Requirements to be Remote, International Medicine and Offshore Medicine. OIL Industry Basic Offshore Safety Induction Emergency Training (BOSIET) and FOET

Remote Offshore and International Medicine
https://www.facebook.com/groups/Complexmedicine

#DrRamonReyesMD desde una Plataforma 🏭🚁🚢 ⛽ 🛢️ 🔱 ⚓ en medio del océano 🌊⛵🪸 ☣️ 🛟 ⚠️
Medicina ⚕️ Marítima 🔱 ⚓

https://www.facebook.com/reel/1635537973872209

You must READ

Certifications You Must Have As An Oil And Gas Professional!

 https://www.linkedin.com/pulse/certifications-you-must-have-oil-gas-professional-dr-ramon-reyes-md

De interés en caso de Emergencias para los Ciudadanos de la Unión Europea: Articulo 23 del Tratado de Funcionamiento de la Unión Europea. Todo Ciudadano de la Unión podrá acogerse  en el territorio de un tercer país en el que no este representado el Estado miembro del que sea nacional, a la protección de las autoridades diplomáticas y consulares de cualquier Estado miembro, en las mismas condiciones que los nacionales de dicho estado 

https://emssolutionsint.blogspot.com/2022/12/proteccion-del-ciudadano-de-la-union.html

Dr. Ramon REYES, MD onboard Remote Platform on the way from Singapore to Australia 


https://www.facebook.com/groups/Complexmedicine

Remote Offshore and International Medicine

 https://www.facebook.com/groups/Complexmedicine 

by EMS SOLUTIONS INTERNATIONAL

Medicina Remota "Offshore" en condiciones de remotidad y temperaturas extremas. En St. John de Terranova. Canada en ruta de navegacion a Noruega, cruzando el circulo polar artico (Groelandia), Islandia.

Requirements to be Remote, International Medicine and Offshore Medicine. OIL Industry Basic Offshore Safety Induction Emergency Training (BOSIET) and FOET
https://emssolutionsint.blogspot.com/2015/07/requirements-to-be-remote-international.html #DrRamonReyesMD 

Dr. Ramon Reyes, MD

¿Cuantos nos puede costar acreditarnos y tener toda la documentación para trabajar en medicina remota, internacional, offshore y alto riesgo? by #DrRamonReyesMD Requirements to be Remote, International Medicine and Offshore Medicine. OIL Industry Basic Offshore Safety Induction Emergency Training (BOSIET) and FOET

http://emssolutionsint.blogspot.com/2015/07/requirements-to-be-remote-international.html

España activará su pasaporte verde Covid para viajeros "en junio"

La intención del Ejecutivo es que el certificado "funcione plenamente" para la campaña de verano 

https://www.redaccionmedica.com/secciones/sanidad-hoy/pasaporte-verde-covid-espana-junio-viajeros-activara-4097

Así escapamos/Abandonamos la Plataforma 🏭/ Barco ⚓ ⛵ en caso de EMERGENCIAS. 🛟 ⚡ ⚠️ 

https://emssolutionsint.blogspot.com/2015/07/requirements-to-be-remote-international.html

@seguidores #DrRamonReyesMD 

https://emssolutionsint.blogspot.com/2011/09/basic-offshore-safety-induction.html

ENGLISH is the main and primary speaking language in International, Remote and Offshore Medicine

Requirements to be Remote, International Medicine and Offshore Medicine. OIL Industry BOSIET and FOET

PASAPORTE 

Países participantes en el Programa de Exención de Visa  a Estados Unidos de América USA / EUA https://emssolutionsint.blogspot.com/2023/12/paises-participantes-en-el-programa-de.html 

posted by Dr. Ramon Reyes, MD ∞🧩 #DrRamonReyesMD ∞🧩 𓃗 @DrRamonReyesMD

ESPACIO SCHENGEN Europa y La Unión Europea  

https://emssolutionsint.blogspot.com/2023/12/espacio-schengen-europa-y-la-union.html 

¿Qué tan FUERTE es tu PASAPORTE? by Henley and Partner https://emssolutionsint.blogspot.com/2019/01/que-tan-fuerte-es-tu-pasaporte-by.html

Documento provisional de viaje (DPV)/ Documento de Viaje de Emergencia de la Unión Europea UE/EU  

https://emssolutionsint.blogspot.com/2023/12/documento-provisional-de-viaje-dpv.html

ARTICULO 23 DEL TRATADO DE FUNCIONAMIENTO DE LA UNION EUROPEA

https://emssolutionsint.blogspot.com/2023/12/articulo-23-del-tratado-de.html

Remote and International Medicine

Offshore Medicine

***English is the official language***

1. Medical License more than 5 years graduate 

2. Medical License Number and Insurance 

3. Passport

¿Qué tan FUERTE es tu PASAPORTE? by Henley and Partner 2019

España se mantiene en el puesto 4to de los mas fuertes

https://emssolutionsint.blogspot.com/2019/01/que-tan-fuerte-es-tu-pasaporte-by.html

4. Seaman´s Book

 Seaman´s Book

https://www.superyachtcrewagency.com/blog/what-is-a-seamans-discharge-book/7736

5. Basic Offshore Safety Induction and Emergency Training (BOSIET) by OPITO

http://emssolutionsint.blogspot.com/2011/09/basic-offshore-safety-induction.html

by STIER España

Recuerda que Stier Training Centre impartimos el curso BOSIET, tanto EBS como CA-EBS. Es un requisito indispensable para trabajar en plataformas offshore.

https://emssolutionsint.blogspot.com/2011/09/basic-offshore-safety-induction.html

¡También ofrecemos la teoría online!

En el BOSIET aprendemos de lucha contra incendios 🔥, supervivencia en mar 🌊, primeros auxilios🧑‍⚕️, emergencia en helicópteros 🚁e introducción a la seguridad en plataformas ⚓️.

GRUPO STIER

Teléfono +34 638 24 04 51

CONTACT

Las Palmas G.C. Head Office,

Juan Rejón 48 - 6º - 35008,

Las Palmas de Gran Canaria,

Spain

 (+34) 928 97 10 43

Training Center,

Muelle de Taliarte s/n - 35214

Telde, Las Palmas de Gran Canaria,

Spain

 (+34) 928 97 10 43

https://stier.es/en

Further Offshore Emergency Training FOET

Norwegian Oil and Gas accepted upgrade to the Norwegian Continental Shelf

6. ALS "ACLS" Advanced Carrdiac Life Support by AHA/ERC 

7. Trauma Course ATLS, PHTLS, ITLS. 

8. International Medical Certificate OGUK, MLC 2006 and 

https://oilandgasuk.co.uk/doctors/

https://www.sdir.no/en/shipping/seafarers/approved-seafarers-doctors/

https://www.edumaritime.net/mlc-2006/mlc-regulation-1-2-medical-certificate

Norway confirms acceptance of Oil & Gas UK medical certificates Dr Morten Hellang of the Rogaland County Medical Office in Norway spoke at a recent Oil & Gas UK examining doctors conference in London, where he confirmed that Norway has been accepting unrestricted Oil & Gas UK medical certificates since early 2013. Dr Hellang repeated assurances also given to Oil & Gas UK at a meeting of UK, Norwegian and Dutch oil industry associations in Stavanger. The meeting discussed the longstanding informal 'Hardanger agreement' between Oil & Gas UK, OLF (now NOG), and NOGEPA, which had been intended to achieve mutual recognition of medical certificates but which had been difficult for OLF/NOG to implement because of Norwegian law. The change in circumstance has arisen because Norway is changing the qualifications required for doctors to issue Norwegian medical certificates: from 2014 onwards no doctor will be able to issue a Norwegian certificate unless they have completed a training course – details of the course are not yet confirmed, but it is expected that it will only be run in Norway, and in Norwegian. The practical implications of the new training requirement are that from 2014 only Norwegian doctors will be able to undertake Norwegian medical examinations for offshore work, and that Oil & Gas UK members with employees working in the Norwegian sector will encounter difficulties in obtaining certification for employees. The acceptance of UK certificates by Rogaland County Medical Office greatly reduces the expected problems as a result. Oil & Gas UK members may wish to discuss future international certification procedures for their offshore employees with their usual medical provider – all major medical providers will be aware of the forthcoming change and the decision by the Norwegian authority to accept UK medical certificates. Full details of the Norwegian position on accepting UK (and Dutch) offshore medical certificates can be seen at: http://www.fylkesmannen.no/en/Rogaland/Health-and-careservices/Offshore-health-services/Helseerklaring/Acceptance-of-British-and-Dutch-medicalcertificates/

https://www.fylkesmannen.no/en/Rogaland/Health-and-care-services/Offshore-health-services/Helseerklaring/Acceptance-of-British-and-Dutch-medical-certificates/

9. Passport with at least 6 month before expiration 

10. Vaccines Tetanus, Polio, Hep A, Hep B, Yellow fever.  

Guia Practica del Control de la FIEBRE AMARILLA OPS/OMS PDF Gratis. OMS dice que la vacuna de la fiebre amarilla es para toda la vida CERTIFICADO INTERNACIONAL DE VACUNACION FIEBRE AMARILLA / INTERNATIONAL CERTIFICATE OF VACCINATION / YELLOW FEVER, FIEBRE AMARILLA.

http://emssolutionsint.blogspot.com/2012/12/certificado-internacional-de-vacunacion.html

We deeply recommend the Vaccine for the season Influenza every year due the high risk of flu inside Offshore facilities. 

11.A new mandatory Compressed Air Emergency Breathing System (CA-EBS) Initial Deployment Training by OPITO

11. Profilaxis Malaria 2019 Vacuna
http://emssolutionsint.blogspot.com/2019/04/malaria-paludismo.html

12. Today is really important the Covid-19 Vaccination Card (Covid-19 Passport) and the PCR Covid-19 negative test less than 72 hours


by Dr. Ramon Reyes Diaz, MD 2019

Requirements to be Remote, International Medicine and Offshore Medicine. OIL Industry BOSIET and FOET

Basic Offshore Safety Induction Emergency Training (BOSIET)

DURACIÓN DEL ENTRENAMIENTO

3 días

OBJETIVO

El objetivo del BOSIET es proporcionar a los delegados un conocimiento básico de los procedimientos de seguridad y respuesta de emergencia para trabajar en entornos costa afuera, dotándolos de las habilidades para viajar desde y hacia las instalaciones offshore en helicóptero.

PÚBLICO ASIGNADO

Este curso está diseñado para cumplir con los requisitos iniciales de capacitación en seguridad en tierra y respuesta de emergencia para personal nuevo en la industria de petróleo y gas en alta mar.

PROGRAMA DE ENTRENAMIENTO

Mod. 1 Inducción de seguridad

Mod. 2 Seguridad y escape del helicóptero

Mod. 3 Supervivencia del mar y primeros auxilios

Mod. 4 Lucha contra incendios y auto rescate

MODO

Asistencia

METODOLOGÍA

Fomento de la participación de los delegados con la interacción mediante preguntas, ejercicios prácticos, videos y simulaciones.

MANUALES

Notas del estudiante Folleto Información adicional.

DELEGADOS PRE-REQUISITOS

No se requieren requisitos previos.

DEMANDAS FÍSICAS Y ALTURAS

Las actividades de capacitación contenidas dentro de los estándares OPITO pueden incluir elementos físicamente exigentes y potencialmente estresantes. Todo el personal que participa debe ser físicamente y mentalmente capaz de participar plenamente. El Centro llevará un registro de la declaración de aptitud del delegado / candidato de acuerdo con su política o procedimientos de control de documentos.

CERTIFICADO

Entrenamiento de Emergencia de Inducción de Seguridad Marítima Básica OPITO Aprobado

Islas Canarias-España. 

http://stier.es/es/article/95/basic-offshore-safety-induction-emergency-training-bosiet

From the original creators of the MIRA course, comes another industry-leading programme specifically designed for medical practitioners operating in challenging environments.

Incorporating the best elements of MIRA with the new gold standard FREC Level 3 syllabus, the ground-breaking course will challenge the most seasoned remote/hostile environment/expedition medic.

Students who pass the course will leave with updated and new skills as well as 2 accredited certificates from QUALSAFE and the ROYAL COLLEGE OF SURGEONS EDINBURGH respectively.
The course has been designed by Industry and Special-Forces veterans, providing only credible and ‘Real-World’ knowledge and skills to participants, trimming the fat off most courses currently available. We focus on both gold-standard and improvised techniques.

The FREC/MIRA Level 3 combined course includes:

– Roles/Responsibilities of the remote medic
– Catastrophic haemorrhage management
– Advanced airway management including surgical airways
– Chest injury management
– Shock management including sternal intra-osseous access
– Management of fractures/dislocations/sprains/strains
– Minor injury management
– Intermediate life support of adult/paediatric/infant/third trimester pregnant patients
– Altitude and Polar medicine
– Jungle and Desert medicine
– Poisons
– Burns & scalds
– Remote pharmacology
– Triage and mass casualty incidents in the remote setting
– Prolonged fieldcare
– Bites & stings (with industry experts and live specimens)
– The most immersive moulages currently available in the UK

The course includes over 13 hours of practical scenarios and moulages, ensuring each participant receives the finest one-to-one training, benefitting from our Instructor’s knowledge and experiences.

Overview
This training program is designed to meet the initial offshore safety and emergency response training requirements for personnel new to the offshore oil & gas industry.

The OPITO-approved Basic Offshore Safety Induction and Emergency Training (BOSIET) course provides students with a range of knowledge and skills relevant to working offshore and the proper emergency response procedures to include: safety induction, fire safety and self rescue, helicopter safety and escape, and sea survival inclusive of TEMPSC and first aid.

Course Length: 24 hrs

Course Price: ******

The Standard: The OPITO standards are a set of training and/or competence standards, produced and agreed by the offshore oil and gas industry covering a variety of offshore emergency response duties and occupational roles.

This course is accepted in most regions of the world where oil and gas industries operate.

Aim: The BOSIET will also equip students with the knowledge, skills, and confidence to respond appropriately in the event of an offshore emergency and to enhance their survivability through proper use of emergency equipment and procedures.

Course Objectives
The objectives of the BOSIET training are that students will be able to:

• Identify the generic hazards which are specific to offshore oil & gas installations, potential risks associated with those hazards, and how controls are put in place to eliminate or reduce risks.

• Identify key offshore related safety regulations and explain the basic safety management concepts.

• Demonstrate, in a simulated environment, that they can use the safety equipment and follow procedures in preparing for, and during, helicopter emergencies - with particular focus on escaping from a helicopter following ditching.

• Demonstrate sea survival and first aid techniques.

• Demonstrate that they can effectively use basic firefighting equipment, and practice self-rescue techniques in low visibility situations, including smoke filled areas.

Topics Covered

MODULE 1 Learning Outcomes: Safety Induction

To successfully complete this module, students must be able to:

• Identify the main offshore hazards and hazard effects/consequences; explain their associated risks, and how they are controlled.

• Explain the potential environmental impact of offshore installation operations.

• Identify key offshore installation safety regulations and explain the basic concept of these regulations.

• Explain the principles of managing safety on offshore installations.

• State the procedure for prescribed medicines offshore.

• Explain the concept of alcohol and substance abuse policy.

• Explain PPE requirements of working on an offshore installation.

• Explain how to report incidents, accidents, and near misses on an offshore installation.

• Explain the role of the offshore medic.

MODULE 2 Learning Outcomes: Helicopter Safety and Escape

To successfully complete this module, students must be able to demonstrate:

• Donning an aviation transit suit, aviation lifejacket, and Emergency Breathing System (EBS) equipment and conducting EBS integrity checks.

• Actions to take in preparation for a helicopter ditching and an emergency landing.

• Actions following a controlled emergency descent to a dry landing with evacuation via a nominated exit.

• Deployment, operation and breathing from the EBS in a pool utilizing personal air prior to Helicopter Underwater Escape Training (HUET) exercises.

• Actions following a controlled ditching on water (including deploying the EBS and, on instruction from aircrew, operation of a push out window) and evacuation through a nominated exit to an aviation life raft.

• Assisting others where possible in carrying out initial actions on boarding the aviation life raft, including mooring lines, deploying the sea anchor, raising the canopy and raft maintenance.

• Escaping through a window opening which is underwater, from a partially submerged helicopter.

• Escaping through a window opening which is underwater, from a partially submerged helicopter utilizing EBS.

• Escaping through a window opening which is underwater, from a partially submerged helicopter utilizing an EBS and operating a push-out window.

• Escaping through a window opening which is underwater, from a capsized helicopter

• Escaping through a window opening which is underwater, from a capsized helicopter utilizing EBS.

• Escaping through a window opening which is underwater, from a capsized helicopter utilizing an EBS and operating a push-out window.

• Inflating an aviation lifejacket and deploying a spray visor in water.

• Boarding an aviation life raft from water.

MODULE 3 Learning Outcomes: Sea Survival and First Aid

To successfully complete this module, delegates must be able to demonstrate:

• Donning of a permanent buoyancy lifejacket prior to use in an emergency.

• The correct actions when mustering and boarding a survival craft (Totally Enclosed Motor Propelled Survival Craft: TEMPSC) as a passenger during launching operations.

• Fitting of a helicopter strop and correct body posture during winching.

• Individual and group sea survival techniques, to include: swimming, getting into Heat Escape Lessening Position (HELP), wave-slap protection, towing, chain, huddle and circle.

• Boarding a marine life raft from the water.

• Immediate first aid actions, to include: Airway Breathing & CPR (ABC).

MODULE 4 Learning Outcomes: Firefighting and Self-Rescue

To successfully complete this module, delegates must be able to demonstrate:

• Correct use of hand-held portable fire extinguishers and which ones to use for different classes of fires.

• Self-rescue techniques with a smoke hood from areas where visibility is reduced due to smoke.

• Self-rescue techniques with a smoke hood from areas where visibility is completely obscured.

• Small group escape techniques with a smoke hood from areas where visibility is completely obscured.

Prerequisite
Training and assessment activities contained within this standard include physically demanding and potentially stressful elements. All personnel who participate in such activities must be physically and mentally capable of participating fully. Prior to participating in practical exercises, the student must be fit for training* and able to:

• Hold their breath underwater for 10 seconds.

• Move through water using their arms.

• Wear and use a lifejacket and survival suit in a pool.

• Re-breathe using an EBS for up to 30 seconds.

• Sit in class for up to 60 minutes per session.

• Step into a pool from a height of 1m / 3.2ft.

• Use upper body muscles (lifting and pulling actions)when climbing in/out of a life raft.

• Lift and operate a 12 kg / 26.5 lbs. fire extinguisher.
• Wear a smoke hood in a potentially warm environment.

*Safety First: Safety Management Systems (SMS)regards your safety first and suggests the following: Candidates that are concerned with  participating in practical exercises due to current or pre-existing medical conditions should consult their primary care provider prior to the onset of the training program as to the nature and extent of the training.

All students must produce the following prior to the onset of training:

• Valid (photographic) government identification

Written exam: Students will be required to take a 30-minute written test at the end of Module 1 as a method of checking that they have met all the Module 1 learning outcomes. It is an open-book test. A minimum test score of 80% is required.

SMS staff will deliver a series of explanations and demonstrations to deliver the BOSIET program. Delegates will be assessed against the learning outcomes specified by using direct observation, oral, and written questions

SMS staff will identify any gaps in students' learning and make reasonable effort to address the gaps to help students meet the learning outcomes.

Attendance Requirements: Daily attendance and 100% participation of each module is required to obtain BOSIET certification.

Course Administration: Each registrant will be registered with the Central Register (CR) operated by OPITO.

Retraining: Every four years (reference FOET).

Location: Only offered at our Lafayette location.

6. Advanced Cardiac Life Support-AHA

7. ATLS/PHTLS Trauma Course

8. OSHA Injury/ Illnes Initial Record Managment

9. MLC 2006 Medical Certificate https://www.gov.uk/government/publications/msn-1839m-maritime-labour-convention-2006-medical-certification

10. Full english speaker

11. Training (Instructor) CPR-AED, First Aid. 

12. knowledge of hygiene inspection

13. Air Medical Evacuation Training MEDEVAC

Air Medicial Medicine MEDEVAC

Offshore Helicopter EMS Operations
Credits EMSWORLD Magazine   

It is licensed in the state of Louisiana as an air ambulance, but this is not your typical air ambulance—not in its size or the scope of its mission. Its fuselage is 56 feet long with a rotor diameter of 56 feet. Its maximum weight is 26,000 lbs. The cabin is 20 feet long, six feet wide and six feet high. It has a maximum speed of 190 mph. Its mission is to provide medical and rescue services to the offshore oil industry in the Gulf of Mexico.

Vital Statistics

The helicopter is a Sikorsky S-92, and it’s crewed by five people: a pilot, copilot, flight medic and two rescue specialists. It is based in Galliano, LA, and operated by CHI Aviation. The operation is run on a subscription basis for oil companies with platforms in the Gulf of Mexico. CHI also has an AgustaWestland AW139 helicopter it uses for the same mission on an ad hoc basis for customers without subscription contracts for the S-92. They also get rescue assignments from the U.S. Coast Guard. Both ships are crewed 24/7.

The contract covers personnel on oil platforms, the ships that supply the platforms and the helicopters that transport the workers to and from the platforms. Containing one of the world’s largest oil fields, the Gulf of Mexico has about 5,000 oil-related structures, supported by dozens of supply ships and a fleet of over 400 helicopters. In 2014 these helicopters made 740,000 flights over the gulf and transported two million passengers.

“We use the S-92 because of its range, speed and payload capabilities,” explains David Jacob, CHI’s director of offshore operations and a longtime paramedic. “Some of the platforms are 200 miles or more offshore. We can carry a huge amount of rescue gear. Our rescue specialists are certified in vertical rope, confined-space and hazardous-atmosphere rescue. We can also rescue all of the passengers of the largest helicopters used for offshore transport if one ditches in the gulf.”

The S-92 is one of the newest helicopter designs. It has an all-glass electronic display instrument panel that incorporates the latest flight control, navigation, communication and engine systems. The helicopter can perform rescue missions day or night and in bad weather. It has a color weather radar that can also detect the oil platforms. It has dual GPS systems for navigation.

It also has forward-looking infrared (FLIR) and low-light television cameras in a gyrostabilized turret under the nose. The helicopter can be used as an airborne command post for an incident on an oil platform. Its crew can record and transmit imagery, and an oil company representative can be on board and talk with his personnel via the satellite phone in the cabin. They can also use it to see hot spots on an oil platform in case of a fire.

Another feature is a sophisticated autopilot system customized for search and rescue missions. It can automatically come to a 50-foot hover at any location specified by the pilot. Search patterns can be programmed and flown by the autopilot coupled to the GPS system to maximize search coverage. It is also equipped with dual rescue hoists in case one fails.

The facilities at Galliano are high-tech. The hangar is climate-controlled, which is especially important in the summer, with its high temperatures and humidity. The base has its own power supply, and the hangar is rated for a Category 3 hurricane.

Staffing and Training

It is licensed in the state of Louisiana as an air ambulance, but this is not your typical air ambulance—not in its size or the scope of its mission. Its fuselage is 56 feet long with a rotor diameter of 56 feet. Its maximum weight is 26,000 lbs. The cabin is 20 feet long, six feet wide and six feet high. It has a maximum speed of 190 mph. Its mission is to provide medical and rescue services to the offshore oil industry in the Gulf of Mexico. Vital Statistics The helicopter is a Sikorsky S-92, and it’s crewed by five people: a pilot, copilot, flight medic and two rescue specialists. It is based in Galliano, LA, and operated by CHI Aviation. The operation is run on a subscription basis for oil companies with platforms in the Gulf of Mexico. CHI also has an AgustaWestland AW139 helicopter it uses for the same mission on an ad hoc basis for customers without subscription contracts for the S-92. They also get rescue assignments from the U.S. Coast Guard. Both ships are crewed 24/7. The contract covers personnel on oil platforms, the ships that supply the platforms and the helicopters that transport the workers to and from the platforms. Containing one of the world’s largest oil fields, the Gulf of Mexico has about 5,000 oil-related structures, supported by dozens of supply ships and a fleet of over 400 helicopters. In 2014 these helicopters made 740,000 flights over the gulf and transported two million passengers. “We use the S-92 because of its range, speed and payload capabilities,” explains David Jacob, CHI’s director of offshore operations and a longtime paramedic. “Some of the platforms are 200 miles or more offshore. We can carry a huge amount of rescue gear. Our rescue specialists are certified in vertical rope, confined-space and hazardous-atmosphere rescue. We can also rescue all of the passengers of the largest helicopters used for offshore transport if one ditches in the gulf.” The S-92 is one of the newest helicopter designs. It has an all-glass electronic display instrument panel that incorporates the latest flight control, navigation, communication and engine systems. The helicopter can perform rescue missions day or night and in bad weather. It has a color weather radar that can also detect the oil platforms. It has dual GPS systems for navigation. It also has forward-looking infrared (FLIR) and low-light television cameras in a gyrostabilized turret under the nose. The helicopter can be used as an airborne command post for an incident on an oil platform. Its crew can record and transmit imagery, and an oil company representative can be on board and talk with his personnel via the satellite phone in the cabin. They can also use it to see hot spots on an oil platform in case of a fire. Another feature is a sophisticated autopilot system customized for search and rescue missions. It can automatically come to a 50-foot hover at any location specified by the pilot. Search patterns can be programmed and flown by the autopilot coupled to the GPS system to maximize search coverage. It is also equipped with dual rescue hoists in case one fails. The facilities at Galliano are high-tech. The hangar is climate-controlled, which is especially important in the summer, with its high temperatures and humidity. The base has its own power supply, and the hangar is rated for a Category 3 hurricane. Staffing and Training

“Acadian Ambulance provides the paramedics for our operation,” Jacob says. “They also provide all the medical equipment, protocols, 24-hour online medical control, and dispatching and flight-following services. We can use Acadian’s aircraft to back us up, and we may handle a local call for them with our AW139. Acadian ground operations span from Mississippi to Texas, so if we need additional equipment or personnel for an MCI, we can get them from Acadian ground ambulances.”

“The flight medics do not go through the rope and confined-space rescue training,” says flight paramedic Anthony Cramer, Jr., who is also an RN. “We do go through hoist training. In water rescues, the rescue swimmer would deploy and bring the patient into the helicopter, where the flight medic would then begin treatment. If the patient is on land, a vessel or an oil platform, the flight medic would be hoisted down to the victim, as well as a rescue specialist. There are always two people going down to the patient.

“The flight medics have a good working relationship with the rescue specialists. We pretty much live together when we’re on duty. The rescue specialists have a varied amount of medical training. The minimum is EMR, but many are EMTs and paramedics. They can work on the patient under the direction of the flight medic. Since we work so much together, they can anticipate the flight medics’ needs. It is just like a crew in the back of an ambulance.

“The flight medics work under the same protocols as the Acadian Air Med flight crews, which are pretty extensive. We can do RSI, CPAP and 12-lead ECG, and we carry a ventilator. We can initiate a lot of treatment before arrival at the hospital because of our long transport times. They have a protocol for what they call chemical extrication. They use it in case they have a patient who is trapped by machinery or has a difficult extrication from where they fell. They use etomidate as a hypnotic sedative. The patient isn’t aware and has no memory of the event afterward.

“Our calls run the gamut from trauma to medical,” explains Cramer. “There is a lot of heavy machinery and moving heavy equipment on oil platforms. We have all the medical-type calls found in any community. One of our biggest complaints is chest pain. We do 12-leads and can send them to the hospital while we’re en route. We also carry beta blockers and IV nitrates for STEMI patients. Once the hospital has the 12-lead, the ED doctor and cardiologist decide whether to bypass the ER and send the patient directly to the cath lab when we land. We have done that several times with very good results. If we need to talk with medical control for orders or to contact the receiving facility, we have a satellite phone as part of the communications suite on the helicopter.

“Acadian Air Med has a QA/QI process, and we are part of that as well. Our charts get reviewed like any other Air Med chart. We can also use the Air Med quality improvement coordinator for advice and opinions on patient care issues that occur. Our flight medics are all very experienced, and most have come from the Air Med side of Acadian. We work seven-on, seven-off, and many work shifts for Air Med to get more volume and keep their skills fresh.

“An MCI is a real possibility on oil platforms. Do people just need to be moved off a platform because it is on fire or in danger of sinking? Or was there an event that created a large number of casualties? If there is a medic stationed on the platform, he or she will have done the initial triage by the time the helicopter arrives. If not, we can begin to do the triage and packaging for transport. We might move victims to another close platform with medics on it and transport the more serious patients to shore. We can also use our AW139, and Air Med might be able to send some of their helicopters offshore to platforms. We can also pick up some Acadian Air Med crews and their gear on the way out to a known MCI.”

Due to the size and weight of the S-92, the crew may have to land at an airport near the hospital and have a ground ambulance transport the patient and flight medic from there. They’ll go to the most appropriate facility for the patient’s condition—STEMI center, stroke center, trauma center, burn center, etc. The dispatch center, which is Acadian’s, finds the closest, most appropriate destination so the crew doesn’t have to “shop” for a receiving facility.

“Almost 100% of our pilots and rescue specialists have military search and rescue experience,” says Jacob. “We have U.S. Air Force pararescuemen and rescue pilots, U.S. Coast Guard rescue swimmers and pilots, and U.S. Navy pilots and rescue swimmers. There is a large amount of trust among the crews because of that. We know we will revert to our military training when things get challenging. The crews rely on their crew resource management training, which they all had in the military. We all know how to communicate effectively in stressful situations.”

A Hazardous Environment

“Acadian Ambulance provides the paramedics for our operation,” Jacob says. “They also provide all the medical equipment, protocols, 24-hour online medical control, and dispatching and flight-following services. We can use Acadian’s aircraft to back us up, and we may handle a local call for them with our AW139. Acadian ground operations span from Mississippi to Texas, so if we need additional equipment or personnel for an MCI, we can get them from Acadian ground ambulances.” “The flight medics do not go through the rope and confined-space rescue training,” says flight paramedic Anthony Cramer, Jr., who is also an RN. “We do go through hoist training. In water rescues, the rescue swimmer would deploy and bring the patient into the helicopter, where the flight medic would then begin treatment. If the patient is on land, a vessel or an oil platform, the flight medic would be hoisted down to the victim, as well as a rescue specialist. There are always two people going down to the patient. “The flight medics have a good working relationship with the rescue specialists. We pretty much live together when we’re on duty. The rescue specialists have a varied amount of medical training. The minimum is EMR, but many are EMTs and paramedics. They can work on the patient under the direction of the flight medic. Since we work so much together, they can anticipate the flight medics’ needs. It is just like a crew in the back of an ambulance. “The flight medics work under the same protocols as the Acadian Air Med flight crews, which are pretty extensive. We can do RSI, CPAP and 12-lead ECG, and we carry a ventilator. We can initiate a lot of treatment before arrival at the hospital because of our long transport times. They have a protocol for what they call chemical extrication. They use it in case they have a patient who is trapped by machinery or has a difficult extrication from where they fell. They use etomidate as a hypnotic sedative. The patient isn’t aware and has no memory of the event afterward. “Our calls run the gamut from trauma to medical,” explains Cramer. “There is a lot of heavy machinery and moving heavy equipment on oil platforms. We have all the medical-type calls found in any community. One of our biggest complaints is chest pain. We do 12-leads and can send them to the hospital while we’re en route. We also carry beta blockers and IV nitrates for STEMI patients. Once the hospital has the 12-lead, the ED doctor and cardiologist decide whether to bypass the ER and send the patient directly to the cath lab when we land. We have done that several times with very good results. If we need to talk with medical control for orders or to contact the receiving facility, we have a satellite phone as part of the communications suite on the helicopter. “Acadian Air Med has a QA/QI process, and we are part of that as well. Our charts get reviewed like any other Air Med chart. We can also use the Air Med quality improvement coordinator for advice and opinions on patient care issues that occur. Our flight medics are all very experienced, and most have come from the Air Med side of Acadian. We work seven-on, seven-off, and many work shifts for Air Med to get more volume and keep their skills fresh. “An MCI is a real possibility on oil platforms. Do people just need to be moved off a platform because it is on fire or in danger of sinking? Or was there an event that created a large number of casualties? If there is a medic stationed on the platform, he or she will have done the initial triage by the time the helicopter arrives. If not, we can begin to do the triage and packaging for transport. We might move victims to another close platform with medics on it and transport the more serious patients to shore. We can also use our AW139, and Air Med might be able to send some of their helicopters offshore to platforms. We can also pick up some Acadian Air Med crews and their gear on the way out to a known MCI.” Due to the size and weight of the S-92, the crew may have to land at an airport near the hospital and have a ground ambulance transport the patient and flight medic from there. They’ll go to the most appropriate facility for the patient’s condition—STEMI center, stroke center, trauma center, burn center, etc. The dispatch center, which is Acadian’s, finds the closest, most appropriate destination so the crew doesn’t have to “shop” for a receiving facility. “Almost 100% of our pilots and rescue specialists have military search and rescue experience,” says Jacob. “We have U.S. Air Force pararescuemen and rescue pilots, U.S. Coast Guard rescue swimmers and pilots, and U.S. Navy pilots and rescue swimmers. There is a large amount of trust among the crews because of that. We know we will revert to our military training when things get challenging. The crews rely on their crew resource management training, which they all had in the military. We all know how to communicate effectively in stressful situations.” A Hazardous Environment

Oil platforms are built like ships, with compartments, vertical ladders and complex machinery. Dangerous chemicals and gases like methane and hydrogen sulfide are common, so the rescue specialists can extricate people from hazardous atmospheres with low oxygen using air tanks. They can also do vertical rope rescue for victims of falls or others who cannot use the ladders inside the platforms.

Hoist missions in the water and bayous have their own set of unique hazards. “In addition to looking for the normal hazards for a helicopter hoist operation, we are also looking for natural hazards such as sharks and alligators,” says Mike Fout, a rescue specialist instructor and former U.S. Navy rescue swimmer. “We also look for debris or contaminants in the water. In addition, we have to think about the sea state and water temperature. For contaminants, we will minimize our time in the water and use a direct-deployment rescue method where we’re never unhooked from the hoist cable. We also have dry suits we put on to minimize skin exposure.”

Many of the rescue specialists had this training in the military, but all of them are current with the necessary civilian certifications for these skills. They have to recertify every two years on all of them. They also adhere to international standardized training and hold internationally recognized certifications for their rescue skills. All the paramedics are nationally registered and certified by the states of Louisiana and Texas.

“When we’re first hired, we get qualified in one position on the team, and then we get dual-qualified with time as both hoist operators and rescue swimmers,” Fout says. “The goal is to have all rescue specialists dual-qualified.

“In addition to maintaining currency with the different helicopter deployment methods, day and night, we also have confined-space and vertical rope rescue training to stay current with. We do a lot of training. We try not to be idle. We will pull out our confined-space and rope rescue gear a couple times a week and train. Our hangar is about three stories high inside, and we can practice vertical rope rescue techniques in there.

“A new person gets qualified on the aircraft first and then is sent to different rescue schools. We work with Roco Rescue, which specializes in industrial rescue training, for high-angle rope and confined-space rescue training. Medical training is done by Acadian Ambulance.”

There is an instructor cadre that includes hoist operators and rescue swimmers who meet regularly to discuss new gear and new procedures they might want to adopt. If a new piece of equipment looks promising, they will get it and test it both in a static environment in the hangar and then with the aircraft.

The instructor cadre also meets to decide on future training needs, updates that might be needed in the process, and any improvements to the operation they might be able to make. They also look at how other civilian and military rescue units do things to see if they might want to add to or adjust their program.

“We are fortunate enough to have a large cross-section of military rescue experience,” says Fout. “Each brings their own experiences we can look at to see if something would be a good fit here.”

Conclusion

CHI’s S-92 helicopter is a combination rescue truck and critical care transport ambulance. It can handle rescue and medical incidents on ships, oil platforms and in the bayous and open water of the Gulf of Mexico. All of the people interviewed by EMS World said there is no better air ambulance and rescue helicopter anywhere in the world.

Barry D. Smith is an instructor in the Education Department at the Regional Emergency Medical Services Authority (REMSA) in Reno, NV. Contact him at bsmith@remsa-cf.com.

Oil platforms are built like ships, with compartments, vertical ladders and complex machinery. Dangerous chemicals and gases like methane and hydrogen sulfide are common, so the rescue specialists can extricate people from hazardous atmospheres with low oxygen using air tanks. They can also do vertical rope rescue for victims of falls or others who cannot use the ladders inside the platforms. Hoist missions in the water and bayous have their own set of unique hazards. “In addition to looking for the normal hazards for a helicopter hoist operation, we are also looking for natural hazards such as sharks and alligators,” says Mike Fout, a rescue specialist instructor and former U.S. Navy rescue swimmer. “We also look for debris or contaminants in the water. In addition, we have to think about the sea state and water temperature. For contaminants, we will minimize our time in the water and use a direct-deployment rescue method where we’re never unhooked from the hoist cable. We also have dry suits we put on to minimize skin exposure.” Many of the rescue specialists had this training in the military, but all of them are current with the necessary civilian certifications for these skills. They have to recertify every two years on all of them. They also adhere to international standardized training and hold internationally recognized certifications for their rescue skills. All the paramedics are nationally registered and certified by the states of Louisiana and Texas. “When we’re first hired, we get qualified in one position on the team, and then we get dual-qualified with time as both hoist operators and rescue swimmers,” Fout says. “The goal is to have all rescue specialists dual-qualified. “In addition to maintaining currency with the different helicopter deployment methods, day and night, we also have confined-space and vertical rope rescue training to stay current with. We do a lot of training. We try not to be idle. We will pull out our confined-space and rope rescue gear a couple times a week and train. Our hangar is about three stories high inside, and we can practice vertical rope rescue techniques in there. “A new person gets qualified on the aircraft first and then is sent to different rescue schools. We work with Roco Rescue, which specializes in industrial rescue training, for high-angle rope and confined-space rescue training. Medical training is done by Acadian Ambulance.” There is an instructor cadre that includes hoist operators and rescue swimmers who meet regularly to discuss new gear and new procedures they might want to adopt. If a new piece of equipment looks promising, they will get it and test it both in a static environment in the hangar and then with the aircraft. The instructor cadre also meets to decide on future training needs, updates that might be needed in the process, and any improvements to the operation they might be able to make. They also look at how other civilian and military rescue units do things to see if they might want to add to or adjust their program. “We are fortunate enough to have a large cross-section of military rescue experience,” says Fout. “Each brings their own experiences we can look at to see if something would be a good fit here.” Conclusion CHI’s S-92 helicopter is a combination rescue truck and critical care transport ambulance. It can handle rescue and medical incidents on ships, oil platforms and in the bayous and open water of the Gulf of Mexico. All of the people interviewed by EMS World said there is no better air ambulance and rescue helicopter anywhere in the world. Barry D. Smith is an instructor in the Education Department at the Regional Emergency Medical Services Authority (REMSA) in Reno, NV. Contact him at bsmith@remsa-cf.com.

ADVANCED AIR MEDICAL

 This program is available to those that are seeking advancement into air ambulance transportation. Medical Personnel that qualify to perform air ambulance transport will find this course informative and direct. This class follows the DOT 40-hour program and is one day of class with homework to return.

To take this course

http://shop.eeti.training/product.sc?productId=6&categoryId=1

14. Safety Audit

15. Knolege about develop MERP Medical Evacuation Response Plans

20.04.2014 from Walvis Bay-NAMIBIA to CURAZO. Real Remote and International Medicine by @DrRamonReyesMD Onboard Noble Paul Romano as SENIOR OFFSHORE SITE MEDICAL OFFICER

Requirements to be Remote, International Medicine and Offshore Medicine. OIL Industry Basic Offshore Safety Induction Emergency Training (BOSIET) and FOET

 from Walvis Bay-NAMIBIA to CURAZO. Real Remote and International Medicine

https://www.noblecorp.com/our-fleet/fleet/fleet-details/2020/Noble-Tom-Madden/default.aspx

Ship Drill Rig Offshore 

16. Multicultural Knolege 

17. Tropical Medicine

18. Alcohol and Drug Tets

19. International Medicine

20. excellent fitness

22. To work offshore USA the Visa B1 OCS

B-1/OCS visas are issued to crewmembers of international vessels operating on the Outer Continental Shelf or Gulf of Mexico for more than 29 days.  In determining who qualifies for the B-1/OCS visa, Consular Officers take into consideration the individual’s responsibilities and activities on the ship, shipyard, or platform.

How To Apply   
      
To apply, please comply with the Nonimmigrant Visa Application Procedures. B-1/OCS applicants must select C1/D as their purpose of travel on the DS-160 application form.  The applicant should bring these documents to the interview in case the consular officer requests to see them.    

1. Letter from the U.S. Coast Guard granting an exemption from the Outer Continental Shelf Lands Act Amendments in accordance with 33 CFR 141
2. Seafarer’s Identification and Record Book (SIRB) issued by the Philippine Department of Transportation and Communication’s Maritime Authority (MARINA) 
3. Seafarer’s Registration Card (SRC) issued by the Philippine Overseas Employment Administration (POEA), with attached signed photo
4. First page of the original valid Overseas Employment Commission Certification (OEC) issued by the POEA or a POEA in-house processed OEC issued by certified agencies
5. Seafarer recruitment agency guarantee letter with signature and all appropriate information; each seafarer must be issued an individual guarantee letter with each application. 
6. Employment history – applicant’s job experience from age 21 up to present 
7. All seaman’s books that have expired in the past ten years and any additional seaman’s book or passport which contains a U.S. visa 
8. Signed and valid contract of employment in POEA format 
9. Original Basic Safety Course (BSC) training certificate with Personal Safety and Social Responsibility (PSSR) (photocopies are not accepted) 
10. College transcripts and diplomas (first-time seafarers) 
11. Certifications of training (first-time seafarers) 
12. Employment certification letters from previous employers (first-time seafarers)
13. For seafarers taking unusual or uncommon seafaring positions, seafarer recruitment agencies must provide a complete job description and indicate whether the position is a temporary or permanent component of the ship’s crew.  In some circumstances, seafarer applicants may be requested to submit a complete itinerary for the vessel.
14. Copy of the Appointment Confirmation letter. 

Notes:  

• In certain cases, additional documents may be requested. 
• All documents must be originals.  Photocopies will not be accepted, unless specified.  The applicant must submit these documents to the interviewing consular officer during the interview. The Nonimmigrant Visa Unit does not accept documents before the interview. Any documents received will not be returned and will be destroyed. Please note, however, that presentation of the documents will not guarantee visa issuance. Applicants must still qualify for the type of visa being sought. 

Guidelines for Document Submission    
      
Every seafarer recruitment agency should carefully check all seafarer applications prior to submission to ensure the form has been filled out correctly and completely. Incomplete applications will be denied.  Follow these guidelines when submitting documents: 

• Remove plastic covers or jackets from SIRBs and passports.    
• Remove excess papers and staples. 
• The guarantee letter must be stapled to the back of the application form. All guarantee letters must follow the format described in the instructions found in the Embassy accreditation kit. Guarantee letters not in the correct format or without required information will not be accepted. 
• The SRC must be attached to the inside front cover of the SIRB.
• The POEA approved or in-house processed contract of employment and OEC must be stapled together inside the back cover of the seaman’s book. Original documents including the contract, OEC and SRC will be returned to the seafarer after the application is processed.

Note: The seafarer recruitment agency must contact the call center to make any corrections to inaccurate information before the applicant’s interview. 

B-1 Yacht Visas   
      
B-1 visas are issued to qualified applicants going to work on privately owned yachts.  A B-1 visa will permit applicants to stay in the United States or U.S. coastal waters for more than 29 days.  If you will be working on a privately owned yacht, you must comply with the Nonimmigrant Visa Application Procedures and comply with both the seafarer (C-1/D) and working visa (B-1) requirements.  B-1 Yacht applicants must select C1/D as their purpose of travel on the DS-160 application form.

Applicants going on privately owned yachts must present detailed information about the yacht (e.g. yacht specifications) and yacht owner (e.g. contact information) and must present the yacht’s itinerary at the time of interview.   

Helpful Links to Visit: 

• Frequently Asked Questions (FAQs)

OPITO Basic Offshore Safety Induction and Emergency Training - BOSIET

 Guia Sanitaria a Bordo. gratis en PDF

Guia Sanitaria a Bordo 

Enlace para bajar guia en formato PDF Gratis   by Instituto Social del Mar. España

Guidelines on the medical examinations of seafarers 

Link to DOWNLOAD 

GRATIS PDF: MAS de 230 LIBROS MEDICINA Y SALUD 

Directrices para la realización de los reconocimientos médicos de la gente de mar PDF gratis http://emssolutionsint.blogspot.com/2018/07/directrices-para-la-realizacion-de-los.html

Information courtesy:

MANUAL DE ATENCIÓN AL PARTO EN EL ÁMBITO EXTRAHOSPITALARIO. Ministerio de Sanidad, Servicios Sociales e Igualdad. España

Viajar y volar durante el embarazo. INFOGRAFIA

Facilitador de parto ODON Autorizado por la OMS. Video

DOCUMENTACIÓN ESTRATEGIA DE ATENCIÓN AL PARTO NORMAL. MINISTERIO DE SANIDAD, POLÍTICA SOCIAL E IGUALDAD

Plan de Parto y Nacimiento Consejeria de Salud JUNTA de ANDALUCIA España

Parada Cardio-Respiratoria "PCR" en Embarazadas "REANIMACION CARDIO-PULMONAR, RCP EN EMBARAZADAS 2015-2020

Posiciones de Traslado y asistencia de pacientes by SERRALCO.es

EMBARAZO, PARTO y PUERPERIO Recomendaciones para Madres y Padres. Junta de Andalucia, España

MANUAL BASICO DE OBSTETRICIA Y GINECOLOGIA Gratis PDF. Ministerio de Sanidad, Servicios Sociales e Igualdad. España

¿Qué es el parto velado "Parto Empelicado" o nacer con bolsa intacta? by NATALBEN.com

Balística de las heridas: introducción para los profesionales de la salud, del derecho, de las ciencias forenses, de las fuerzas armadas y de las fuerzas encargadas de hacer cumplir la ley

http://emssolutionsint.blogspot.com/2017/04/balistica-de-las-heridas-introduccion.html

Guía para el manejo médico-quirúrgico de heridos en situación de conflicto armado by CICR http://emssolutionsint.blogspot.com/2017/09/guia-para-el-manejo-medico-quirurgico.html

CIRUGÍA DE GUERRA TRABAJAR CON RECURSOS LIMITADOS EN CONFLICTOS ARMADOS Y OTRAS SITUACIONES DE VIOLENCIA VOLUMEN 1 C. Giannou M. Baldan CICR

http://emssolutionsint.blogspot.com.es/2013/01/cirugia-de-guerra-trabajar-con-recursos.html

Manual Suturas, Ligaduras, Nudos y Drenajes. Hospital Donostia, Pais Vasco. España http://emssolutionsint.blogspot.com/2017/09/manual-suturas-ligaduras-nudos-y.html

Manual CIERRE DE HERIDAS by ETHICON

http://emssolutionsint.blogspot.com/2017/09/manual-cierre-de-heridas-by-ethicon.html

Manual de suturas. Menarini

http://emssolutionsint.blogspot.com/2017/09/manual-de-suturas-menarini.html

Técnicas de Suturas para Enfermería ASEPEYO y 7 tipos de suturas que tienen que conocer estudiantes de medicina

http://emssolutionsint.blogspot.com/2015/01/tecnicas-de-suturas-para-enfermeria.html

Cuaderno Enfermero.Cirugia Menor Heridas Suturas http://emssolutionsint.blogspot.com/2016/07/cuaderno-enfermerocirugia-menor-heridas.html

Manual Práctico de Cirugía Menor. Grupo de Cirugia Menor y Dermatologia. Societat Valenciana de Medicina Familiar i Comunitaria http://emssolutionsint.blogspot.com/2013/09/manual-practico-de-cirugia-menor.html

Protocolo de Atencion para Cirugia. Ministerio de Salud Publica Rep. Dominicana. Marzo 2016 http://emssolutionsint.blogspot.com/2016/09/protocolo-de-atencion-para-cirugia.html

Manual de esterilización para centros de salud. Organización Panamericana de la Salud http://emssolutionsint.blogspot.com/2016/07/manual-de-esterilizacion-para-centros.html

CURSO

Bleeding Control for the Injured Course "Stop The Bleed" / Control de Sangrados para el Herido

Offshore "Remote" life (Vida Offshore "Remota")

Requirements to be Remote, International Medicine and Offshore Medicine. OIL Industry Basic Offshore Safety Induction Emergency Training (BOSIET) and FOET

LIBROS GRATIS #PDF solo dirígete al enlace de las fotos y allí tienes el enlace en donde puedes descargar de forma legal y sin trucos tu libro. Dr. Ramon Reyes, MD @DrRamonReyesMD 
Blog EMS SOLUTIONS INTERNATIONAL

Heli-operaciones
Estableciendo una Zona de Aterrizaje de Helicóptero
MEDEVAC / TACEVAC / CASEVAC / AROMEDICINA / TRANSPORTE AEROMEDICO https://emssolutionsint.blogspot.com/2019/08/medevac-tacevac-casevac-aromedicina.html #MEDEVAC #DrRamonReyesMD #AIR #AVION #HELICOPTERO #CASEVAC #TACEVAC #AEROMEDICAL 

Fuente 

Clinical Practice Manual (CPM)

https://emssolutionsint.blogspot.com/2023/01/clinical-practice-manual-cpm.html  online and pdf

Por favor compartir nuestras REDES SOCIALES @DrRamonReyesMD, así podremos llegar a mas personas y estos se beneficiarán de la disponibilidad de estos documentos, pdf, e-book, gratuitos y legales..

Grupo Biblioteca/PDFs gratis en Facebook

https://www.facebook.com/groups/PDFgratisMedicina #DrRamonReyesMD

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Pinterest

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Twitter

https://twitter.com/eeiispain

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Gracias a todos el Canal somos más de  1000 participantes en WhatsApp. Recordar este es un canal y sirve de enlace para entrar a los tres grupos; TACMED, TRAUMA y Científico. ahí es que se puede interactuar y publicar. Si le molestan las notificaciones, solo tiene que silenciarse y así se beneficia de la información y la puede revisar cuando usted así lo disponga sin el molesto sonido de dichas actualizaciones, Gracias a todos Dr. Ramon Reyes, MD Enlace al 

Canal https://chat.whatsapp.com/F7mJ70klFrL3r2MUdEPKfv

Enlace a TACMED en WhatsApp https://chat.whatsapp.com/HtjPZ9LSB093rDn2Vo48t0 

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Enlace a Científico https://chat.whatsapp.com/IK9fNJbihS7AT6O4YMc3Vw en WhatsApp 

TELEGRAM Emergencias https://t.me/+sF_-DycbQfI0YzJk  

TELEGRAM TACMED https://t.me/CIAMTO

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