A physician working in offshore units (such as oil and gas platforms, drilling vessels, or other remote locations) performs diverse and crucial functions due to the high-risk environment, isolation, and specific challenges of these operations. The required skills involve the ability to make quick decisions in critical situations, expertise in occupational health and medical emergencies, resilience to work in isolated environments, and knowledge of maritime regulations and occupational safety.

Additionally, the physician has daily, occasional, weekly, monthly, bi-monthly, semi-annual, and annual tasks, all controlled under a strict schedule. This is because there is constant interaction with various sectors of the unit, the onshore office, and compliance with laws, standards, and regulations governing our activity.

Our daily routine fundamentally revolves around medical care, which includes conducting clinical consultations (due to constant exposure to extreme temperature variations, we see numerous cases of the common cold, upper respiratory infections, and polymyalgia, typically treated with symptomatic medications). This involves diagnosing and treating common conditions such as fevers, infections, and pain. We also monitor chronic diseases in workers, such as hypertension and diabetes. Additionally, we provide first aid and emergency care for workplace accidents, such as trauma, lacerations, burns, or chemical exposures, stabilizing patients until they can be evacuated in medical emergencies.

It is important to note that advanced care begins on board, as we have all the necessary equipment and supplies to treat patients with severe clinical conditions, such as trauma or cardiovascular decompensations. Surgical cases are stabilized and evacuated to shore, and in units without physicians, telemedicine is utilized. In such cases, the healthcare professional on-site is typically a nursing technician, nurse, or a Navy officer with basic medical training.

We are responsible for ensuring the occupational health of the crew by evaluating working conditions to prevent accidents and illnesses related to the offshore environment. This includes conducting health and environmental safety inspections and monitoring exposure to hazardous agents such as noise, vibration, extreme temperatures, and chemicals.

As part of health and safety management, we are responsible for emergency planning, developing, and reviewing medical evacuation (Medevac) plans, and participating in rescue and evacuation training in case of severe accidents or disasters. These training sessions are typically conducted weekly, engaging the entire crew in the procedures.

We also manage medications and equipment by maintaining inventory control, ensuring proper stock levels, and monitoring the validity of medicines and first aid materials. Furthermore, we handle medical and legal documentation by recording treatments, issuing reports, and maintaining regulatory compliance.

We play an essential role in health promotion on board, conducting lectures and training on disease prevention, ergonomics, first aid, and healthy lifestyle habits. Preventive planning is also a key aspect, including organizing vaccination campaigns, infectious disease control programs, and monthly health awareness initiatives (e.g., Blue November, Yellow October, Orange December).

Psychological support is another fundamental aspect, primarily due to the close emotional ties formed with the crew. Offshore workers spend half their lives on board, naturally developing strong bonds with the physician and fellow crew members. Identifying signs of stress, fatigue, isolation, or depression is crucial in providing initial support and referring workers to specialists when necessary.

A crucial aspect of offshore medical work is interdisciplinary collaboration. Physicians must interact with safety technicians, engineers, radio operators, operations managers, and all personnel to ensure a safe and healthy environment. It is important to emphasize that safety culture is deeply ingrained in offshore companies.

The Emergency Team Training, including first aid and Basic Life Support (BLS) training, is essential to ensure the physician has adequate support in life-threatening situations.

On a daily basis, some tasks are essential for the proper functioning of the unit. We need to send the previous day's attendance sheet to the manager, check our corporate email and process requests, such as material requests and medications or receiving reports. We also monitor the temperature of the refrigerator where the medicines are stored, we carry out a daily test of the water and forward it to the responsible chemist. During working hours, we serve patients and record care, file medical forms and we control the ASOs. Additionally, we keep inventory spreadsheets updated of medicines and materials consumed, as well as personnel control. In some units, doctors also organize shift change schedules and manage team overtime.

Weekly, we carry out hygiene inspections throughout the unit, we train the Medical Team (First Aid Team) and participated in Drill, a realistic training previously mentioned that simulates situations such as gas leaks, fires and rescues in difficult to access places. We also inspect the containers of food that arrives on board, ensuring that the products are intact and within the validity period for consumption by the crew.

Every fifteen days, we carry out a detailed check of the equipment hospital devices, such as mechanical ventilator, monitor, electrocardiograph, nebulizer, flashlights and laryngoscope, recording all checks on a specific form.

Every month, we carry out specific tasks that require strict control. We collect drinking water samples for analysis and send to land, discard hospital waste and expired medicines whenever the bottles are full and We check the controlled medications with the unit manager. Also We carry out inspections of essential equipment, such as washing stations, eyes (Eye Wash Stations), First Aid Kits, Burn Kits, stretchers, oxygen cylinders and defibrillators. Furthermore, we monitor the pest control service and participate of the Safety Meeting, which addresses topics related to health prevention.

Less frequently, but equally important, are the bimonthly tasks and semiannually. Every two months, we place orders for materials and medicines, while every six months we send water tests for analysis on land. In the cycle Annually, we check the equipment certificates, the cleanliness of the air ducts, conditioning and air quality, in addition to issuing the Maritime Health Declaration required by ANVISA.

Finally, there are occasional demands that require immediate attention, such as coordination of MEDEVAC in cases of medical emergency or the disembarkation of patients by regular flight in less urgent situations. We also collect and proper disposal of sharps boxes (Descarpack), we inspect external vessels and forward reports to the Navy, in addition to receiving and archive chemical product safety data sheets (MSDS/MSDS).

As described, offshore medicine involves extensive responsibilities, all governed by strict regulatory standards. Ideally, offshore physicians should have training in both Occupational Medicine and Emergency Medicine—a crucial innovation, particularly for companies classified under risk level 4 according to CNAE.

Among the four risk levels, this category requires the highest number of legal obligations concerning occupational health and safety. Moreover, the challenging access to offshore drilling/production units, which require helicopter transport beyond 35 nautical miles (as per NR 37), further complicates medical evacuations. Many of these units are mobile (self-positioning or not) and rely on satellite communication for internet and telephony, which can be unstable due to meteorological variations, limiting telemedicine capabilities.

Given that most offshore health services rely on nurses and/or nursing technicians rather than physicians, telemedicine shifts from being a consultative process (between doctors) to a problem-solving one (between a doctor and a non-doctor).

The isolation factor significantly increases risk, as patient transport—whether trauma-related or for urgent medical conditions—depends on weather conditions that can suspend aerial operations for days. In scenarios where communication with shore (call center) is lost and aeromedical evacuation is impossible, the presence of a physician becomes essential in managing life-threatening emergencies.

Currently, most units have a single doctor, nurse, or nursing technician on board, but ideally, there should be a full team comprising a physician and a nurse or technician. Health care is a team effort, and every member is vital in sustaining life. Having both a doctor and a nurse working together would significantly increase survival rates in critical cases.

The common argument against this setup is that severe cases account for less than 5% of medical incidents, making a complete team financially unjustifiable.

But among those 5%, how many lives could be saved with a full team on board?

What impact does a fatality have on crew morale?

What is the cost of a life?

About the Author: Max Pinheiro de Farias Junior is Medical Colonel, Rio de Janeiro Military Fire Department Member, Technical Chamber of Emergency Medicine, CREMERJ Member, Technical Chamber of Patient Safety, CREMERJ, MBA in Strategic and Economic Human Resources Management, FGV RJ and Postgraduate in Cardiology, IPGMRJ.