GETR the procurement of an armoured Ford F550 ambulance from a reputable supplier in the UAE. 4.5, RMS! HARDWARE, SOFTWARE, COMMUNICATIONS AND REPORTING Remote clinic software and communications allow the RMSI Medical Officers to support and supervise deployed hostile environment medical teams, providing advice and assistance where required. This ensures effective care and clinical governance. is of medi RMSI has a robust system of reporting and analy: I trends in order to track incidents and make recommendations © Daily Report; provided after the close of the clinic by email to the persons designated by GETR’s management to receive the reports. + Weekly / Monthly Reports; provided to detail medical trends and problems encountered. ‘The disclosure of confidential medical information has legal liability implications, therefore individual consent will be required to authorise the distribution of medical reports to designated managers detailing the results of drug testing, other medical conditions, Incidents, and presentations of traumatic on-duty injuries. Incident investigation reports will be in the format provided for all injury-on-Duty (10D) events. In addition, the records and other documentation associated with the site and the operation will also be quality assured to ensure that not only was the work done well, but that the records are accurate, comprehensive and complete. 4.6. _ MEDICAL ASSISTANCE FOR SITE STAFF (PROJECT MEMBERSHIP VIA THE UNAOIL CONTRACTED AGREEMENT) AND INTERNATIONAL AIR AMBULANCE EVACUATION In order to provide medical assistance services to all staff on site, an additional service called Project Membership has been contracted by UNAOIL. This service also provides a site-specific Medical Emergency Response Plan ("MERP”) to allow integration of the site with the RMSI Mission Response etanercept nee mde sh cesSekai Center ane the International SOS Dubai alarm center. The MERP is due to be updated to incorporate the GETR Al-Fao 400 man camp and the mobilisation of the RMSI medical team. The following diagram outlines the various components of responding to an on site emergency though to arranging an out of country medevac: Responding to an on-site medical emergency Site Level Local Medical Emergency Response ‘ta new ener magonse “turn endorse rear fe _/ Seogenrs ar anion 80, FtA master, CPR AED oe “ Risiene of a unas ‘Rit pg at ect pe ete We hwo ty fae our troojes an he ver eos ‘rea eat ERP wich aly ‘etre song ea monde. US! dnt! SO cn pro ‘mdse o> Se Medal Siabization nd Movenont Structures | na pe ones in ‘een at th sleton po Th | yoo lca oepal cine Sporto ‘ii te mona lak sR pone Sato mee ‘Saigo ror ambree copes, ‘it ard rate’ SOS cn oe ‘mcommencton fries plat Sparare se suver ‘Medical Evacuation Response Pian oe nied onpyeefre {Siaabor pat bere ore ‘Simeon ween | RMS! and ran 90 ety Pome e pr efegard Pret Smo ‘Data em sey itd ‘vt fe MEP, oy med iepocreestopeber tr nah aman is i ht at dt sR me eee aahS2heh antes ‘The following constitutes the services of Project Membership: ‘+ Access to emergency medical evacuations and medically supervised repatriation. ‘+ Preparation of the site-specific Medical Emergency Response Plan. ‘+ Case management, medical monitoring and guarantee of payment for medical expenses. + Access to dispatch of prescription medication and medical supplies (where local regulations allow). + Emergency and routine medical advice. ‘Medical and dental referrals. ‘+ Access to arrangement of the repatriation of mortal remains. Specific benefits of Project Membership: ‘+ _Allstaff working on site are covered; employees, contractor and subcontractor staff and any other persons performing work on sit. ‘© GETR/UNAOIL’s Authorized Persons as specified in the Project Membership Agreement is able to make a decision to evacuate based upon medical need, independent of the contractor, ‘management or the insurance company. + Nominated international SOS alarm center for the site. ‘+ Training of alarm center medical staff on site-specific operating and emergency procedures. Project Membership, the approach: © GETR and RMS! will work together to update the Medical Emergency Response Plan (“MERP"’ for the site, in conjunction with International SOS. The MERP takes into account the in- ‘country and out-of-country evacuation capabilities available from RMSI and / or International SOS. Operating procedures where appropriate will be prepared specifically for each site and integrated with the MERP. ‘+ Inthe event of a medical incident requiring treatment abroad, RMSI, in conjunction with International SOS, will offer the capability to provide, on a fee-for-service basis, (usually with a three hour mobilization time}, a same day jet air ambulance evacuation employing our UAE-based ai ‘ambulance aircraft. These are fully ICU configured and staffed by aFlight Physician and Flight Paramedic / Flight Nurse. Air Ambulance aircraft and teams are on permanent 24 hour stand-by for rapid response and can be airborne within 3 hours from notification to any regional location. ‘Additional onward air ambulance services can also be procured from International SOS or other providers as required. it should be noted that any patient must bein possession of a valid passport to fly as per international laws. This evacuation will include: * International SOS" or RMSt’s out-of-country evacuation capabilities (Air Ambulance) from the identified in-country point of extraction to Dubai or other appropriate international destination. ‘© Further repatriation from Dubai on to other e.g. home country of ill or injured patient or another center of medical excellence. “a a TanaLPRAL ENERGY ‘© Atall times, RMSI and international SOS will provide medical assistance services to ‘employees at the site according to the MERP. ‘© No payments need to be made in advance other than the medical team prices stated below. For international air evacuations, RMSI has a new dedicated Hawker 800 XP air ambulance, based at Dubai International Airport. As part of the Strategic Alliance between RMSI and International SOS, overflow missions or mass-casualty situations can utilize International SOS' dedicated Learjet 45 air ‘ambulance, based in Abu Dhabi: (ox yNcin? Intensive Care Stretcher Patient Plus 2 seated patients 1.Companion 2.3 Medical Personnel ‘The RMSI Hawker 800 aircraft can be airborne approximately three hours after activation, flying from Dubai directly to any of the main airports listed to collect the patient (initially transported to the airport via client's ground ambulance), returning with them to the regional center of medical excellence (the United Arab Emirates). The replacement and multiple-casualty aircraft also have relatively short activation times, and are able to access the same airports. While the majority of cases will be returned to the United Arab Emirates, for certain specific medical conditions (or at the specific request of the client), RMSI and International SOS can recommend alternative destinations. Prior to returning tothe United Arab Emirates, ground ambulance transfers from the airport to the appropriate care facility are arranged by the International SOS alarm center, ensuring a seamless bed-to-bed transfer of the patient regardless of which aircraft is being used. ‘As an example, an end-to-end evacuation from Basra to Dubai, utilizing the RMSI dedicated Hawker 800 XP, can be completed in approximately 9 hours: © 3hour activation time of the aircraft © Zhour flight from Dubai to Basra © __Lhour at the airport loading the patient and passing customs and immigration © -2hour return flight from Basra to Dubai © hour trans‘er of the patient from the aircraft to the hospital bed Flying times from the United Arab Emirates to the majority of airports in Iraq range from 2~2.5, hours, with all coordination carried out by the RMSI Mission Response Centre based in Dubai ‘tard ore arin mt fr nd mit mth nd oy thei St i dry heh.SRERShEnRESS ANNEXURE A - BASIC SETUP WITH MONITORING CAPABILITIES Reenter eaten’ Phillips Onsite AED ‘Oxygen Cylinders + Regulator (Filed) ‘Small Cylinders + Regulator (Filled) Glucometer + Strips and Lacents Laryngoscope ENT Set Braun Digital Thermometer + Ear Cones inger Pulse Oximeter Head Blocks ‘Spider Harness ‘Suction Unit Crutches Examination Couch ‘Scoop Stretcher Spinal Board Vacuum Mattress Dressing Trolley WStand Ventilator ALS BagGLgbal eneRs: Wheel Chair ‘Air Way Kit Complete with Cylinders Cera ccre tty amox/Clav (Augmentin) 20 100 | tabs | 625mg “Amoxicilin (Amoxil) 20S 100 | caps 500mg Cefuroxime (Zinnat) 10S 50 | tabs | 250mg Cirprofioxacin (Ciprobay) 10'S 30 | tabs | 500mg Clarithrimicine (Kaci) 20'S 50 | tablet | S00me ‘Metronidazole (Metrolag) 20° 100 | tab 250mg ‘Azithromycin (Mazit) 6S 30 | tabs | 250mg ‘Reyclovir (Zovirax) 70'S 20 | tablet [400mg Mebendazole (Vermox) 6S 300 | tablet | 100mg Doxycycline (Vibramycin) 10'S 100 | tablet | 100mg Cefazolin (Kefzol) 10 | vial 10g “Amoxyclav (Augmentin) 20 | val 126 Rocefin (Ceftriaxone) 20 | wal ie Promethazine 30 | amp | 50mg Diclofenac (Voltaren) 5'S 20 [amp | 75mg/3mi sear he ermeton nce ec cnet tb ia yh pt Sy i ey sheDiclofenac (Voltaren) 20° 300] tabs | SOmg Diclofenac cream (Voltaren gel20 gm) 10 | pack | 30g Ibuprofen (Neoprofen 205) 200 | tablet | 400mg Paracetamol (Panadol) 96'S 200 | tabs | 500me Lignocaine 2% S| vials | Smt Tignocaine 2% with Adrenaline 10 | vials | Smt Ketorolac 100 | tablet | 10mg ‘Acetyl salicilate (Aspirin) Jusprin 300 MG 30'S 200 | tablet | 325mg Chlorpromazine ‘Metoclopramide (Premosan 50'S) Diazepam 10 | amp ‘10mg/2ml Diazepam 20 | tablet | Smg ‘Morphine 5 | amp 1Omg/imi | 10 | amp 20] amp 25me/ml 10mg/2ml ‘Metoclopramide(Primperan 20'S) 50 | tablet 10mg Inocain 20 | bottle | 4mg/Imi Tetryzoline (Vizine) 20 | tube [ism Cloramphenicol ointment 10 | tube | 1%3g ‘Acyclovir eye ointment 5 | tube | 3%45@ Futsitalmie(Fusidie acid) 5 | tube | i0mg/ig Fluorescein Minims or strips 1 | box Tears naturale 5 | bottle | ism “Say ean ‘neon Conai nornsin one senate andy the pr Sma dr ye.Xylometalazine Spray (Xylocomed) 30 | bottle | 10mi Bactroban nazal oint.(Mupiracin) 5 | tube | 23g “Aqva-maris{Marimer Fisiomer) 20 | bottie | 30mi Lip Balm- LABELLO EACH ‘Strepsils with Vit 100 | tablet | 245 Cholisal gel i | pack | 10g Miramistine 1 | bottl | i50mi Metrogil denta cream 1 | pack | 20g ‘Aciclovir Zovirax) cream 10 GMS 1 | pack | 5% Coldrex Hot remedy LEMSIP FLU SACHET 25 | sachets | 10S Fluticazone MDI (Flixotide) a | Mor 250meg ‘Salbutamol (Ventolin) nebules 20 | nebules [25mg Salbutomol (Ventolin) MDI Ss | Mor 200 doses “Ambrobene (Ambroxol) MUCOSOLVAN 20S 10 | tabl 30mg Coldrex Broncho (Guaifenesin) RESYL 10 | bottle |” 60mi Hyoscine Buthylbromide (Buscopan) 205 100 ed 10mg loperamide (Imodium) 60S 300 | tablet] 2mg ‘Maalox PLUS (tablets) 505 100 | tablet Oral rehydration (Regidron) NFOIYTF 6GM 10S 100 | sachets | 105 eae ean an Th noreron ma i cet ante sy ae i maa mdr yc.Ranitidine ZANTAC TABS 150 MG 30] tablet | 150mg Procto-glyvenol 10 | supp ‘Bisacodyl DULCOLAX TABS 100 | tablet | Sma ‘Omeprazole NEOPRAZOLE TABS 20 MG 145 30 | Tablet [20mg ‘Motilium(Domperidone) 305 30 | tablet [10mg 10 | tube “Moisterizing Hand cream EUCERIN 75 ML Sunscreen SPF3O+ NIVEA 20 | tube | SOML MICONAZOLE NITRATE (DAKTARIN) CANDIZOLE 40 | bottie | 2%- 20g Lignocaine gel sterile 256 (Regard) 5 | wb Heparine cream HIRUDOID 5 | tube | 258 Bactroban CREAM 15 GMS 5 | tube | 20 ‘Sulfadiazine/siwver (Dermazine) FLAMAZINE 3 | tube | 50g Waterbased lubricant gel («Y-gel) 30 | topical | 50¢ Clotrimazole cream CANESTIN 30 | tub 308 Tamizil spray 30 ML 30 | spray | 308 ‘Betametazone/Celesderm DIPROSONE 30 | tube | 30g ‘Mosquito repellent DEET 50% Spray 20 | bottle | i00mi Ben-Gey cream Hydrogen peroxide 100 ML Todine spirituose TINCTURE IODINE Gel antiseptic Sanitelle Indapamide NATRILIX 30S Nefidipine (Adalat CR) Gant Team taasee oo soda tomato a i ce a na dy th en. ny edn br yh.Enalapril (Enap) RENITEC 28S 20 tab 10mg “Atenolol TENORMIN 23S 30 | tabs | Some ‘Capoten (Captopril) 50 tablet 12.5 mg Adenosine 5 amp ‘6mg. Amiodarone (Cordarone) 6 S 10 amps ‘5Omg/m! Atropine 10 amps 0.6 mg Dopamine 10 amp 200mg/Sml Furosemide (Lasix) 5S 10 amp 20mg/2mi Glucose (25%) 20 mi 10 amp 5% 10 ml Low Molecular Weight Heparin (Enoxaparin) CLEXANE 2 amp 4000.1. Insulin (fast) Actrapid 10 amp Itropinin T Cardiac Enzyme Test Kit 20 amp Tignocaine 5 | amp | 2X2mi Magnesium sulfate 10 amps 20 mg/ml Naloxone (Narcane) 10 amps: 0.4mg Betaloc (metoprolol) LOPRESSOR 50 MG 40S 20 | tabs 25me ‘Sodium chloride for injection 30% 20MI 30 amp ‘1 mg/ml Water for Injection 50S 5 amps ‘Smg/2 mi Prednisolone 30S 20 tabs ‘5mg ‘idazolam for Intubation 5 | amps | 15me/ami Hydrocortisone 10 | amps | 100mg GIN Spray (nitroglicerine) 2 | SPY | camg/tdose oo a anata herman ait hy eta an mt be cd yr ri my ecko ecTetanus vaccine TETAVAX Normal Saline NaCl0,9% 25 | infusion | 500m Ringers Lactate 25. | infusion [500 ml Glucose 50% 10 | infusion | 50mi Glucose 5% 10 | infusion [100 m1 Gelafusin OT ‘500 mi ‘Anatoxin Diphtheria Tetanus Chlorhexidin p-p 0,05% 100mn ‘Alaminol 5 | bot | 107 Betadine ANTISEPTIC SOLUTION 20 | both | 120ml ‘Multivitamins SUPRADYN 1005 200 | tabl Penarth eras 1 Portable and fixed suction apparatus 1 2 ‘Suction Catheter Vankeur 5 3 Suction Catheter - 18% 5 4 ‘Suction Catheter - Size 16 5 5 Suction Catheter Size 14 5 6 Suction Catheter - Size 12 5 7 |" Suction Catheter - Size 10 5 8 Bag valve mask 7 Sawer ean ae oo rt nana aman et et cr mat yt my a mast yh ede9 Laryngoscope Kit - (Blades 4/set) with extra bulb and batteries 1 10 | Portable/fixed oxygen cylinders 2 It. with flow regulators 1 1 Portable/fixed oxygen cylinders 5 It. with flow regulators 1 13 ‘Oxygen Nasal Canulla - 1104 5 14_| Oxygen Mask - 10096 (Non-rebreathing) 5 1s Oxygen Mask - Medium Conc. 1041 5 16 ‘Oxygen Mask - Variable Concentration 5 7 Endotracheal tubes including stiletto 5 18 Endotracheal Tube (Cuffed) - 9.0 5 39 _| Endotracheal Tube (Cuffed)- 80 3 20 Endotracheal Tube (Cuffed)- 7.0 5 2_| Endotracheal Tube (Cuffed). 60 3 2_|_Endotracheal Tube (Cuffed) S 5 23 Nasopharyngeal Airway - Size 9 5 4 ‘Nasopharyngeal Airway - Size 8 5 2 ‘Nasopharyngeal Airway - Size 7 5 26 Nasopharyngeal Airway - Size 6 5 2 | Oropharyngeal Airway- Size 4 5 28 | Oropharyngeal Arway- Se 5 3 29 Oropharyngeal Airway - Size 6 5 30 | Securing tape for Endotracheal tubes 70 31_| Complete Nebulzing masks 70 “Sag Teas raSe ESS 32 | Basket stretchers 33] Spinal Board 34 | Vacuum mattress (with repair kit and pump) 35 | Cervical collars 37_| Immobilization devices for upper and lower extremity (SPLINT- Universal Head immobilizer, gutter (arm), gutter (leg), Malleable Forearm/Hand (SAM) 39._| Head blocks with straps 40 | Scoop stretcher 41 | Stethoscope 42 | Electronic thermometers Braun 43 | Sphygmomanometer 4 | Glucometer 45 | Weole 46 | Eye protection goggles “47 | Otoscope / Opthalmascope 48 Medical Refrigerator 49 | Alcometer 50 | Chest Seal- Asherman 31 | Chest Drainage Set inc, Trocar Catheter '52_| ADSON'S NON-TOOTHED 5” NON-STERILE 53 | MOSQUITO ARTERY, CURVED 54 | KELLY ARTERY CURVED 55. | SPENCER WELLS ARTERY, STRAIGHT 5" 56 | ARTHUR SPLINTER 4.5" STRAIGHT, 140mm 57 | ADSON SERRATED DISSECTING 1X2 TEETH 5"58 IRIS TOOTHED (ris Dissecting Forceps 10cm) 2 55 | Ring cutter T 60 | BP Handle, knife/scalpel NO.3 z ex] Emetency Room Shears (SCISSORS TUFF CUT 7") - Scissor Universal 18om | Black 62 LISTER BANDAGE SCISSORS 7" (18cm) 3 63 MAYO SCISSORS 6.5" CURVED (17cm) 2 64 MAYO SCISSORS 6.5" STRAIGHT (17cm) 2 65 METZENBAUM B/B - Metzenbaum Dissecting Scissor 18cm Cvd_ 1 66 IRIS STITCH 4.5" CURVED 1 67 IRIS STITCH 4.5" STRAIGHT 1 68 Needle helder,suture, Hegar-Mayo, 6" 1 1 | BANDAGE COHESIVE (coBAN) —10emx45em | item | > | each 2 | Banoact conesive(cosan) —75emx4sem | item | 3 | each 3 | BANDAGE COHESIVE (coBAN) Semx4sem | item | > | each 4 ELASTIC ADHESIVE BANDAGE 5 cm item : each ‘CONFORMING 20 em x 4.5 cm Canin hima ert sey keno et aed hy hee me lene ray ec0 6 | CONFORMING 15 em x45 em item | 3 | each 7 | MEPORE DRESSING 7:cm xem item | E | each 8 | MEPORE DRESSING 9.om x 15 em item | f | each 9° | MePORE DRESSING 9 em x 20m ite each 70. | Bandage, Muslin, TRIANGULAR FAZ0 tem | 3 | each Ti | Tubegauze-type Bandage tem | a [each 72 | Tubegauze 07 Bandage 20m item | a | each 73 | Tubegauze se 22,20m tem | 1 [each 74 | Tubegauze APPLICATOR FINGER PLASTIC tem | 2 [each 15 | Cotton Conforming Bandage 7.5 cm item | 3 | each ; ; 7 16 | Kerlex Dressings item |} | each 17] Grepe Bandage, COTTON Sem item | 6 | each 18 | Crepe Bandage COTTON, 75cm tem | 6 | each 19 | Crepe Bandage COTTON, 15 em item | 6 | each 20 |” DRESSING AMBULANCE LARGE NO. 3 item | 5 | each Z| AMBULANCE DRESSING NO. 7 item | 5 | each SOFFBAN NATURAL BANDAGE 7.5 em 2.7 m 7223 2 item | 2 (Smith & Nephew) = 2 | G23xr item [10 ] each earn Thifarten doce nee nase hes hes Sa ei ened ne bee Tana‘5Oml, HYPODERMIC LUER ECCENTRIC LOCK 24 ] G2ixis item [10 | each 2 | G25xi" item [10 | each 26 | Wing needie/BUTTERFLY CANNULA 23°, item [10 | each 28 | _20mi, HYPODERMIC Box 6 | each 29° | 10m, STERILE, HYPODERMIC Box. 1 | each ‘30 | 5 ml STERILE, HYPODERMIC Box 1 | each 31 | 2 mi, STERILE, HYPODERMIC item [40 | each 32 | 1 mi, STERILE, HYPODERMIC item [10 |” each 221 Sharps container 33 | Intra Osseous access device = or > 18— item [3 | each 34 | CANNULALV. C/W PORT 14fe Box [a | each 35 | CANNULALY. C/W PORT Tete Box [a | each 36 | CANNULATY. C/W PORT 18%6 Box |i _| each 37 | CANNULALY. C/W PORT 20% Box [a | each 38 | CANNULALY. C/W PORT 226 Box |i _| each 39 | CANNULALY. C/W PORT 276 Box fa | each 40 | PLUG STOPPER & INJECTABLE BUNG Box [a _| each ‘SHARPS BOX 1 LITRE WATERGEL 2x6" DRESSING item each 44 | WATERGEL 4x4” DRESSING item [a | each 45 | WATERGEL 4x 16” DRESSING item [6 | each6 WATERGEL 8 x 18" DRESSING item ‘each 7 WATERGEL FACIAL DRESSING item ‘each ‘CATHETER FOLATEX MALE 10 mi 12g MEDIUM each Si_| CATHETER FOLATEX MALE 10 mi 14g MEDIUM item each 52_| CATHETER FOLEY MALE 10 ml 16fg item each 53. | Pre-Pack Sterile Catheterization PACK item each ‘54 | CATHETER NELATION 16 NO BALLOON item each 55 | Urine Drainage Bags/ Bladder bags Simpla S4 item each 56 | Suction Catheters G14 2 EVES item each ‘57 | Suction Catheters G16 2 EES item each 58 | Yankeur suction catheter 126 open tp item each 59. | Suction Catheters G18 item each 60 | Suction tubing 2m rolls item each G1] RYLES TUBE SIZE 12fg 122 cm item each 62 | RYLES TUBE SIZE i4fg 122m item ‘each 63 | RVLES TUBE SIZE t6fg item ‘each 64 | RYLES TUBE SIZE 18g 122 cm item each 65 | MICROPORE TAPES cmx5m item each 66 | MICROPOROUS TAPE 2.5 cmX5m item each @7 | Wopsite ‘box each MEPORE ULTRA Adhesive dressi 9x15 = ; resive dressing 9x 15cm a a (opsite) 69 | Bioclusive Adhesive Film 10.2 x 12.7 em Boxes each “Gao ae Tames Petar CoretThefereon th cse hc cde nd mute es yh i MSy nab my h re70 | Combine Dressing/SURGIPAD STERILE 10 x 20cm Box 1 | each 7i_| Coverplast Barrier Assorted Boxes [2 | each 72_| ELASTIC ADHESIVE BANDAGE 2.5 om item [40 | each Jelonet paraffin gauze/ORESSING (Smith & Nephew) | 73 | sonanon item | 6 | each 74 | MELOLINPFADRESSINGS (Smith & Nephew) 10m | Te | oa, 30cm 75 | Steristrips 6mm X75 mm item | 20 | each 76_|_ Steri-strips 3 mim X75 mm X5 STRIPS item [20 | each 77 | Semx75cm item [6 | each 78 | 10xi0cm item [6 | each 79 | VICRYL COATED SUTURE 3/0 16 mm CUTTING NEEDLE | item [6 | each 80_| VICRYL COATED SUTURE 2/0 W9390 item [6 | each 81 | ETHILONSUTURE3/0 item [6 | each 82 | ETHILON SUTURE 4/0 item [6 | each 83 | ETHILON SUTURE 5/0 BLACK item [6 | each ‘84 | MERSILK SUTURE 3/0 item [6 | each ‘85 | MERSILK SUTURE 2/0 item [6 | each 86 | Suture Removal Kit item [8 | each No. 12 No. 15 a) 8) §‘390 | No.10 10 | each 91 | No.it 10 | each 92 | No.15 10 | each SIZE a4 | SETS 1 | PAR 35 | ses 7 | PAR GLOVES VINYL POWDER FREE LARGE (100°S) 6pcs - 96 paresis 1 | (b/100) ‘97 | Stick-on Labels, BLANK FOR DISPENSING, ROLL 1 | pkt ‘98 | MEDICINE MEASURE 30 ml 6 | each ‘99° | MEDICINE CONTAINERS C/W LID 20 | each ‘STERETS ALCOHOL SWABS Plastic Apron. 1] pkt 101 | THEATER GOWN WRAP STERILE LARGE 6 | each 102 | THEATER GOWN WRAP STERILE EXTRA LARGE 6 | each 1103 | PROCEDURE MASK PLEATED WITH FLUID SHIELD 1 | each 1104 | DRESSING TOWEL 45 x 50 2 PLY STERILE drape 20 | each NAIL BRUSH NYLON GAUZE SWAB 5 x 5 cm STERILE (5's) 107 each 108 | GAUZE SWAB 10x 10 cm STERILE (5'5) 20 | each 109 | GAUZE SWAB 7.5 x7.5 cm STERILE (5's) 40 | each Saray eae oo mandrel fern nee ch ce mt he sy ht Sy kh mde she110 | EYE PADS, STERILE item [20 | each 11 [COTTON WOOL Balls, pack [a | each 112] 10x19cm item] 5 113 | 20x19cm item [5 114] 30x30cm item [5 115 | DRESSING PACK Sterile item [45 | each 116 | SURGIPADS 10 cm X20 em item [20 | each 117] Mortuary/Body Transfer Bag , DISPOSABLE, WHITE item [4 | each 118 | Safety pins ASSORTED item [30 | each 119 | WOODEN tounge depressors Box 1 | (box/100) 120 | Disposable dental repair kit item [a | 2 121 | SMALL Zip lock bag item [30 | box 122 | LARGE Zip lock bag item [30 | box 123 | STERILE EYEWASH SOLUTION 500 ml STUBBY item [20 | each 124 | DIPHOTERIN EEWASH with station set 4 | set 125 | DIPHOTERIN EYEWASH without station bot 3 | bot 126 | Oxygen (Venturi) Mask 24% item [6 | each 127 | Oxygen (Venturi) Mask 35% item [6 | each 128 | OxyMask Non-rebreather c/w tube & sfvent R22005 | item | 42 | each 129 | LAERDAL POCKET MASK W/ 02 VALVE # 820410 item [2 | each 130 | Adult Oxygen Nasal Cannula item [40 [each 131 | Oxygen mask (60%) - Hudson mask or similar item [40 | each 132 | Oxygen Tubing (2 meters) item [6 | each 133 | Nebuliser mask complete 6 | each134 | Airway Guedal SIZE 2 (9) item [5] each 135 | Airway Guedal SIZE 3 (10) item [5 | each 136 | Airway Guedal SIZE 4 (10.5) item [5 | each 137 | McGil’s Forceps, ADULT 8.5" item [2 | each 138 | _Endotracheal Tube INTRODUCER 5 mm item [2 | each 139 | Endotracheal Tube CUFFED PORTEX 6.0 item [3 | each 140 | Endotracheal Tube CUFFED PORTEX 7.0 item [3 | each 141 | Endotracheal Tube CUFFED PORTEX 8.0 item [3 | each 142 | Endotracheal Tube CUFFED PORTEX 9.0 item [3 | each 143 | Nasopharyngea Airways SIZE 6 item [3 | each 144 | Nasopharyngea Airways SIZE 7 item [3 | each 145 | Nasopharyngeal Airways SIZES item [3 | each 146 | Nasopharyngea Airways SIZES item [3 | each 147 | Combitube SIZE37¥e item [2 | each 148 | Combitube SIZE 4ife item [2 {ag | Eschmann Tracheal Tube introducer (Gum Elastic aero ae Bougie) 150 | Catheter mount item [2 | each 151 | Double swivel connector item [2 | each 152 | Disposable thermometer sleeves tem — | a0 | Pew200 153 | _Lancets item | 20 | (b/100) 154 | Diagnostic strips for glucometer 50 per btl bottie [i | each 155 | Disposable Aural speculum item [5 | (67500) 156 | Urine testing strips in bottle - 8 tests in strip bottle [1 | bot 157 | Umbilical clips item | 0 Fao1158 | Urine pregnancy tests item] 0 a haste diagnostic kits (must be able to test Ree 1160 | Straight Biconic tubing connector item [2 | each 161 | spare batteries for Laryngoscope item [4 | each 162 | Endotracheal Tube fixation device item [2 | each 163 | HEPA filter for tracheotomy Kit only item [2 | each 164 | Tracheotomy kit - Quicktrac preferred (Rusch product) | item | 1 | each aa aaa Set 10 drops permt with drugaccess (with | [a3 | ach 166 | Infusion set with burette - 60 drops per mL. item [10 | each 167 | Pressure infusor for giving IV fluids quickly each [2 | each 168 | IV Tourniquet item [2 | each 169 | Trauma Tourniquet (Mil Spec dial type) item [3 | each 170 | _Heimlich valve( ADAPTOR) each [2 | each 171 [3 way stop cock with dial flow item [5 | each 172 | extension for Vine item [2 | each 173 | Disposable Razors packer [1 | each 174 | Cold pack, endothermic, single use item [6 | each 175 | SAM splint item [2 | each 176 | Trauma shears (paster cutter) item [2 | each 177 | 50 ml catheter tip syringe disposable item [5 | each 178 | Non trocar intercostal catheter size FG.17 item [2 | each 179 | Non trocar intercostal catheter size FG .20. item [2 | each 180 | Non trocar intercostal catheter size FG 22. item [2 | each 181 | Rollof gladwrap item [2 | each182 | Space blanket (foil) item 10 ‘each 183 | Protective goggles item each ean rth artnet ei a ea nd el eS at em yah.GL@BAL ENERGY ANNEXURE B — RMSI CAPABILITY STATEMENTGuide to Medical Services and Emergency Evacuations Capability Statement - Comprehensive Iraq February 2011 January 2011 -1- Capability Statement: Iraq——=_ International RMSI =Ssos MEDICAL SOLUTIONS — serene ST enrounao ene 7 2. Introduction to RMSI and the International SOS / RMSI Alliancé enn 241 BRIEF OVERVIEW. e 22 CORE SERVICES. 8 222 Client Site Medical Services, 8 2.2.3 RMSI Primary Emergency Retrieval to airport or suitable stabilization point " 22.4 RMS! & Intemational SOS International Evacuation and Arrangement of Specialist Medical ‘Treatment (Primary Intemational Evacuation) 1" 225 Intemational SOS Rapatrition of the patient to Home Country Location (Secondary International Evacuation). 12 226 Intemational SOS Proect Membership. : 13 APPENDIX I~ Site Health Review... 15 APPENDIX Il - Medical Emergency Response Plan (MERP). A APPENDIX Ill ~ Client Site Medical Services ‘APPENDIX IV - Primary Emergency Retrieval APPENDIX V — International Evacuation. ‘APPENDIX VI ~ Additional Inform: APPENDIX Vil - Glossary of Terms.. February 2011 Capability Statement: Iraq—S_ International" a> RMSI~. ; Ss MEDICAL SOLUTIONS, 4. Introduction to Iraq 1.1 GEOGRAPHY, POPULATION AND CLIMATE With an area of over 400,000 km’, Iraq is the 58"-largest country in the world. Bordered by Jordan to the west, Syria to the northwest, Turkey to the north, Iran to the east, and Kuwait and ‘Saudi Arabia to the south, Iraq has a narrow section of coastine measuring 58 km (35 miles) fon the northern Arabian Gulf. The capital city, Baghdad, ic in the contre of the country. The total population of Iraq is over 31 million (IMF, April 2008), with almost 75% living in the flat, alluvial plain stretching southeast from Baghdad to Basra and the Arabian Gulf. Over 90% of the population is Muslim, with Arabic the most commonly spcken language. Several other languages are also spoken within the country (including Kurdish, Armenian and Assyrian). English is the most common foreign language spoken, although itis not widespread throughout the national population and language barriers should be anticipated. The majority of Iraq has a hot and arid climate, with mild to cold winters and dry, hot, cloudless summers. Temperatures range from below 10 degrees Celsius in the winter, to above 40 degrees Celsius in the summer. ‘Source: CIA world fact book hitos:/www.cia.govlibrervipublications/the-world-factbook/geos/iz.him! February 2071 -3- Capability Statement: Iraq4> SS international” RMSI ©. + =sos nemcusounos = Iraq can be broadly divided into three main regions: Northern Iraq — primarily Kurdish Sunni majority, it includes the cities of Erbil and io ses 0 el Bap i te tat cet eae ‘+ Southern Iraq - primarily Shia Arab majority, it includes the city of Basra. This region is, also home to a significant amount of Iraq's proven oil reserves, and is currently the main focus of the increasing activity by international oi! and gas companies. Iraq's sea port, Umm Qasr, is located on the southeastem tip of the country at the mouth of the Euphrates River. 1.2 CURRENT COMMERCIAL SITUATION The situation in Iraq is slowly improving. A decreased level of insurgent attacks and an improved security environment are helping to spur economic activity, leading to a major increase in the level of foreign investment and commercial activity within the country — particularly within the Oil and Gas sector, where proven oil reserves stand at 112 billion barrels. However only a fraction of these reserves are currently being exploited and a large proportion cf the country remains unexplored. This huge potential, coupled with the central government's strategy of rapidly increasing oil production in the near term, has resulted in a significant influx cf investment, activity, resources and expertise since the latter half of 2010, particularly into Souther Iraq, 1.3 SECURITY OVERVIEW ‘A complex array of groups has waged an insurgency against US-led coalition forces and the Iraqi government since the end of the full scale military conflict in Iraq. Armed opposition groups ‘and trans-national terrorist networks have also targeted diplomatic, commercial and humanitarian personnel and assets, as well as civilians. The security situation has improved since mid-2007; however, foreign personnel continue to face threats from suicide attacks, roadside bombings, shootings and kidnapping. Violent crime is widespread and includes carjacking, robbery, rape and murder. Although the majority of the multinational companies have strict security procedures and protocols in place to protect their employees from such risks, foreign nationals are stil an attractive target for insurgents. Transferring personnel around the country continues to require significant logistical planning and security resources. 1.4 MEDICAL RISKS In the 1970s and 1980s the Iraqi healthare system was considered to be one of the best in the Middle East. The government placed a very strong focus on international training for its doctors and complemented this with significant investment in hospital and clinic facilities as well as February 2017 -4= Capability Statement: Iraq4> —_ International” RMSI ~ = =vsos mesnee it = slate-cttheart medical equpment om Europe and the US. This high el of core was universally provided free of charge to anyone who needed it. ‘However, since the first Gulf War in 1991, and the subsequent commercial isolation of Iraq, the. national healthcare system has deteriorated significantly. Hospital infrastructure was badly affected, but the most detrimental impact has been the shortage of trained and experienced medial tat ofa dscipnes, 5 may lt the county wth fais end reoated to other countries and regions, particularly Europe, which welcomed their high level of skills and international accreditations. ‘The healthcare system is now a mere shadow of its former self and the quality and capacity of care rood wl blow th levee canlered tobe of tematonal sand. nodlon to the peor facies and cial standards avalele In local medical fects, the security concoms rearing acessing such fecites adé a futher layer of completly and rik, Particularly for foreign nationals. For several years during the height ofthe coalition military presence it was sometimes possible for certain companies, on a case by case basis, to access military medical se-vices, particularly for incidents of a ife threatening nature. This is now however, a completely non-viable part of ‘any company’s medical or security emergency response plan, as the US miltary consolidates its operations and plans for withdrawal from the country. There is now no guaranteed access to military medical treatment for any non-military staff. The resulting lack of reliable and high quality national medical infrastructure in Iraq, coupled with extreme travel security risks, requires companies to be as operationally self-sufficient as possibie. This includes the ability to adequately address the primary healthcare needs of its staff alongside robust contingency plans to deal with emergency medical incidents of both a life threatening and non-lfe threatening nature. 1.8 OTHER MEDICAL OPERATING CHALLENGES In addition to the medical infrastructure challenges and security risks, companies employing staff in Iraq face a number of other medically related challenges: ‘+ Dust storms, sandstorms and floods are regular occurrences in many parts of the country, and can have a direct impact on both the health and safety of personnel, as well as adversely affecting the ability of emergency response plans to work as expected. + Language barriers are a significant limiting factor when dealing with most Iraqi nationals. English is not widely spoken and the majority of staff in locel medical facities, are unlikely to speak any language other than Arabic or Kurdish February 2017 -5- ‘Capability Statement: Iraq4> RMSI . wenearsouros ‘+The transportation, communications and IT infrastructures within traq are subject to frequent interruptions. Most roads are sub-standard and this can have an impact on patient care and security during transport. + Road Traffic Accidents (RTAs) are a very common occurrence due to poor roads, and limited law enforcement and, coupled with the lack of reliable local medical services, present a major risk to personnel travelling within the country. + The extreme remoteness of some areas of the country necessitates access to aircraft for both general transportation and emergency response. However, aircraft options are very limited and this can present @ major challenge for organizations operating in remote locations. ‘+ Strict controls imposed by the military authorities upon aircraft flight plans limit the ability to reach much of the country after dark, which can have a major implication for ‘emergency response. ‘The medical and security challenges listed can frequently combine to create an extremely ‘unpredictable operating environment, in which a minor incident can tum into a major emergency. Even with extensive planning and preparation, itis possible for situations to deteriorate quickly 1s contingency and response plans become unworkable in a live field incident, requiring a high degree of operational flexibility and local experience. As is always the case better planning will yield more robust and consistent results, and companies should fully prepare their medical and security plans and contingencies before entering the country. 1.6 MOST COMMON MEDICAL ISSUES FACED BY EMPLOYEES IN IRAQ ‘The major medical focus of most companies planning to mobilze operations into Iraq is ‘emergency treatment in response to hostile incidents. However, these incidents in reality make up only a very small percentage of the medical issues facing staff. The majority of medical issues are the same as those faced elsewhere in similar ‘operating locations and are, most predominantly, the usual primary care issues (e.g.: coughs ‘and colds). ‘Companies operating in Iraq should therefore ensure that they have access to a broad medical ‘capability, and not rely on or plan solely for the basic trauma / emergency provision offered by the “security first aider* type of role. Below is a list of the major medical risks that companies should expect to affect their employees operating in Iraq: ‘+ Primary care: coughs, colds, flu, aches & pains etc. + Upper-respiratory tract conditions, aggravated by dust and pollution. ‘+ Weather-related conditions: heat-stroke, dehydration (ie threatening in severe cases) February 2011 -6- Capability Statement: Iraq—}_ International 4> RMSI~ = Ty MEDICAL SOLUTIONS Road traffic accidents. ‘Sips, trips and falls which can lead to breaks and sprains. Heart attacks & strokes. Accidents in the industrial environment — falls, burs, crushings, amputations, extreme bodily trauma etc. all stones (particularly in the Basra area, as a result of elevated calcium levels in the water system). ‘Snake bites, scorpion stings and other venomous animal bites. Violent and extreme trauma injury from insurgency activities, including IEDs and ‘gunshot wounds, 1.7 CHECKLIST OF MINIMUM RECOMMENDED MEDICAL SERVICES PROVISION FOR COMPANIES OPERATING IN IRAQ Based on the above synopsis of the current operating situation in Iraq and its relevant challenges, itis strongly recommended that companies employing or planning to employ staff in |raq_ ensure provision of, or access to, the following ALS-evel medical services and contingencies: v SOR 8 February 2011 A pre-deployment Site Health Review to provide companies with a detailed medical gap analysis, highly specific to the project, its exact location and its surroundings, including a detailed analysis of any existing nearby local medical facilities. Primary medical care. Emergency medical care. Trauma and resuscitation response to a life threatening medical incident. Access to an international medical air evacuation operator with proven experience of extracting patients from the nearest international airport to an international centre of medical excellence. ‘A dedicated Medical Emergency Response Pian (MERP), detailing the specific processes and procedures that will be initiated in the event of a medical emergency. Capabiliy Statement: IraqRMSI = =s0os MEDICAL SOLUTIONS 2. Introduction to RMS! and the International SOS / RMSI Alliance 2.1 BRIEF OVERVIEW Operating since 2006 in iraq and Afghanistan, RMSI is at the forefront of providing clients with medical services in hostile locations. These services range from client site medical clinics staffed by fully qualified and internationally trained RMSI medical personnel through to emergency medical stabilization supported by rapid response domestic and international evacuation capabilities. With hundreds of life saving MEDEVAC missions successfully completed, RMS! is the only fully integrated international standard hostile area medical company operating in Iraq and ‘Afghanistan, Clients include the United Nations, the United States Department of Defense and ‘number of the major Oil and Gas producers. Working in a close operational alliance with International SOS, the world’s leading international healthcare, medical assistance and security services company, RMSI offers a range of roducts in combination with International SOS that deliver Iraq-based alients a fully integrated ‘medical solution, from ground based primary care through to rapid response international evacuation and repatriation to home country. 2.2 CORE SERVICES 2.2.1 Pre-Deployment Site Health Review + ASite Health Review (SHR) before (or soon after) the first site mobilization is the most effective HSE tool for a client to objectively understand current local medical capabilities, including their availabilty, quality and suitabilty for use as a stabilization or treatment point. ‘+ Intemational SOS doctors perform the Site Health Reviews in Iraq fully in line with its global standard SHR methodology. ‘+ Client receives a comprehensive and clear document of medical recommendations for the specific site activity and location, with relevant reference to :hird party local medical facilities and emergency medical services. ‘+ SHR assists in the development of the site level Emergency Response Plan (ERP), Which details the protocols and procedures to follow for te primary emergency retrieval. + Avery cost effective engagement of just a few days, deli terms of the client's HSE policy and strategy. ‘© See Appendix | for a description of a Site Health Review. ring a high value-add in 22.2 Client Site Medical Services ‘+ RMSI Site-based Medical Staff February 2011 Capabilily Statement: Iraq,RMSI * =sos MEDICAL SOLUTIONS ‘Supply of single or multiple medical personnel to client sites on a 24/7 basi Fully trained RMSI doctors, nurses and paramedics with intemationally recognized qualifications and with specific emergency care and stabilization skills. Equipped to perform a wide range of routine and emergency medical care services on-site, Either expatriate or local national medical staff available, as per client requirements. Mult-site staffing capability using a hierarchy of medical resources to serve ‘main camp and fly camp operations as required. International medical staff can be sourced from South Africa, Australia, New Zealand, the United States, the UK and Germany, among other locations, due to speciic EMS skillset competencies within those courtries. Specific client requests for doctors of other nationalities can be discussed upon request. Local netional doctors can be sourced, however they are in very short supply, land are required by the Iraqi Government to work for a period of time every month in local public healthcare facilities — their availabilty cannot always be ‘guaranteed for the duration of the project. Staff are predominantly experienced in providing emergency care in remote or hostile environments. Al staff are fully trained in RMSI's Clinical Practice Manual and treatment protocols and work under the medical oversight of the Dubai-based Chief Medical Officer and Divisional Manager of Clinic Services, and the Basra- based lraq Country Manager and Clinic Manager (who is also a medical professional). Staff are available to respond off-site to an emergency response situation in the local area as per prevailing security protocols and contractual agreements. Staff are available to accompany patients during ground transfers to a local trauma stabilization facilty or Intemational evacuation point (airport) as per prevailing security protocols, clinical requirements and contractual agreements. RMS! Staff are not contracted to operate in the capacity of “Personal Security Detail Medics” (“Close Protection Medics’). This role would be carried out by Securily First Aiders provided by a client's security company. Any exception to this wouid need to be discussed and contracted in advance between the client ‘and RMS! Head Office. RMS! staff cannot be equipped with firearms except under very specific conditions to be discussed and contracted in advance between the client and RMS! Head Office. MSI supplies staff as part of an integrated medical solution contract, and does not act as a medical recruitment consultant on behalt of clients wishing to February 2011 -9- Capability Statement: Iraq4> —_ International” RMSI -. S=vso, wenrearsounons © = ‘omploy medical staff dectly. Medical staff based at client stes remain, at ell times, under the direct employment of RMSI. ‘+ RMS! supply of clinical equipment, consumables and medication and ambulances for client sites © Sourcing and rental (or sale) of medical equipment at cient sites, © Sourcing and sale (or rental) of site clinics (shipping containers or similar, fitted out with electricity, water, and necessary medical equipment) # client requires. (© Provision of a wide range of medication and medical consumables to client sites. © Sourcing, on behalf of clients, of fully equipped ground ambulances for emergency response both on-site and off-site (either soft-skin or B6 armored vehicles as per client security protocols). See Appendix IV for ground ambulance details. © Sourcing and supply of incidental medical equipment for site population usage ‘and contingency planning - First Aid Kits and Automatic External Defibrillators (AEDs). © Full scalabilty of all services and equipment depending on the client's Population size, scope of work, and complexity of clinical requirements. © Please note that RMSI are not able to supply equipment, medication, consumables or ambulances to clients that are not also using RMS! Medical staff as part of an integrated site medical solution. ‘+ RMSI and international SOS full clinical, emergency and evacuation support ‘© 24/7 integration of each site with the RMSI Chief Medical Officer and Divisional Manager of Clinic Services in Dubai, and the Basra-based RMS! Iraq Country Manager for clinical support, second opinions, treatment protocols and ‘emergency stabilization support. ‘© 24/7 integration of each site into RMSI's Mission Response Center in Dubai - and subsequent seamless access to any of the 26 alarm centers of International SOS for specialist clinical support and multilingual assistance in over 90 languages - including activation of Medevac resources (see 2.2.4 and 2.2.5 for evacuation information). © Full coordination of initial primary emergency retrieval from incident site to suitable stabilization point or point of international evacuation (airport), primary intemational evacuation to the nearest centre of medical excellence and subsequent repatriation onward to home country if required February 2017 ~10~ Capability Statement: raqRMSI =”: =sos MEDICAL SOLUTIONS 2.23 22.4 RMSI Primary Emergency Retrieval to airport or suitable stabilization point The site level ERP developed following the SHR will provide the initial ground ambulance evacuation protocols and procedures to follow in the event of a medical ‘emergency. ‘The RMSI Mission Response Center, Country Manager, and the client's site based medical staff work with the client to organize and coordinate transport of the patient from the incident site to either a suitable primary stabilization point and/or international ‘evacuation point (nearest international airport). Note: It remains the client's responsibilty to ensure the availability of ground ambulance transport capability (either soft-skin or armored, with driver) and appropriate security protocols, in order to allow RMSI staff to respond to on- and off-site emergency situations, including the transport of the patient to the point of intemational evacuation. (This can potentially be procured by RMSI at the request of the client, however). ‘There will always be a significant security element to any ground ambulance movement ‘or emergency ground response requirement and the company's site level ERP, Medical Emergency Response Plan (MERP) and project operating procedures need to be fully aligned to their emergency and security response procedures (see 2.2.6 and ‘Appendices | and Il for more information on the site level ERP and MERP).. The site level ERP will list protocols for this operation although, in a live emergency incident, operational flexibility is often required due to circumstances beyond immediate ‘control (usually weather or security related). RMSI can (potentially) activate a Bell 412 HP Helicopter for primary emergency retrieval within a radius of approximately 200 miles (300km) of Basra airport (only landing at secured locations, and not, for example, at roadside emergencies). Availabilty is inconsistent and the helicopter is not a dedicated resource as it is also used for general passenger charters and is therefore frequently unavailable, It is also not permitted to fly at night. Clients should therefore always create robust ground ‘emergency response plans, RMSI & International SOS Intemational Evacuation and Arrangement of Specialist Medical Treatment (Primary International Evacuation) Utlizing RMSI's dedicated Dubai-based Hawker 800 XP aircraft or, during mutt- ‘casualty or overflow missions, Intemational SOS' Abu Dhabi-based Learjet 45, Patient transported to the nearest regional centre of medical excellence (generally the United Arab Emirates, however other destinations may more appropriately meet condition specific requirements). Each aircraft is fully equipped with ICU facilities, and staffed with extensively ‘experienced flight medical personnel February 2077 ~11- Capability Statement: Iraq— International” a> RMSI = Ss MEDICAL SOLUTIONS 225 ‘Seamless bed-to-bed transfer of the patient coordinated by the RMS! Mission Response Centre and Intemational SOS alarm centre, ensuring that the patient is safely and efficiently delivered to the appropriate care facility in the United Arab Emirates for specialist medical treatment. Full pre-booking of the appropriate specialist medical facility and guarantee of payment {for medical treatment. (Ongoing medical case management as required, including full updates to company and/or relatives until resolution of treatment and patient departure (90 languages spoken by International SOS staff, allowing for case management in the local language of the patient if required). ‘The access to intemational evacuations from Iraq and arrangement of specialist treatment in a centre of medical excellence for all patients is linked to a valid client Intemational SOS Project Membership agreement at the client site, In order to minimize any potential delays, particularly in time-critical emergency ‘evacuations, all patients and their companions should be in possession of valid passports and associated entry / exit visas, where appropriate, so that customs clearances can be obtained as quickly as possible. Intemational SOS Repatriation of the patient to Home Country Location (Secondary International Evacuation) If required either by the client company or if clinically indicated, patients can be transferred from the United Arab Emirates onwards to their home country or other international destination. Intemational SOS utilizes its dedicated Learjet 45 aircraft based in Abu Dhabi, fully ‘equipped with ICU facilities, to transport the patient, with full bed-to-bed transfer upon arrival o a suitable specialist medical facility. Full pre-booking of the appropriate medical facility and guarantee of payment for ‘medical treatment. ‘Ongoing medical case management as required, including full updates to company andlor relatives as required until resolution of treatment and patient departure (0 languages spoken by Intemational SOS staff, allowing for case management in the local language of the patient if required). ‘Access to secondary international evacuations and arrangement of specialist medical care is linked to a valid client Intemational SOS Project Membership or Corporate ‘Membership agreement. February 2011 ~12- Capability Statement: IraqRMSI * =sos ‘MEDICAL SOLUTIONS. 2.26 Intemational SOS Project Membership Intemational SOS Project Membership provides access for all employees, contractors ‘and subcontractors working at client's site to the emergency international evacuation resources of International SOS and RMSI. Please see 2.2.4 and 2.2.5 for further details on international evacuation capabilites. Includes a site-specific Medical Emergency Response Plan (MERP), which: Provides a clear set of pre-defined procedures to folow in the event of a medical emergency, including clear escalation protocdls, the location of the nearest stabilization point and method of international evacuation © Ensures that all staff on-site have the ability to react and escalate consistently in a medical emergency. © Ensures that RMSI and Intemational SOS have clear visibility over the site, for the provision of support and assistance to the medical personnel on-site and the capability to activate an international air evacuation when necessary. 24/7 access to International SOS' global network of 26 alarm centers from site for ients, 9 Includes 24/7 telephone access to home-language Intemational SOS medical teams by Iraq-based clients (e.g. Arabic, Kurdish, Mandarin, Japanese, ‘Spanish, Portuguese, or Russian speaking physicians). Emergency response and ongoing patient case management in up to 90 languages, reducing the dificuties presented by language barriers in emergency situations. Guarantee of Payment agreements in place with all accredited providers ensuring that the patient receives immediate and seamless access to the most clinically suitable specialist facility without having to worry about payment for treatment. Liaison directly with client’s insurance company if required by the client, for the purpose of direct invoice settlement. Project Membership ensures the close integration of the site level ERP, the MERP, the project operating procedures, and any other site or client specific operations and billing procedures, s0 that the site is able to benefit from the fully integrated, end-to-end service provided by RMSI and Intemational SOS. Intemational SOS Project or Corporate Membership clients who employ the services of “Security ‘medical support from the RMSI paramedic and/or a physician ir the Intemational SOS ‘Alarm Centre. t-Aiders” will be able to benefit from these persomel receiving hands-on 1m practice, all medical cases arising on the site (even for minor conditions) should initially be escalated to the medically qualified RMSI paramedic for diagnosis and treatment. In the event that the RMS! paramedic is not immediately availeble, the Security First- Aider will attend to the patient while the RMSI paramedic travels to the patient. During February 2077 ~13- Capabillty Statement: Iraq4> —S—_ International" RMSI ~ =sos MEDICAL SOLUTIONS < ar this transtional phase, the Securly First-Aider may calla physician inthe International ‘SOS Alarm Centre and/or the RMSI paramedic to receive remote advice on how best to manage the patent. February 2011 14 Capability Statement: Iraq—_ International RMsI ~; =s0s MEDICAL SOLUTIONS APPENDIX | ~ Site Health Review A Site Health Review (SHR) is a structured and systematic analysis of the medical risks present in @ particular area for a particular site, with a focus on determining the appropriate initial procedures and protocols to follow in the event of a medical emergency. Performing a Site Health Review before (or soon after) the first site mobilization is the most effective HSE tool for a client to objectively understand current local medical capabilites and the quality and suitability of any local medical facilities. Extensively experienced Intemational SOS doctors perform the Site Health Reviews in Iraq fully in line with its global standard SHR methodology, producing a ‘comprehensive report highly tallored to the particular site's operating procedures and unique environment, ‘An Intemational SOS Site Health Review evaluates: + The standard of medical provision at the site (either current or planned), to determine ‘any areas that need to be addressed. + Health hazards in the area e.g. infectious diseases. + The quality of local hospitals, clinics, and any other medical facilities in the area, including their capabilities and the standard of care available. + The most appropriate location or facility for emergency stabilization of a patient. + The location of the nearest international evacuation point (airport). * Distance to each facility and evacuation point, including the most appropriate mode of transport, the expected journey time, and any other relevant factors (such as weather Conditions etc.) that may affect the journey. Site Health Review Methodology + Site/ location visit: typically @ 2-3 day visit to the site, incorporating an analysis of the various local medical facities in the area and interviews with key stakeholders, in order to audit the medical facilities and available resources. + Analysis and report writing: this involves the collation and analysis of all data collected from the interviews and audits; prioritization of health hazards identified, and elaboration of recommendations to mitigate those hazards. + Peer review and client final approval: the final report is then reviewed by qualified and experienced intemal medical personnel, with independert oversight from the International SOS regional medical director. Upon completion of the SHR, the client receives a comprehensive and clear document of medical recommendations for the specific site activity and location, wih relevant reference to third party local medical facilities and emergency medical services. The report provides recommendations for the company to help mitigate risks, and is usually used to develop a detailed site-level Emergency Response Plan ("Site Level ERP"), which details the initial February 2077 ~15- Capability Statement: Iraq4> ——_ International RMSI © = =Ssos MEDICAL SOLUTIONS: — RMSI ~ 3 =Ssos (MEDICAL SOLUTIONS.

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