INPEX maser.a..7o.

INPEX MASELA, LTD. ABADI GAS FIELD DEVELOPMENT

PLAN
SAUMLAKI MEDICAL EMERGENCY RESPONSE PLAN (MERP)
Document No. C0120-999-HE-PLN-0001
Information Security Classification
B: BUSINESS INFORMATION
Revision
Date
Description
Prepared Checked Endorsed Approved
6.0
08 MAY 2017
Major changes
(Changes of organizational | Health Advisor | Security Advisor | HSSE Mgr. HSSE Sr. Mgr.
structure and all Medevac
support)
Royanul Arief | Lalu Yusvianto Dadang P. Nicholas Kauffiman
5.0
15 SEP 2015
Major changes
(Changes of Air Medevac
contractor)
This Document is the property of INPEX MASELA, LTD. and the copyright therein is vested
in INPEX MASELA, LTD. All rights are reserved. Neither the whole nor any part of this
Document may be disclosed to others or reproduced, stored in a retrieval system or
transmitted in any form by any means (electronic, mechanical, reprographic recording or
otherwise) without prior written consent of the copyright owner.
Any hardcopy print of this Document should be regarded as “Uncontrolled” and the user is
responsible for verifying that it is still valid before using it (i.e. it is the latest version
available in PIMS).
INPEX MASELA, LTD. Doc. No.: C0120-999-HE-PLN-0001 & 9 ABADI GAS FIELD
DEVELOPMENT Revision No.: 6.0 PLAN Date: 08 MAY 2017 A SAUMLAKI MEDICAL
EMERGENCY Page: 20f 28 INDEX mesma.ro. RESPONSE PLAN (MERP)
Copy No. | Name Hard Copy Electronic Copy 00 Document Control w w 01 All Jakarta Office
Members — w
The information contained in this Document is confidential and for the use of INPEX
MASELA, LTD., and those with whom it contracts directly and must not be communicated
to other persons without the prior written consent of INPEX MASELA, LTD. Any
unauthorized use of such information may expose the user and the provider of that
information to legal action.
Information Security Classification B

INPEX MASELA, LTD. Doc. No.: CO 20 OgoEs & 9 ABADI GAS FIELD DEVELOPMENT
Revision No.: 6.0 A A DI PLAN Date: 08 MAY 2017 AAA SAUMLAKI MEDICAL EMERGENCY
RESPONSE PLAN (MERP) Page: 3of 28 TABLE OF CONTENTS 1. PURPOSE moon
nannnenenae rena 5 2, SCOPBE m.oooooco.W#”(( 0m 5 3. GOVERNANCE &
COMPLIANCE........oo momo aer 5 4. AFFECTED ORGANISATIONAL DEPARTMENTS
....oooooomoomoomatetan H.. 6 5. PROJECT RE@UIREMENTS oom mean kana 6 51 Project
DetailS................oooooooooooooobee teen 6 5.2 Business Processes................oooo oom 6 5.2.1
Resources, Action and Target Response Time .................oo.Woooo 6 5.2.2 Management of
Ill/Injured Patient (IP)... 7 5 2 3 Medical Evatilatiofi ........»...ooo oo. answ mens ceme sean
enreneene nenen ENAK 9 5.2.4 Estimation tiMe ..............oocWoWoW Women 11 5.2.5 Case
Management... teen 12 6. CONTRACTOR REO@UIREMENTS......... oom men
ennnnaenenennaaaanaaaan 12 61 PETSOMMEL........oooooooooooo WWW. mean aan 12 6.2
Tracking and Reporting....................ooooWoWoWo0Woeneeeneeeeneeaaaaaa 12 6.3
TrainiNg..........o.ooooWo.oWo oo aan 13 6.4 Audit and Review... WWW WWW 13 6.5
Ownership and Updating..................oooooWoWoo0ooooomeeeeneneeneenaaaakaaa 13 Ta
MONITOR AND IMPROVE.....oo» oo. oom nee naat 13 TA MeEtFicS.......oooooooooo A na tni
SEKAR EMANAA KA KERAo KERETA ANA EN AMP Pen era aa NAN MANA A NA MAKNA 13
" 7.2 External & internal review .......ooooooooo. momen 13 7.3
IMPTOVEMENE...ooooooooWooooooenea aan 13 8. REFERENCED DOCUMENTS... momen
14 9. ABBREVIATIONS & DEFINITIONS ..........ooooo. moment 14
The information contained in this Document is confidential and for the use of INPEX
MASELA, LTD., and those with whom it contracts directly and must not be communicated
to other persons without the prior written consent of INPEX MASELA, LTD. Any
unauthorized use of such information may expose
the user and the provider of that information to legal action.
Information Security Classification B

INPEX MASELA, LTD. Doc. No.: Bag & 9 ABADI GAS FIELD DEVELOPMENT Revision No.: —
6.0 A PLAN Date: 08 MAY 2017 ABAHA SAUMLAKI MEDICAL EMERGENCY RESPONSE
PLAN (MERP) Page: 4of28 LIST OF TABLES Table 1: Governance & Compliance Documents
.................ooooooooootatan 5 Table 2: Target response time for each responder
..................ooooo.oooo oo 6 Table 3: DECISION BOX - Medical Time-criticality vs Specialist
Unit availability ............ 8 Table 4: Instruction to the On Scene Commander and Medical
Officer.......................... 12 Table 5: Referenced Documents... 14 Table 6: Abbreviations
..............»..ooooWoooWoWo.Wo Women 15 TABLE OF APPENDICES APPENDIX A Location
Information ...............oooooo#Wommeakaaaa 16 APPENDIX B Medical Evacuation Transport
...................ooooooWocccka 17 APPENDIX C Medical Evacuation Process Based on Location
and Activity .................. 18 APPENDIX D Contact Numbers ............ooooo### oom oom enakan
20 APPENDIX E Medical Evacuation FOTM .................ooo.oWoWoomnnnnkeaaaaan 23
The information contained in this Document is confidential and for the use of INPEX
MASELA, LTD., and those with whom it contracts directly and must not be communicated
to other persons without the prior written consent of INPEX MASELA, LTD. Any
unauthorized use of such information may expose
the user and the provider of that information to legal action.
Information Security Classification B

INPEX masmk..ro.
INPEX MASELA, LTD. Doc. No.: PLN-0001
9) ABADI GAS FIELD DEVELOPMENT Revision No.: 6.0 B D PLAN Date: 08 MAY 2017
SAUMLAKI MEDICAL EMERGENCY RESPONSE PLAN (MERP) Page: 5 of 28
1. PURPOSE
This document defines and describes plans in managing medical emergency response
including early treatment, stabilization, and medical evacuation (Medevac) arrangement
for ilinjured
person in Saumlaki.
2. SCOPE
Emergency cases in Saumlaki area and medical evacuations from Saumlaki to designated
hospital in Kupang or Makassar (Phase 1 Medevac), refer to Appendix A on project location
— showing evacuation route. Personnel covered in this plan:
1. INPEX IND employees
2. Contractors
3. INPE IND visitors
Contractors are responsible for their own medevac after Kupang or Makassar (Phase 2
Medevac).
3. GOVERNANCE & COMPLIANCE
This document should be read in conjunction with the following Documents:
HSSE Policy C0100-999-GE-POL-0001 HSSE Standard C0100-999-HA-STD-0001 INPEX IND
HSE General Procedures — Medical INPEX/HSE/GPP/0102 Evacuation : | . x ERP C0100-
999-GE-PRC-0010 Health Risk Assessment Process Overview C0100-999-HE-POV-0008
Peraturan Menteri Kesehatan Republik Indonesia tentang | NOMOR 48 TAHUN 2016 id
Standar Keselamatan dan Kesehatan Kerja Perkantoran
Keputusan Direktur Jendral Pembinaan Pengawasan NOMOR KEP. 22/DJPPK/V/2008
Ketenagakerjaan tentang Petunjuk Teknis Penyelenggaraan Pelayanan Kesehatan Kerja
Table 1: Governance & Compliance Documents
The information contained in this Document is confidential and for the use of INPEX
MASELA, LTD., and those with whom it contracts directly and must not be communicated
to other persons without the prior written consent of INPEX MASELA, LTD. Any
unauthorized use of such information may expose the user and the provider of that
information to legal action.
Information Security Classification B
C0120-999-HE-

C0120-999-HE- $ INPEX MASELA, LTD. Doc. No.: PLN-0001 NN 9 ABADI GAS FIELD
DEVELOPMENT Revision No.: 6.0
B I PLAN Date: 08 MAY 2017
SAUMLAKI MEDICAL EMERGENCY RESPONSE PLAN (MERP) Page: 6of 28 INPEX masaa..ro.
4. AFFECTED ORGANISATIONAL DEPARTMENTS
This document affects all departments which have projects/activities in Saumlaki area.
5. PROJECT REOUIREMENTS
51 Project Details
This document applies to all general activities at Saumlaki. For a specific project, a MERP
bridging document shall be developed. General activities are defined in the ERP document
C0100-999-GE-PRC-0010.
5.2 Business Processes
Business process in this document refers to the overall reguirements and processes in
executing medical management and treatment, and medical evacuation process.
5.21 Resources, Action and Target Response Time Table below shows target response time
to be fulfilled by each parties and activity on each
location: Target Responder Action Site of Health Response care Time C4 First aider e
Search and rescue the injured person to Location of minutes (On scene immediate secure
area and check for the incident commander) possible risk to the injured person, first aider
or anyone else « Check response of the injured person » Apply basic life support » Assess
the need for Magretti Hospital medical team support # Immediate contact Magretti
Hospital «20 Magretti Hospital | « Assess condition of the patient Magretti minutes Medical
team # e Apply advance life support Hospital Ambulance » Stabilize IP and brought the IP
to Magretti Hospital e Monitor the condition of patient e Assess the need to refer patient to
secondary medical facility or medical evacuation 6-12 Travira e Respond Medevac
activation from INPEX | Sorong hours . employee health coordinator e« Communicate the
itinerary of the Air Medevac to INEX employee health coordinator.
Table 2: Target response time for each responder
The response time for the provision of basic life support and immediate first aid shall be
less than 4 minutes, and for advanced life support shall be less than 20 minutes.
The information contained in this Document is confidential and for the use of INPEX
MASELA, LTD., and those with whom it contracts directly and must not be communicated
to other persons without the prior written consent of INPEX MASELA, LTD. Any
unauthorized use of such information may expose the user and the provider of that
information to legal action.
Information Security Classification B

C0120-999-HE- h INPEX MASELA, LTD. Doc. No.: DO aga TN 9) ABADI GAS FIELD
DEVELOPMENT Revision No.: 6.0
ADI PLAN Date: 08 MAY 2017 SAUMLAKI MEDICAL EMERGENCY RESPONSE PLAN (MERP)
Page: 7 of 28 INPEX masmk..ro.
5.2.2 Management of Ill/Injured Patient (IP) Search and Rescue
Search and rescue operation depend strictly on first aiders' initiation. First aiders shali:
• Locate IP

• Remove IP from unsafe location to secure location

• Assess IP status (on site triage or the assessment of urgency degree)

• Provide first aid (basic life support) when necessary

• Contact Magretti Hospital medical team immediately for further treatment when
needed
Field Medical Care
In the event that the activity area is outside of South Tanimbar sub district, which health
care facilities is not appropriate to manage victim or mass casualty incident,
below are the reguirements: - Medical team and ambulance to reach the patients with
response time less than
20 minutes. . Health risk assessment shall be conducted prior to the activity to ensure
medical
eguipment and medicine are appropriate to the risk.
TRIAGE
In the event of single and mass casualty incident, Magretti Hospital medical team will
conduct triage (the assessment of urgency degree) to identify IP's needs for immediate
transport to health care facilities. :
This triage is based on urgency (IP status) and likelihood of survival. The field triage
process will be conducted at two levels:
• Onsite triage
This is the onsite categorization of IPs where they are Iying or at secure area. This onsite
triage shall be performed by first aiders or by medical team on scene. The onsite triage is
expected to identify those victims needing prompt medical attention (guick transport to the
first aid station) and those who can wait by using START (Simple Triage and Rapid
Treatment) method.
• Evacuation triage
This triage will prioritize victims to transfer to secondary medical facility. If Magretti
hospital successtfully treat the patients, the number of “red” patients will decrease and re-
tagging should be conducted before evacuation. Categories of evacuation triage define in
Decision Box below: Medical time criticality vs specialist unit.
The information contained in this Document is confidential and for the use of INPEX
MASELA, LTD., and those with whom it contracts directly and must not be communicated
to other persons without the prior written consent of INPEX MASELA, LTD. Any
unauthorized use of such information may expose the user and the provider of that
information to legal action.
Information Security Classification B

C0120-999-HE-
INPEX MASELA, LTD. Doc. No.: PLN-0001 4 9 ABADI GAS FIELD DEVELOPMENT Revision
No.: 6.0 AB ABADI PLAN Date: 08 MAY 2017 SAUMLAKI MEDICAL EMERGENCY RESPONSE
PLAN (MERP) Page: 80of28 ABADI Lo.
, Referral His : Medical Li . PN Specialist Unit Priority Definition Faciiity/Decislon
Availability
rocess An emergency medical case due |... T, DCS, CI, NS, O, C, NI, to a life threatening
condition First Line: Kupang | 14 Ic 2 P1 reguiring urgent treatment in hospital. Aero
medevac support Ka. must be reguested in less than Secang King: T, CI, NS, O, C, NI, IM, IC 1
hour Makassar DCS, IM, IC First Line: Kupang T, DCS, CI, NS, O, C, NI, IM, IC Makassar T, CI,
NS, O, C, NI, IM, IC DCS, IM, IC Manado T, DCS, CI, NS, O, C, NI, IM, IC An urgent referral case,
not due to an immediately life Bali B, H, T, DCS, CI, NS, O, p2 threatening condition. C, NI, IM,
IC Evacuation is initiated using available aircraft, as guickly Surabaya T, CI, NS, O, C, NI, IM,
IC practically possible Jakarta B, C, IC, IM, NS, O, E, S, T, NI, CI, H, ENT, Other sub-specialists |
Ambon T, DCS, CI, NS, O, C, NI, IM, IC . B, C, IC, IM, NS, O, E, S, aa T, NI, CI, H, ENT, Other ingap
sub-specialists A non-urgent medical assistance es B, C, IC, IM, NS, O, E, S, pa. | orreteral
case. The patontis | Jakarta TN Ci EN, Other g sub-specialists transport T - Trauma: DCS -
Damage Control Surgery: E - Eye, C - Cardiology: NS - Neurosurgery, O - Orthopedic, NI -
Neurology intervention: B - Burn: IC - Intensive care, CI - Cardiac Intensive: IM - Internal
medicine: H - Hyperbaric, ENT - Ear, Nose, & Throat “) IP must be stabilized before
evacuated to another facility
Table 3: DECISION BOX - Medical Time-criticality vs Specialist Unit availability
The information contained in this Document is confidential and for the use of INPEX
MASELA, LTD., and those with whom it contracts directly and must not be communicated
to other persons without the prior written consent of INPEX MASELA, LTD. Any
unauthorized use of such information may expose the user and the provider of that
information to legal action.
Information Security Classification B

120-999-HE- $ INPEX MASELA, LTD. Doc. No.: CO120-99 HE TX 9 ABADI GAS FIELD
DEVELOPMENT Revision No.: 6.0 DI PLAN Date: 08 MAY 2017 SAUMLAKI MEDICAL
EMERGENCY RESPONSE PLAN (MERP) Page: 9 of 28 INPEX masmA.ro.
5.2.3 Medical Evacuation
. Medical Evacuation Phases » First Phase of evacuation (IP Location - Saumlaki - Kupang or
Makassar).

Second Phase of evacuation (Makassar or Kupang, to other center of

medical
excellence). In case if there is escalation in the severity of the event and called for further
evacuation beyond Kupang or Makassar, Siloam Hospital or other source of Air Medevac
capability will be used to support the transfer process.
• Mobilization
IP will be transferred by ambulance from IP location in Saumlaki area to Magretti Hospital
for stabilization. After condition is stable, the IP will be evacuated to Kupang or Makassar
by fixed wing. For Medevac transportation detail, refer to Appendix B.
For the Medevac process and detail, which are based on the location and activity, are
defined in Appendix C.
. Communication and decision flow for all INPEX Projects at Saumlaki
Flowchart 2 below shows the flow of communication during a medical evacuation including
each party's tasks. For more information about contact numbers for each party and
Hospital, refer to Appendix D.
The information contained in this Document is confidential and for the use of INPEX
MASELA, LTD., and those with whom it contracts directly and must not be communicated
to other persons without the prior written consent of INPEX MASELA, LTD. Any
unauthorized use of such information may expose the user and the provider of that
information to legal action.
Information Security Classification B

1G BADI
INPEX masmk..ro.
INPEX MASELA, LTD.
ABADI GAS FIELD DEVELOPMENT
PLAN
SAUMLAKI MEDICAL EMERGENCY RESPONSE PLAN (MERP)
Doc. No.:
Date: Page:
Revision No.:
C0120-999-HE- PLN-0001
6.0
08 MAY 2017 10 of 28
Communication and Decision flow
lekyai Magretti Hospital
PO Ye Akom al lia)
NICE IN MANIA leh ola
NO ln AN ato) A') Leela alas dn)
Ht
TIA Ia-e ae
Assessed aider/paramedic for Nol EM (Kel man eja basic life support on Nadi kelor hitola)
medical Ker Idul)
alel Nun as location and give Ng medical treatment
Receive
report from NE Ka Mana to LE Medical team
TOL AN: Tai
Brought IP To Magretti
Tea)
Update the EDT & ETA
PN Ooh c-lag designated Hospital - Prepare
PN ea aa Handover IP at Keenan co Mv oloat - Prepare the Tele SA Kara
Ap Tart ni kolt)
Hospital, Yes stabilized — andcontact Contal |conduct further assessment &
treatment
admit the IP, ita ea Mts sat aoter- INKA)
eed Medica elok herela)
No
Referthe IP to Jakarta/IP home town
Tea TM AN nol) Advisor Health
Medevac Support,
Activate the Air
mobuilize to Saumlaki
Ainmedevac is mobilized to Kel eig
TheIP Evacuated to designated Hospital
Communicate & Update HSSE Sr. NAK NN Ai
Dr Royanul Arief
(Advisor Health)
Tel :t62 21 29700100 ( Ext.13575) Fax 1462 21 29700111
Mobile : #62 8111974616
Andika Ardyansyah
(Health specialist)
Tel : #62 21 29700100 ( Ext.13585) Fax 1462 21 29700111
Mobile : #62 85720033338
Travira Air
Djoko Suwarto/Eko Hersanto (PIC Sorong)
Tel : 628118703839
Kuncoro PIC Jakarta Tel : #628111003315
Capt. Iwan Michael (Commercial Manager) Tel : #62811876866
Nico Muhyiddin
(Incident Commander)
Tel 162 21 29700100 (ext.11401) Fax 1 t62 21 29700111
Mobile : t62 811844689
Timbul P. Gurning
(HSSE Sr. Mgr.)
Tel 1162 21 29700100 (ext.19021) Fax 1162 21 29700111
Mobile : #62 8119334707
Nicholas Kauffmann (Alternate Incident Commander)
Fax 1162 21 29700111 Mobile : #62 8111367359
Tel : #62 21 29700100 (ext.11101)
Nikson Abraham
(On scene comman der)
Tel :t62 21 29700100 (ext.13001) Fax 1 #62 21 29700111
Mobile : #62 8111535771
Figure 1: Communication and decision flow
The information contained in this Document is confidential and for the use of INPEX
MASELA, LTD., and those with whom it contracts directly and must not be communicated
to other persons without the prior written consent of INPEX MASELA, LTD. Any
unauthorized use of such information may expose the user and the provider of that
information to legal action.
Information Security Classification: B

C0120-999-HE-
9 INPEX MASELA, LTD. Doc. No.: PLN-0001 An 9 ABADI GAS FIELD DEVELOPMENT
Revision No.: 6.0 B DI PLAN Date: 08 MAY 2017 SAUMLAKI MEDICAL EMERGENCY
RESPONSE PLAN (MERP) Page: 11 of 28 INPEX masak. ro.
5.2.4 Estimation time
1. Medevac to designated Hospital at Kupang Below is the estimation time for Medevac
to Siloam Hospital in Kupang. Total time to reach Siloam Hospital Kupang from the
start of Medevac activation is 8 hrs and 15
minutes. Sorong mm) MIN UtES om Langgur a45 minutes Pp Saumlaki 1 Pon for 1 hour
refueling 'anetorng 135 minutes Siloam Hospital — (15 minutes—— Kupang
30 minutes patient transfering
2. Medevac to designated Hospital at Makassar Below is the estimation time for Medevac
to Siloam Hospital or Awal Bross Hospital in Makassar. Total time to reach both
Hospitals in Makassar from the start of Medevac activation is 11 hrs and 15 minutes.
Sorong a90 minutes—P Langgur 5 MINUS pi Saumlaki 1 hour preparation for 1 hour
patient Plat i 1 hour refueling t ransfering 90 minutes Siloam Hospital or “ | " i ta 14150
minutes —— Ambon Awal Bross Hospital 430 minutes Makassar 30 minutes patient 1
hour refueling transferring
Figure 2. Medevac scheme from Saumlaki to designated hospital
Patient shall be on the stable state/condition (normal or controlled on vital signs including
blood pressure, heart rate, respiration rate, and temperature) prior to
The information contained in this Document is confidential and for the use of INPEX
MASELA, LTD., and those with whom it contracts directly and must not be communicated
to other persons without the prior written consent of INPEX MASELA, LTD. Any
unauthorized use of such information may expose the user and the provider of that
information to legal action.
Information Security Classification B

I PLAN Date: 08 MAY 2017 SAUMLAKI MEDICAL EMERGENCY RESPONSE PLAN (MERP)
Page: 120f 28
mobilization and evacuation. Patient stabilization and initial treatment will be conducted at
Magretti Hospital.
5.2.5 Case Management
For case management, the On Scene Commander and Medical Officer shall follow the
instructions below:
Notification of Case INPEX Health Advisor must be notified for any case and evacuation
decision. INPEX Health Advisor needs to validate medical decision.
In case of INPEX Health Advisor can't be contacted, On Scene Commander must contact
Health Specialist or Incident Commander immediately.
Insurance details Guarantee of Payment to the designated hospital is managed by Health
Specialist. Contractor shall inform and communicate their insurance company (if any) to
Health Specialist.
Special Instructions/ In case of fatality, as declared by Magretti Hospital comment medical
team, the deceased shall not be moved until permission is granted by local authorities. The
deceased should be kept at Magretti Hospital and INPEX will manage further processes.
Table 4: Instruction to the On Scene Commander and Medical Officer
6. CONTRACTOR REOUIREMENTS
Contractors involve in this MERP including Air Medevac contractor (Travira Air), medical
support contractor (Magretti Hospital) and contractors for project shall follow guidance in
this document
, and fulfill all reguirements.
6.1 Personnel
1. Air Medevac personnel shall fulfil all reguirements: that are mentioned on the ITT
doetiment contract prior to tender process (Exhibit B and Rexhibit F). ,

2. Medical personnel shall have certification in managing cardiac emergency, Advance

Cardiac Live Support (ACLS) and managing trauma, Advance Trauma Live Support
(ATLS) with valid certificate.
6.2 Tracking and Reporting
All reporting for injured/ill person shall be completed using form refer to Appendix E and
should be informed verbally to Health Advisor/Health Specialist during the evacuation
processes.
The information contained in this Document is confidential and for the use of INPEX
MASELA, LTD., and those with whom it contracts directly and must not be communicated
to other persons without the prior written consent of INPEX MASELA, LTD. Any
unauthorized use of such information may expose the user and the provider of that
information to legal action.
Information Security Classification B
C0120-999-HE-
INPEX MASELA, LTD. Doc. No.: PLN-0001 9 ABADI GAS FIELD DEVELOPMENT Revision
No.: — 6.0

C0120-999-HE- INPEX MASELA, LTD. Doc. No.: Ma aa & 9 ABADI GAS FIELD
DEVELOPMENT Revision No.: 6.0 AB DI PLAN Date: 08 MAY 2017 SAUMLAKI MEDICAL
EMERGENCY RESPONSE PLAN (MERP) Page: 13 of 28 INPEX masmA..rD.
Report that has been completed and has been signed shall be submitted to Health
Advisor/Health Specialist maximum 1 week after medevac complete. The complete report
will be submitted to
HSSE Mar. for approval. Reporting and communication with INPEX management will be
conducted through IC.
6.3 Training
All medical staff shall have certificate Advance Cardiac Life Support (ACLS) and Advance
Trauma Life Support (ATLS). Drill shall be conducted routinely corresponding with the
document contract.
. Contract with Magretti Hospital: drill should be conducted every month with 2 times wet
drill in a year.
. Contract with Travira Air: drill should be conducted 2 times desktop drill/year.
6.4 Audit and Review Audit and review will be conducted by HSSE team and lead by HSSE
Assurance, once per year.
6.5 Ownership and Updating
This document will be maintained based on the project status, site activities, capability, and
availability of the Air Medevac and Medical Facility at Saumlaki. Health Advisor/Health
Specialist are the one who responsible to update this document.
7. MONITOR AND IMPROVE
74 Metrics Metrics will not be tracked at this stage.
7.2 External & internal review
The INPEX PMS team is responsible for initiating the annual review process of this
document to ensure that all documents are current, are aligned with business strategy and
are being improved towards set targets.
This process will be reviewed internally either annually to identify opportunities for
improvement, or on a as and when basis for necessary changes and improvements. 7.3
Improvement
Regular review of these processes will occur periodically to ensure that continuous
improvement opportunities are captured. These reviews can occur on a needs basis but not
more than 12 month since this documentation was issued or since the last review occurred.
The information contained in this Document is confidential and for the use of INPEX
MASELA, LTD., and those with whom it contracts directly and must not be communicated
to other persons without the prior written consent of INPEX MASELA, LTD. Any
unauthorized use of such information may expose the user and the provider of that
information to legal action.
Information Security Classification B

C0120-999-HE- $ INPEX MASELA, LTD. Doc. No.: PLN-0001 TN 9 ABADI GAS FIELD
DEVELOPMENT Revision No.: — 6.0
PLAN Date: 08 MAY 2017
SAUMLAKI MEDICAL EMERGENCY RESPONSE PLAN (MERP) Page: 14of 28 INPEX
masm.uro.
8. REFERENCED DOCUMENTS
The following documents are used in the execution of this Process Overview:
Managing Health for field operation in oil and gas activities — | N/A OGP guideline
Standard for local medical support Report No. 6.44/222, May 1995, OGP
Table 5: Referenced Documents
9. ABBREVIATIONS &
DEFINITIONS Jefinitioi
“1 1
Tata
Time from reguest for aircraft support until aircraft mobilized to the scene for Medical
Evacuation.
Activation time
Aeromedical Evacuation: The movement of patients under medical Air Medevac
supervision to and between medical treatment facilities by air transportation
Authorized Person: The representative identified to act on behaif of AP a company if a
medical emergency involving one of its employees occurs on-site.
Hospital where patients can be admitted for specialized and Definitive Care Facility |
comprehensive medical care, with the ultimate aim of providing final medical treatment for
the patient's condition.
Transportation is managed by INPEX Masela Ltd. and includes the First Phase Evacuation |
movement of the patient from onshore or rig/vessel to a patient handover point in Kupang
or Makassar.
IP I/Injured Person.
IP location Location where an Injury/illness occurred.
Any incident in which emergency medical services resources, such Mass casualty incident
Jas personnel and eguipment, are overwhelmed by the number and severity of casualties.
The information contained in this Document is confidential and for the use of INPEX
MASELA, LTD., and those with whom it contracts directly and must not be communicated
to other persons without the prior written consent of INPEX MASELA, LTD. Any
unauthorized use of such information may expose the user and the provider of that
information to legal action.
Information Security Classification | - B

$ INPEX MASELA, LTD. Doc. No.: Menag aiEs Sx 9 ABADI GAS FIELD DEVELOPMENT
Revision No.: — 6.0 B A D | PLAN Date: 08 MAY 2017 SAUMLAKI MEDICAL EMERGENCY
RESPONSE PLAN (MERP) Page: 15 of 28 INDEX masmA.1D.
Medical evacuation. Process of transporting, by means of boat, plane, helicopter or vehicle,
an ill/injured patient from primary
Medevac medical facility to a facility which provides secondary or tertiary level of care and
escorted by gualified medical staff who have been trained in emergency medical care.
MERP Medical Emergency Response Plan.
Medical Evacuation
The process of transferring ill/injured patient from one place to other advanced facility
On Scene Commander
Saumlaki INPEX representative.
Patient Handover Point
A pre-identified location from where the patient will be entrusted to MUK3, for future care,
treatment and case-monitoring.
Phase 1 Medevac
Medevac from Saumlaki to Kupang or Makassar
Phase 2 Medevac
Medevac from Kupang or Makassar to other destination
Primary Medical Facility
A medical facility at or near the project location that provides primary health services
includeing emergency medical services, preventive program such as health promotion,
early diagnosis of occupational disease, etc.
Priority 1 - An emergency due to a life threatening condition
P1 reguiring urgent treatment in hospital.
po Priority 2 - An urgent referral case, not due to an immediately life threatening condition.
P3 Priority 3 - A non-urgent medical assistance or referral case”, . (Evacuation using
scheduled transport)
START Simple Triage And Rapid Treatment The process of determining the priority of
patients' treatments based
Triage on the severity of their condition. This rations patient treatment
efficiently when resources are insufficient for all to be treated immediately
Table 6: Abbreviations
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ABADI GAS FIELD DEVELOPMENT PLAN SAUMLAKI MEDICAL EMERGENCY RESPONSE
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Doc. No.:
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APPENDIX A Location Information 3.1 Site Details
e Maximum estimated population 2016 v Saumlaki :1 Personnel v C&R project : 10
personnel e IP Handover Point for first phase evacuation “ Makassar “ Kupang
3.2 Map and Evacuation Route
Figure 6. Evacuation route for 15! phase (red line) and 2"4 phase (blue line)
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APPENDIX B Medical Evacuation Transport
Saumlaki (Mathilda) to Kupang or Makassar: Travira DHC - 8
Kupang/Makassar to Jakarta: Commercial flight (Garuda Indonesia Airline, Sriwijaya
Airline,
Batik Airline)
Saumlaki — Magretti Hospital/Mathilda Airport: Magretti hospital's Ambulance
Magretti Hospital Ambulance
Type Location
Travel -.time. to Handover Point
Medical Configuration
Availability
Patient
Hyundai Mover 2 wheel drive
Saumlaki
Mathilda Airport to-Magretti Hospital 20 minutes
Ambulance Stretcher, Long Spinal Board, Basic Life Support Medical Eguipment, AED,
Responder Bag, and fit for 2 escort
2417:
Magretti Hospital Ambulance
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Fixed Wing Aircraft - Travira
Type TRAVIRA DHC:8-315:
Location Sorong
Capability Meddeck Lifeport Stretcher (one thru six configuration) Activationtime 3 hours
(estimate) . aja 4,
Travel time to Patient See Figure 2 Handover Point
Medical Configuration ..6stretchers
Availability
Travira Air DHC - 8
APPENDIX C Medical Evacuation Process Based on Location and Activity Medical
Evacuation Process for Activity Location around Saumlaki
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h INPEX MASELA, LTD. Doc. No.: PLN-0001 —- » ABADI GAS FIELD DEVELOPMENT
Revision No.: 6.0 A B A DI PLAN Date: 08 MAY 2017 SAUMLAKI MEDICAL EMERGENCY
RESPONSE PLAN (MERP) Page: 19 of 28 INPEX masam a..ro. Activity . IP Medical
Evacuation , location Time location Process Response Time Responder On scene first
response « 4 minutes On Scene Commander (first aider) Magretti hospital medical team |
around South shall respond to the scene by Tanimbar sub district | Magretti hospital
medical ambulance, transfer and 5-20 minutes by team stabilize IP at Magretti hospital |
ambulance Day land Evacuate IP to Mathilda Airport | Magretti hospital - . . . by ambulance
and hand over Mathilda: 35 minutes Ka opa eakal the IP to Air medevac medical by
ambulance dical sean £ medical team evacuate IP to secondary , . health care unitat
Kupangor | 8-11 hours byaircratt | Air medevac medical team Makassar , . On Scene
Commander (or On scene first response « 4 minutes first aider) Saumlaki Magretti hospital
medical team | around South shall respond to the scene by Tanimbar sub district | Magretti
hospital medical ambulance, transfer and 5-20 minutes by team stabilize IP at Magretti
hospital | ambulance stabilize and monitor IP at first aid station- Magretti hospital medical
Magretti hospital until morning | Magretti: 6 minutes team by ambulance Night land
Evacuate IP to Mathilda Airport by ambulance and hand over the IP to Air medevac medical
team
first aid station - Mathilda: 35 minutes by ambulance Magretti - Mathilda: 34 minutes by
ambulance
Magretti hospital medical team and Air medevac . medical team
evacuate IP to secondary health care unit at Kupang or Makassar
8-11 hours by aircraft
Air medevac medical team
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APPENDIX D Contact Numbers
REFERRAL HOSPITALS AND TRAVEL TIME FROM AIRPORT
4
AMBON AND SAUMLAKI #6291 1353595
Operator 16291 1353438 RSUD Dr. M. V 162 (0) 813 4300 2372 Haulussy, Ambon Dr. Susi
(Secretary (0)
Director) “Not recommended 20 tom AmibaA for referral hospital p but may use for Dr. Ita
Saberina 162 (0) 813 430 43 285 temporary transit (Deputy Director) only
Dr. Frona(Director) 162 (O) 811 475 500 RS Magretti - dr. Lucia Felnditi #62 813 9906
9800 Saumlaki ( Director) 10” from Mathilda
dr. Nurlela 462 811 444 028 Airport
dr. Lambertus Afaratu 162 821 9830 6325
JAKARTA
RS Premier » ' Jatinegara, Jakarta Operator (021) 2800 888 45” from Halim RS Pondok
Indah, » Jakarta Operator (021) 769 2252 60” from Halim
Operator (021) 521 0200 ext 0 RS Medistra, Jakarta 30” from Halim
Emergency (021) 521 0201 RS Premier Bintaro, Operator (021) 745 5500 ext 9 Sen oom
Jakarta Unit Gawat Darurat (021) 745 8118
RS Mintohardjo (diving Case), Jakarta
Operator
(21) 570 3081
30” from Halim
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C0120-999-HE-
Doc. No.: PLN-0001 Revision No.: 6.0
Date: 08 MAY 2017 Page: 21 of 28
MAKASSAR
Siloam Hospital —
Emergency Operator
0411-3662900 ( ext 0)
40 “ from Sultan
Makassar Hasanuddin Hospital operator and
RS Awal Bros, Admin 0411-454687 45" from Sultan
Makassar Hasanuddin
Emergency room
0411-454567 ext 222
MANADO
Siloam Hospital -
Operator
0431-8883131
45” from Sam
Manado Ratulangi Airport KUPANG Siloam Hospital — Emergency Operator (0380
)8530900 20” from El tari Kupang Airport BALI RSUP Sanglah Operator #62 (0) 361 227
911 30” from Ngurah Rai International Airport ER/Ambulance: Via operator ICU: Ext 311,
Burn Unit: Ext 308 t62 (0) 813 387 89 690 Dr. Andre (International Patient Liaison Officer)
30” from Ngurah RS Bali Royal Operator Hae 2 SL Da Rai International 1 Airport
SURABAYA “
RS Husada Utama
Emergency Room

62 (0) 31 501 0555

40” from Juanda International Airport
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RESPONSE PLAN (MERP) Page: 22 of 28 INPEX nasma..ro. SINGAPORE Mount Alvernia
Emergency Department | #65 6347 6210 30” from Changi Hospital and Ambulance Airport
Nina S. Harjoko (Jakarta rep) 162 816 4844993 Mount Elizabeth Emergency Department |
#65 6731-2218 20” from Changi Hospital 465 6731-2219 Airpori Ambulance #65 6473-
2222 . «
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APPENDIX E Medical Evacuation Form 1. FORM IP CONDITION REPORT
LOCATION :
A.
B.
TIME:
IP IDENTITY Last Name Birth Date Nationality
IP CONDITION
First Name
Age
PRIMARY SURVEY Time:
Airway Breathing C. Spine Circulation/ Hemorrhage
Disability respond to
Blood Pressure : O» Saturation
O Clear
DO Spontaneous O Normal
() External
U None/Slight
U Moderate
U Severe
U Alert
HJ Visual Stimuli
/ mmHg
General Condition :
Hj Syncope
DUO
Head Trauma
Spine Trauma
Fracture : multiple/single Bleeding :
Cardiac Arrest
PRIMARY MANAGEMENT
Airway H Oropharyngeal O C/Thryrotomy U Oxygen
Breathing Ventilated
C. Spine LI! Sand Bags
U Obstructed
O Difficulty
O Possible Injury O Internal
U Possible
U Pain O Unresponsive
Pulse Rate Respiratory Rate
HJ) Nasal
DJ ET Tube
O Suction
O Chest Drain UH Stiff Neck
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$ INPEX MASELA, LTD. Doc. No.: PLN-0001 J-—- 9 ABADI GAS FIELD DEVELOPMENT
Revision No.: 6.0 A B AD | PLAN Date: 08 MAY 2017 : — SAUMLAKI MEDICAL EMERGENCY
RESPONSE PLAN (MERP) Page: 24 of 28 INPEX maseLa..ro. SECONDARY SURVEY
EXPOSURE/INJURY Eye Opening Spontaneous To voice To pain None Best Verbal Oriented
Response Confused Inappropriate Incomprehensible None
Obeys command Localizes pain Withdrawal (pain) Flexion (pain) Extension (pain)
Motor Response
None Pupils React OR Constricted OR Normal DR None OR Coma Score Time... Score
Comments sesaceceseneenan
.o0cooracecacecer
C. MEDICAL TREATMENT
Injection -
Time
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PLANTMERP) Page: V 250f28 INPEX masmA..ro.
D. OTHER IP ASSESSMENT RESULT
E. RECOMMENDATION

Observe IP every minute

e Or: It/mnt
Tools : Nasal/ Mask (RM/NRM) e IV Fluid: dpm
F. MEDEVAC PREPARATION
H No Need H Evacuated by : o Boat a Start From: ETD: “# Destination to : ETA: o Helicopter
« Start From: ETD: # Destination: ETA: Prepared by, Approved by, Acknowledged by, ( ) ( )
()
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Medical Staff 1. 2. Pick-up Point Referral Hospital
Patient Name Patient Work Location
Job Description
Ti Patient Condition ime RR Temp | sp.O2 General Condition / Remarks
Delivered by: Accepted by:
Position : InStitUtiON : oo InStitUtiON £ Loka
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ACCIDENT MEDICAL REPORT
DATE OF ACLIDENI « PLACE OF AGCIDENT
MEDICAL TREATMENT — Recordable/WorkRelated | ——
LOST WORK DAY RESTRICTED ACTIVITY FATALITY s FIRST AID ONLY Date of retment |
Time Tretment Administrated by : Clia tion REPORTED BY SIGNA TURE
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