Doc. No.

: ETP/IV/HSE-MEP/ETP#03/DOC-01/08

Issued Date: 26th August, 2008

MEDICAL EMERGENCY PLAN (MEP)

Sub tier document to Emergency Response Plan

PERTAMINA GEOTHERMAL ENERGY

LAHENDONG
 MEDICAL EMERGENCY PLAN

TABLE OF CONTENT

1. Purpose....................................................................................................................................................3
2. Scope.......................................................................................................................................................3
3. Definition of Medical Emergency .............................................................................................................3
4. Reference ................................................................................................................................................3
5. Responsibilities ........................................................................................................................................3
6. Medivac Preparation................................................................................................................................4
7. First Aider.................................................................................................................................................4
8. Medical Personnel Support......................................................................................................................4
9. Transportation..........................................................................................................................................5
10. Category of Injury / Illness .......................................................................................................................5
11. Incident/ Accident Even Log ....................................................................................................................5
12. Medivac Scenario ....................................................................................................................................6
13. Drill / Exercise ..........................................................................................................................................6
14. Refferal Hospital & Medical Insurance ....................................................................................................6
ATTACHMENT 1 – INCIDENT MANAGEMENT TEAM / IMT............................................................................7
ATTACHMENT 2 – MEDIVAC PROCEDURE ...................................................................................................8
ATTACHMENT 3 – BETHESDA HOSPITAL FACILITY (NON LIFE THREATENING REFERRAL ONLY) ......9
ATTACHMENT 4 – EIAMC HOSPITAL FACILITY (MAIN REFERRAL HOSPITAL) ...................................... 10
 MEDICAL EMERGENCY PLAN

1. Purpose
1.1 The purpose of this procedure is as the sub tier of the main Emergency Response Procedure to
provide detail actions specific to the emergency medical situation.

2. Scope
2.1 The Medical Emergency Plan applies to all PT. Energi Tata Persada employees, subcontractors and
visitors as well as entirely consortium member who work on site.
2.2 The Medical Emergency Plan covers on site activities including the well site where the personnel work
at as well as base camp area, or mobilization/transportation from/to the well site or base camp.

3. Definition of Medical Emergency

3.1 Medical Emergency is defined as a serious injury or illness, which is a potential danger to life, limb or
an organ. Under all these critical situations this Medical Emergency Plan will be used as a basic
guideline to do a medical evacuation - medivac.

4. Reference
4.1 This document references Section 5; of the PT. Energi Tata Persada Site HSE&T Procedures.

5. Responsibilities
5.1 Rig Superintendent:
• Manage First Aid Team within their respective area.
• Give alert to related groups if there some high probability of medivac case.
• Responsible to arrange transportation from the site of incident/accident to medical pickup point,
• Coordinate with Rig Doctor on duty during medivac situation.
• Coordination with Incident Management Team.
• Write notes and remarks Accident / Incident even in the Accident / Incident even log.
5.2 First Aid Team
• Responsible to manage all the first aid equipment.
• Give first aid treatment to the Injured Person.
• Communicate Injured Person condition with Rig Doctor on duty.
• Escort Injured Person during transportation to Rig Doctor.
5.3 Rig Doctor on duty
• Assist Rig Superintendent to manage First Aid Team on each flow stations.
• Provide first aid training and refresh as per performance contract to the work force.
• Discussed IP – Injured Person condition with Duty Roster Doctor in the referral hospital, and
decide category of injury, and treatment plan for the Injured Person.
• Monitor IP condition during transportation to escort Injured Person if required.
• Notes and remarks Accident / Incident even in the Accident / Incident even log.
5.4 Jakarta IMT – Incident Management Team
• Communicate with Field Incident Management Team when the evacuation procedure is activated.
• Provide immediate approval on the type of evacuation used by the Field IMT.
• Classify and decide the type and class of accident.

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5.5 IMT – Administrator

• Arrange proper communication between Field IMT and Jakarta IMT.
• Coordinate with ETP ambulance, Referral hospitals and Evacuation provider.
• Provide immediate administration information to referral hospital and evacuation provider when the
evacuation procedure is activated.
5.6 Field IMT – Incident Management Team
• Communicate with Rig Doctor on duty; provide advice of medical action should be taken.
• Coordinate medical evacuation from Rig Site to designated hospital.
• Coordination with the contractor to ensure any required facility arrangement such as ambulance,
medic and hospital available.
• Monitoring IP’s condition and ensure that IP got good treatment in the hospital.

6. Medivac Preparation
6.1 Elements should be prepared before the medivac happened such as:
• First aid team arrangement
• Medical personnel support
• Transportation arrangement
• Guideline for the category of injury and illness
• IMT support and communication.
• Incident / Accident even log.

7. First Aider
7.1 Rig Superintendent is responsible to arrange First Aid team (trained and assigned personnel) to take
an action in any incident. Rig Superintendent with assistance from Rig Doctor is responsible to ensure
that the team is ready and provided with knowledge to perform first aid to the Injured Person.
7.2 The arrangement of First Aid team should include:
• Trained First Aid training.
• Stretcher, first aid box, medicine, at flow station and transportation to the aircraft.
• Personnel assignment on flow station.
7.3 On the flow station where Rig Doctor available, he will act as the leader of the First Aid team.
7.4 Rig Doctor in coordination with Rig Superintendent will provide arrangement of first aid training and
schedule.

8. Medical Personnel Support

8.1 Rig Doctor should be ready at any time to assist Rig Superintendent and the first aid team, if required
the Doctor will provide with transportation to reach the Injured Person, decision whether the doctor or
the Injured Person that will come, should be decided by the Rig Superintendent based on the fastest
transport available and any scenario of medivac.
8.2 Rig Doctor located at Quarters as the coordinator will establish communication with IMT, he should
monitor the condition of the Injured Person, decide who will escort the Injured Person and coordination
with on IMT on what action plan that will perform to treat the Injured Person.
8.3 IMT will be responsible to arrange Injured Person treatment from rig site to hospital, this include
communication with field evacuation team, assurance on the ambulance arrangement, ensure that the
Injured Person is appropriately handled in the hospital.
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9. Transportation
9.1 Transportation in medivac is one important element to ensure that the injured/illness is evacuated time
effectively.
9.2 In order to get a clear authorization, the transportation plan is divided into two categories:
• Ground ambulance from Rig Site to Bethesda hospital.
• Ground Ambulance from Rig Site to EIAMC hospital.

10. Category of Injury / Illness

10.1 Rig Doctor is the person to decide category of injury/illness based from the information and self-
evaluation to the Injured Person. There are two categories of injury / illness.
10.2 Life Threatening: Injury / illness that require immediate medical evacuation and or require hospital
facility treatment, which could not provided at rig site. This Injury / illness such as:
• Acute Heart Attack
• Back bone Injury
• Stroke
• Loss of consciousness
• Shock & comatose
• Wound burn > 20%
• Open fracture (except on the fingers)
• Acute Abdominal Disease (Ileus & intususepsi hernia incarserata)
• Head Injury
• Close fracture (except on the fingers)
• Moderate wound burn
• Appendicitis acute (depend to travel hours)
10.3 This category should be evacuated to the main referral hospital (EIAMC Hospital) as soon as possible
by the Ground Ambulance from Rig site to Manado.
10.4 Non Life Threatening: Injury / illness which can be treated with available at Rig site medical facility,
this type of injury / illness will be evacuated using normal crew change, Doctor will closely monitor the
condition during waiting for the transportation. This Injury / illness such as:
• Fever
• Moderate high blood pressure
• Wound burn < 10%
• Mental Illness
• Out-break category of infection disease (Chicken pox, eye infection).
10.5 In certain case where the illness is epidemic, Rig Doctor shall ensure isolation for the Injured Person to
avoid spreading the epidemic to other personnel while waiting the transportation is available.
10.6 The needs of evacuation for this case will be referred to either Bethesda Hospital or EIAMC hospital
considering the severeness of the case.

11. Incident/ Accident Even Log

11.1 To monitoring and evaluate the implementation of this procedures, an Accident / Incident even log
should be filled up by all related parties such as Rig Superintendent, Rig Doctor and Site HSE&T
Personnel.

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11.2 All detail even that related to the Accident / Incident should be recorded and this even log should be
kept and file then will be use for evaluation of the Incident / Accident response performance.

12. Medivac Scenario

12.1 Incident or accident could happen at any time and anywhere, when this happened, it should be
reported immediately to Rig Superintendent.
12.2 Following are steps of procedures to ensure the medivac is performed appropriately.
• First Aid team responsible to secure the Injured Person and treated appropriately. In case where
the first aid team not on the incident/accident site, the closest person will secure the Injured
Person into a safe place and communicate the condition to Rig Superintendent for further action.
• Rig Superintendent and First Aid team responsible to give the best effort to evacuate the Injured
Person to a safe place (Medical Center at Rig Site).
• Rig Doctor on duty communicates the Injured Person condition with Incident Management Team.
Discussed and decide injury category of the Injured Person
• Rig Superintendent responsible to arrange communication with Rig Doctor on duty and PGE
Company Man, for further evacuation plan and onshore support.

13. Drill / Exercise

13.1 Drill or exercise for this procedure should perform quarterly. Rig Superintendent should develop
scenario of medivac then run the drill / exercise. All even during exercise should be recorded in the
Accident / Incident Even Log.

14. Refferal Hospital & Medical Insurance

14.1 PT. Energi Tata Persada as the main contractor for this Drilling project has an agreement with both
Bethesda Hospital and EIAMC Hospital regarding the appointment of those hospitals as the referral
hospitals in Manado.
14.2 Referral hospital facilities will be specifically used in the emergency case arrangement and only can be
activated with the Rig doctor referral letter, with refer to point 10 of this document.
14.3 Form ETP-HSE-SF-C-01 Personal Medical Database should be filled by all personnel working at the
Rig site. Form ETP-HSE-SF-C-09 Emergency Medical Identification then will be prepared by the Site
doctor and to be kept by each personnel when he work at site.
14.4 The forms in 14.3 are to be used as identification form by the referral hospital in case of emergency.
14.5 Claim on the cost of the medical facilities to the referral hospital will be reimbursed to the related party
as it will be charged first to PT. Energi Tata Persada unless the Injured Personnel has been covered
by his/her company or insurance.
14.6 Insurances those are accepted by the main referral hospital – EIAMC as follow:
• SOS
• Allianz Gold & Platinum
• Manulife
• BNI Life
• Sinar Mas
• Bakri Life

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 MEDICAL EMERGENCY PLAN

ATTACHMENT 1 – INCIDENT MANAGEMENT TEAM / IMT

JAKARTA INCIDENT MANAGEMENT TEAM

PGE Representative : I Ketut Sujata (Drilling Manager)
IPM Coordinator : Prapseno Danusubroto (Operation Manager)
Hasta Hartoko (Engineering Manager)
ETP Rig Division : Roger Boyko (General Manager)
Andreas Krisbayu (HSE&T Manager)
Member of Consortium : Agus Sutomo (PT. Dowel Anadril Schlumberger)
Yudhi Dahlan (PT. Dyfco)
Bambang Widjatmiko (PT. Prima Hidrokarbon Internusa)
Noer Kholis (PT. Pancuran Karya Mukti)
Jan Silitonga (PT. Halliburton)

MEDICAL FACILITY SUPPORTS

IMT ADMINISTRATOR 1. Evacuation Transport by

Ambulance
ETP Occupational Health & 2. Referral Hospitals
Training Coordinator (OH&T): Bethesda, EIAMC Hospital
Geoffrey Ramschie 3. Administration Purpose
In coordination with IPM

FIELD INCIDENT MANAGEMENT TEAM

PGE Representative : On duty Company Man

Field IPM Coordinator : On duty Field IPM Coordinator
ETP Rig Division : On duty Rig Superintendent (FIELD IMT COMMANDER)
On duty Field HSE&T Personnel
On duty Rig Doctor
Member of Consortium : On duty Supervisors

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ATTACHMENT 2 – MEDIVAC PROCEDURE

Medivac Activated

Response to ERP Appendix Five

Rig Doctor to analyze

condition of IP

Field IMT to activate Jakarta IMT for

evacuation approval and
acknowledgement

IMT Administrator to
coordinate with medical
support providers

Administrative Arrangement

Life NON LIFE

threatening or THREATENING
Non-Life
threatening

LIFE
THREATENING Ground Ambulance
Evacuation

Ground Ambulance
1st Stage of Medivac Evacuation
1. BETHESDA Hospital
2. EIAMC Hospital

EIAMC Hospital

2nd Stage of Medivac

nd
2 stage of Medivac will only be done as advance evacuation &
treatment.
SILOAM Hospital – Jakarta has been appointed by ETP as the center
of advance evacuation on this stage.
Evacuation will be through commercial flight or SILOAM charter flight.
Evacuation escort team will be appointed by the ETP Management in
nd
case there’s a need of the 2 stage of medivac.

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ATTACHMENT 3 – BETHESDA HOSPITAL FACILITY (NON LIFE THREATENING REFERRAL ONLY)

EMERGENCY ROOM

ER Surgery Room

ICU / ICCU

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ATTACHMENT 4 – EIAMC HOSPITAL FACILITY (MAIN REFERRAL HOSPITAL)

EMERGENCY ROOM

ICU / ICCU

ULTRASONOGRAPHY SURGERY THEATRE

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