The only official magazine for mountain rescue in England, Wales, Scotland and Ireland
ISSN 1756-8749
75 WINTER 2021
THE ONLY OFFICIAL MAGAZINE FOR MOUNTAIN RESCUE IN ENGLAND, WALES, SCOTLAND AND IRELAND
issue inthis
WELCOME TO ISSUE 75: WINTER 2021 Mountain Rescue is the only official magazine for mountain rescue in England, Wales, Scotland and Ireland.
Judy Whiteside 07836 509 812 • editor@ mountain.rescue.org.uk
Andy Simpson 07836 717 021 • media@ mountain.rescue.org.uk
A collection of guidelines and information for teams and team members, relative to these challenging times – recently updated 4
01829 781 327 • caroline@ media-solution.co.uk
NEXT ISSUE ISSUE 76: SPRING 2021
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Reporting from a virtual Greek ICAR: Chris Cookson reports from the online international congress 2020
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Remembering those we lost in 2020: Perhaps the greatest number of obits we’ve had yet in one issue, including The Fox of Glencoe, Hamish MacInnes 27 40 43 Navigation: Following the science with Nigel Williams Macdonalds to Munros to the Mera Glacier: Sean McBride’s diary of an overweight mountaineer
Cover story Solitary team member takes in the view during a Penrith training session at Blea Tarn in December © Tim Sanders.
PLEASE NOTE Articles carried in Mountain Rescue do not necessarily reflect the opinions of Mountain Rescue England and Wales. We do not accept responsibility for advertising content.
OBITUARIES: 27-35 SARLOC: 42-43 WELLBEING: 46-47 FROM THE ARCHIVE: 50-61 WHO’S WHO: 56-57 what’s in at a glance
CORONAVIRUS: 4-13 ICAR: 16-17 EDITOR’S BIT: 18 ALAN HINKES: 22-23 IN THE NEWS: 24-25
MOUNTAIN RESCUE ENGLAND AND WALES IS A CHARITABLE INCORPORATED ORGANISATION REGISTERED IN ENGLAND AND WALES NO: 1178090 REGISTERED OFFICE: 12 EDWARD V11 AVENUE, NEWPORT NP20 4NF
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MOUNTAIN RESCUE ENGLAND AND WALES SCOTTISH MOUNTAIN RESCUE: COVID-19 GUIDELINE 1 INITIAL APPROACH TO THE CASUALTY
UPDATED
ASSESS RISK TO SELF • CASUALTY • OTHERS No risk assessment means NO rescue Any of the following: • Casualty known to be Covid-19 positive • Recent dry cough/fever/loss of smell or taste • Contact with known or suspected case in last 14 days • Unconscious or unable to give history • Medical symptom of shortness of breath/chest tightness started recently but before today.
Mask on casualty (unless requires oxygen or other priority need)
YES TO ANY [HIGH RISK] or
NO TO ALL [MEDIUM RISK] BUT Need to be within 2 metres of
NO TO ALL [MEDIUM RISK] But Able to maintain social distance and no direct contact with contaminated objects.
• Gloves Need to give casualty care Minimum PPE required is:
other rescuers or people Minimal PPE required is:
• Surgical mask • Medical gloves • Eye protection • Waterproof layer.
• Surgical mask* • Gloves (no need for medical, can use washable gloves) • Eye protection • Waterproof layer. *This should be the normal action. Dynamic risk assessment required in exceptional circumstances where safety or operational effectiveness would be compromised.
Throughout the rescue:
• Minimise total team to safe operational number • Team to maintain social distancing • Kit dump away from immediate casualty site • Casualty Care by minimal number • Advise aircrew or ambulance of Covid-19 status and risk • Avoid the use of a bivi shelter unless for environmental and clinical need • Consider use of Blizzard bag and/or alternative methods of insulation • Dispose or isolate and wash and decontaminate.
• Assist rescue and maintain social distance • Do not touch any potentially contaminated equipment • Dynamic risk assessment • Put on PPE if role changes.
MREW Covid-19 Guideline 1: Mike Greene Medical Director Updated October 2020. V4.0
Please note: These documents were updated in October 2020 to reflect UKSAR guidelines. These are guiding principles and will need to be implemented at a local level. This continues to be a fast-moving crisis and guidance can change. Further amendments will be posted in the MREW Moodle Covid-19 site.
MIKE GREENE MREW MEDICAL DIRECTOR
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MOUNTAIN RESCUE MAGAZINE WINTER 2021
MOUNTAIN RESCUE ENGLAND AND WALES SCOTTISH MOUNTAIN RESCUE: COVID-19 GUIDELINE 2 CHANGES TO CASUALTY CARE ABCDE MANAGEMENT
UPDATED
You MUST have done your risk assessment and have appropriate PPE for this rescue.
A
Make a risk assessment – use MREW Airway and Breathing Risk Assessment
• Turn a casualty with an ‘airway at risk’ into lateral position • Avoid use of suction — use positional drainage if possible • Use manual airway opening manoeuvres only after risk assessment • Only use airway adjuncts — OPA/NPA after risk assessment.
B
Cardiac arrest: • Use level 2 PPE (minimal requirement) • Check for signs of life but do not listen for breathing or get close to mouth or face • Cover casualty’s mouth and nose with a face covering/mask • If AED is immediately available apply before chest compressions • Apply AED and follow instructions • Perform chest compression-only CPR as instructed by the AED • Do not ventilate or perform airway interventions (see MREW Airway and Breathing Risk Assessment) • Consider use of mechanical chest compression devices if available. • Do not use a pocket mask or face shield • Only use a BVM with good fitting mask and filter after risk assessment • Use oxygen with a face mask according to clinical need. Avoid nasal delivery • Use pulse oximeter to guide oxygen use if possible • Use inhaler and spacer as first line (single use/dispose after use) • If required, use nebuliser — lowest functional flow (approx 6l/min), do not use in enclosed space, rescuers to remain upwind. Make a risk assessment – use MREW Airway and Breathing Risk Assessment
C
• No change — record conscious level D
E
• Avoid use of bivi shelter unless environmental or clinical need. Keep warm using alternative methods of insulation if possible.
MREW Covid-19 Guideline 2: Mike Greene Medical Director Updated October 2020. V4.0
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MOUNTAIN RESCUE ENGLAND AND WALES AND SCOTTISH MOUNTAIN RESCUE COVID-19 GUIDELINE 3 EVACUATION AND END OF RESCUE Consider: • Minimise members involved — but must be operationally appropriate • Face mask on casualty to act as a barrier • Sledging may create more distance between members than carrying • Wheel may be less stressful and helps to reduces breathing rate/high intensity exercise whilst wearing face mask • Gloves — use washable gloves — medical gloves not required • Do not touch face • PPE is hot — consider adjusting layers of clothing/regular change of personal etc.
UPDATED
EVACUATION
WORKING WITH OTHER AGENCIES
• Inform other agencies of your risk assessment. • Maintain your PPE and social distance when working with other agencies • If uncomfortable, ask other agencies to respect your PPE and distancing.
END OF RESCUE AT ROADSIDE AND AT BASE
Dispose. Isolate. Decontaminate. At roadside: • Consider: Decontaminate as much as possible before leaving roadhead, setting up a decontamination zone at roadhead. Use of a buddy system. Removing personal clothing: • Do not touch face. Clean hands between each step . • Removes gloves — turn inside out — dispose/isolate (if washable) • Remove waterproofs — turn inside out — isolate in bags — wash (follow manufacturer’s instructions) • Remove eye protection — isolate/decontaminate • Remove helmet/headwear — isolate/clean (manufacturer’s instructions) • Remove face mask — dispose • Clean hands. At base: • Ensure you have a local procedure to decontaminate or isolate all equipment • Refer to manufacturer’s instructions as required • Clean vehicles and base • Ensure immediate access to hand sanitiser in base for all members.
DRUGS
• There is no proven link between Ibuprofen and worsening of Covid-19. Ibuprofen can be used for analgesia in MR casualties
• Only use Entonox with a viral filter to protect the system from contamination • In HIGH risk casualty avoid the use IND (risk of sneezing or coughing) • Consider use of IM Morphine or Fentanyl Lozenge in these cases.
MREW Covid-19 Guideline 3: Mike Greene Medical Director October 2020. V4.0
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REMINDER... HOW TO REGISTER WITH MOODLE Go to http://tiny.cc/Moodle4MR and use a team email address to register but NOT a role specific one! If you’ve registered correctly, you’ll receive an automated email within thirty minutes confirming your request has been received. Your account will usually be approved within a few days, but please be aware it may take up to a week. An email will arrive with a temporary password which you’ll be invited to change when you first log in. Moodle will ignore duplicate registrations so if you have previously registered, but forgotten, try the forgotten password link. If you have any queries regarding registration, please email moodlesupport@mountain.rescue.org.uk .
Advice and Risk Assessment for Airway and Breathing Management These notes are intended to provide a framework to guide decision- making in complex situations where a Casualty Care Certificate holder is faced with the situation of considering an Airway or Breathing intervention and no other help is available. It is not possible to provide advice on every situation in mountain rescue. Covid-19 will remain in the community for the foreseeable future. The virus is transmitted by airborne particles or direct transfer from a contaminated surface to the face — entering via the eyes, mouth and nose. Management of the airway in first aid situations has the risk of producing airborne particles that can be inhaled by the rescuer and cause infection. A patient who requires airway intervention will be very sick and is likely to have an unknown Covid ‘status’. Infection rates in the community are increasing and casualties come from a variety of areas in the UK. Increased Covid-19 in the community increases our risk. ● Infection depends not only on exposure to the virus but the amount of virus, protection (to reduce viral contamination from the casualty and exposure to it by carers), and immunological factors in the host. Working in an outdoor environment considerably reduces risk compared with an indoor space. ● Mountain casualties do not usually have active Covid illness (but could be asymptomatically shedding virus and cause infection). ● Airway and breathing treatments all have some risk to the rescuer therefore they require an informed risk assessment. ● In all cases, the safe default is no airway intervention, but in mountain rescue there may be no other professional and help to manage the airway in timely manner. ● Rescuers are not required to place themselves at risk by their actions. This decision will always be supported. ● Health Care Professionals (HCPs) will make their own risk-based assessment of the situation and are likely to have access to Level 3 PPE. ● Some teams will have the resources to provide limited amounts of Level 3 PPE and this must be administered at a local level. ● The advice in this document should ideally be supported and supplemented with local professional support and decision making. ● In nearly all mountain accidents, the time delay for deployment, reaching and extracting the casualty means that those in cardiac arrest are non- survivors.
NHS COVID-19 APP CALDER VALLEY SRT
The NHS Covid-19 App provides electronic contact tracing via Bluetooth. This is automatic and performed in the background. Users are notified by the app if a ‘contact’ registers a positive test result. A notification then advises the user to self-isolate for a period. If mountain rescue team members are using the app and attending call-outs, it is important they suspend contact tracing within the app when practicing Infection Prevention and Control (IPC), including the use of appropriate Personal Protective Equipment (PPE) and should remember to turn the contact tracing function back on when IPC is no longer practised ie. at the end of a job 1 . This can be achieved by toggling the button within the app (see below). Why is this important? The app uses Bluetooth to establish a contact if you are in range for a period of time. However, due to data protection, the ‘contact’ is a code that changes regularly 2 . Only in the cases of a positive test are a user’s ‘contacts’ uploaded to a central server (with their permission) and matches established. This notifies those ‘contacts’ via the coded database. To prevent data breaches, the codes cannot be identified to individual users and users will not be notified the identity of the positive ‘contact’. In instances where IPC is in place, there may be no need to isolate, however, due to the anonymity of data within the app it is not possible to ascertain where the contact occurred so a ‘false’ period of isolation may be indicated. Consider the following
example: A team treats a casualty whilst practising IPC in full PPE who goes on to test positive for Covid- 19. Members who are using the app and have been in close proximity to the casualty are then notified of a positive interaction. However, because this is anonymised, team members cannot be sure it was the casualty or another contact from, for example, a shopping trip. Worst- case scenario: teams could see a substantial number of team members isolating for up to two weeks following a call-out.
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1 https://tinyurl.com/yc6qgktb 2 https://tinyurl.com/ya8893vj
MREW MSC Airway Management Covid-19. V.2.0. October 2020. (Contributors: Dr R Walker, Dr L Gordon, Mr D Whitmore, Dr S Rowe, Mr M Hughes, Dr A Morris, Dr K Greene) .
MREW Track and Trace: Mike Greene Medical Director June 2020. V1.0
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AIRWAY AND BREATHING MANAGEMENT CONTINUED...
PROBLEM
BENEFIT & CONSIDERATIONS
AIRWAY RISK FOR CASUALTY CARE CERTIFICATE HOLDERS
COMMENTS
Adult cardiac arrest/medical unwitnessed or CPR ongoing >15 minutes
Risk likely to outweigh benefit.
• MREW teams attend approx 10 cardiac arrests per year. • Use current MREW Covid-19 CPR guideline.
• Extremely likely to have very poor outcome. • Usually has a cardiac (heart- related) cause. • Success dependent on early defibrillation and prompt chest compressions within first few minutes after collapse. • If team is present at ‘collapse’ or within first few minutes, outcome initially more hopeful. • Cause likely to be cardiac (heart-related). • Early defibrillation and chest compressions remain the best means of treating the reversible cause. • Respiratory cause but very poor outcome unless recently submerged and rescued within 10 minutes. After 25 minutes’ submersion, very poor outcomes. • There can be a protective effect of hypothermia in ice cold water. • Outcome very poor once arrest has occurred. Mountain accidents cause blunt trauma. • Rapid intervention is not usually available for a reversible cause in remote situations. Blood loss is the cause of arrest in 50%. Although other reversible causes may be present in 15%, these cannot be corrected by Casualty Care Certificate interventions.
Adult cardiac arrest/medical witnessed
• AEDs are used by MREW teams approx 8 times a year. • Use current MREW Covid-19 CPR guideline. • See below for risk assessment and interventions if A & B interventions considered.
Risk likely to outweigh benefit. Consider A & B if defibrillation not successful in first three shocks.
Adult cardiac arrest/trauma
Risk is likely to outweigh benefit.
• Defibrillation will not treat the cause of a traumatic cardiac arrest.
• Gloves
Paediatric arrest/ drowning
Benefit increased BUT requires assessment of situation.
• MREW teams attend approx 3 drownings (of all ages) per year. • Emotional dilemma present in all child cardiac arrest. Assess the risk: 1: Children do have the potential to infect adults BUT this might be less likely to do so. 2: Cause of arrest is lack of oxygen and airway intervention with ventilation is more likely to reverse the cause than with some other causes. 3: Time under water: improved survival if child is rescued within 10 minutes. Very poor outcomes after 25 minutes under water. 4: Improved outcome if CPR started immediately. Ideally, decision by experienced HCP. Resuscitation requires Level 3 PPE available and suitably skilled provider — is this available? • If you accept the risk, use a bag-valve- mask (well-fitting mask and filter) + oxygen, rather than a face shield or pocket mask.
• Bystander immediate CPR/ventilation critical.
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PROBLEM
BENEFIT & CONSIDERATIONS
AIRWAY RISK FOR CASUALTY CARE CERTIFICATE HOLDERS
COMMENTS
Paediatric arrest/ trauma
• Likely to have very poor outcome. Cause severe blood loss, severe hypoxia or severe brain trauma. • These causes cannot be reversed by interventions available to Casualty Care Certificate holder. • More likely to have respiratory cause. Children have less severe illness from Covid-19 but can carry and transmit the infection. • They also interact with many potential contacts. Perform a risk assessment Best assessed and managed by HCP. When no professional help will be available in a suitable time period consider the following: • Airway intervention in MR is a rare event. • Only 6 records of the use of airway adjuncts in MREW database in 2019. • If airway and breathing intervention is to be carried out, use a step-wise approach and non-invasive methods first. Only use more invasive actions if simple action is not successful. • Do something simple and ‘safe’ or wait for help if this is possible: • Lateral position • Simple airway manoeuvres before • Adjuncts • Suction. • Use BVM rather than a pocket mask or face shield. • Use a well-fitting mask and must use a filter.
Risk likely to outweigh benefit.
Follow BLS Guideline if professional help is quickly available to support further resuscitation.
Paediatric arrest/ medical
Benefit maybe higher than in other forms of arrest.
A very rare event in a mountain rescue team. Ideally, decision by experienced HCP and resuscitation requires Level 3 PPE available and suitably skilled provider. If you accept the risk use a bag-valve- mask (well-fitting mask and filter) + oxygen, rather than a face shield or pocket mask. Ideally requires Level 3 PPE available and suitably skilled provider. There is much more risk to the rescuer if the casualty coughs during an airway intervention. • Only use an intervention if required. • Keep your head and face as far away from casualty as possible. • Position yourself out of the ‘line of fire’ from a cough (upwind if possible). • Only insert an airway adjunct in sufficiently unconscious patients to avoid coughing. • Avoid using suction if possible. Try positional drainage first. • Do not use a pocket mask or face shield. • Use a BVM only with a well-fitting mask and a filter. Other factors are the individual profile of the rescuer. Factors such as age and other illness may make the rescuer more susceptible to more severe infection so these individuals should not be exposed to unnecessary risk from Covid-19. A local arrangement for ‘fit testing’ and supply of FFP3 respiratory protection may be available through local resilience forums. The Fire Service is providing fit testing in some areas. Note that FFP3 masks are manufacture specific and not interchangeable. Also be aware that the wearer must be clean-shaven. It is likely that such an arrangement would require limited number of individuals in a team to be suitably tested, equipped and trained.
‘Live’ casualty requiring airway support
Ideally, intervention by appropriately protected and trained carer or HCP. Consider risk on individual case basis.
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ROUTINE DECONTAMINATION OF REUSABLE NON-INVASIVE PATIENT CARE EQUIPMENT
Routine decontamination of reusable non-invasive care equipment ▼
• Check manufacturer’s instructions for suitability of cleaning products especially when dealing with electronic equipment • Wear appropriate PPE eg. disposable, non-sterile gloves and aprons.
▼
Is equipment contaminated with blood?
Yes
No
▼
Is equipment contaminated with urine/vomit/faeces or been used on a patient with a known or suspected infection or colonisation?
▼
Yes
No
• Immediately decontaminate equipment with disposable cloths/ paper roll and a fresh solution of detergent, rinse, dry and follow with a disinfectant solution of 10,000 parts per million available chlorine (ppm av cl)* , rinse and thoroughly dry • Or use a combined detergent/ chlorine releasing solution with a concentration of 10,000 ppm av cl* , rinse and thoroughly dry • If the item cannot withstand chlorine releasing agents, consult the manufacturer’s instructions for a suitable alternative to use following, or combined with, detergent cleaning.
▼
▼
• Decontaminate equipment with disposable cloths/paper towel and a fresh solution of general-purpose detergent and water or detergent impregnated wipes • Rinse and thoroughly dry • Disinfect specific items of non-invasive, reusable, communal care equipment
• Immediately decontaminate equipment with disposable cloths/paper roll and a fresh solution of detergent. Rinse, dry and follow with a disinfectant solution of 1,000 parts per million available chlorine (ppm av cl)* , rinse and thoroughly dry • Or use a combined detergent/chlorine releasing solution with a concentration of 1,000 ppm av cl* , rinse and thoroughly dry • If the item cannot withstand chlorine releasing agents consult the manufacturer’s instructions for a suitable alternative to use following or combined with detergent cleaning.
if recommended by the manufacturer (eg. 70% isopropyl alcohol on stethoscopes).
▼
▼
• Follow manufacturer’s instructions for dilution, application and contact time • Clean the piece of equipment from the top or furthest away point • Discard disposable cloths/paper roll immediately into the healthcare waste receptacle
• Discard detergent/disinfectant solution in the designated area • Clean, dry and store re-usable decontamination equipment
• Remove and discard PPE • Perform hand hygiene.
* Scottish National Blood Transfusion service and Scottish Ambulance Service use products different from those stated in the National Infection Prevention and Control Manual
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MOUNTAIN RESCUE MAGAZINE WINTER 2021
A guide for MRT members*
DAVID WHITMORE DERBY MRT & MIKE GREENE
This article was published on the Moodle VLE in May 2020 but its message remains as pertinent going forward into 2021. Covid-19 remains endemic in the UK and we can expect a significant number of the UK population to have the potential to be infected so, as mountain rescuers, we must continue to be alert. Not all infected persons display symptoms, and therefore it is wise to assume that your casualty or missing person has the potential to be infected with the virus. We must continue to adapt not to ‘business as usual’ but ‘our normal business done differently’. MREW, regions and teams have all been working to ensure we have safe systems of practice in place to keep both team members and our casualties safe during this crisis. This document is a summary of important information for all team members.
WHAT IS COVID-19, AND HOW IS IT SPREAD? Covid-19 is a coronavirus 1 discovered in November 2019 in Wuhan province China, and passed from animals (bats) to humans 2 . In humans the virus is spread via droplets as a result of breathing, coughing or sneezing in close proximity (within two metres) of an infected person. It can also be spread by a person touching an infected person, a surface or object that has been contaminated with respiratory secretions and then touching their own mouth, nose or eyes 3 . The virus can last for up to 72 hours on some surfaces 4 . HOW CAN WE LIMIT THE SPREAD? Because the virus cell is surrounded by a lipid (‘fatty’) layer it is inactivated by soap 5 . This is one of the main reasons why really good hand hygiene and cleaning down of potentially contaminated surfaces assists in restricting the spread of the virus. It is also a reason why washing clothing in an ordinary washing machine is effective in killing the virus 6 . We can limit spread by staying outside the range of droplets expressed from the respiratory system (two metres), avoiding any interaction with the airway (the most potentially infectious area) and never touching our own faces with gloves that might be contaminated. We can minimise droplet spread by placing barriers between the casualty’s airway and ourselves, hence the use of a fluid resistant face mask on the casualty and ourselves when we have to get within two metres of the casualty.
HOW DO WE DETERMINE IF A CASUALTY HAS COVID-19? If casualties meet the below criteria they are classified as a possible case: • Acute respiratory distress syndrome 7 • High temperature (of 37.8°C or higher) And at least one of the following which must be of acute onset: • Persistent cough (with or without sputum), hoarseness, nasal discharge or congestion, shortness of breath, sore throat, wheezing or sneezing. However, there is a wide variety of presentations and not all patients will have fever or these signs and symptoms. The dilemma for MRTs is that some casualties will have no signs of Covid-19 but could be shedding 8 the virus and be infectious. We do not how often this happens. Therefore it is prudent for the assessment and treatment of the patient to be by as few people as possible, depending on the physical location and clinical condition of the casualty. These team members must be wearing gloves, a mask, eye protection 9 and a waterproof layer (Level 2 PPE). A second dilemma is that assessment and treatment can be more difficult when we are trying to avoid viral spread. It is advisable to keep a physical ‘hand on’ assessment to a minimum. Collect as much information as possible from the casualty, their relatives or friends and use observation to help diagnosis. Thus, observation of the effort of breathing, inability to speak in whole sentences, their colour and their demeanour take on a much more nuanced meaning for the casualty carer.
Physical contact should be reduced to essential assessment and treatment. It is advised that the most clinically competent person carries out the examination and assessment. Think — will the examination or procedure I am going to carry improve my decision-making and or change treatment. If, due to the casualty’s injuries or medical condition, a closer physical examination of the chest or abdomen is required, then the casualty carer must replace their outer layer of gloves having completed the examination 10 . It is worth considering putting in place systems that restrict the self-deployment of team members, and that they wait at the RVP and approach the casualty site as a team; and that the most clinically experienced member of the approach party makes the initial assessment. This will also allow for PPE kits to be made available from the RVP to ensure that a casualty carer, and others, have the correct PPE. Remember your D-R-C-A-B-C-D-E approach. Danger encompasses Covid-19. A sensible and calm approach in our normal manner is what is required. You are there to treat a casualty, who might, as an aside, have Covid-19. The fact that they are ‘on the hill’ is a sign that they are probably not seriously ill with the virus, but they might be infected with it. It is unlikely that the reason you have been called out is because they have the virus as the main problem. The majority of casualties treated within MREW have had the normal injuries and illness that we expect to treat in MR. After the lockdowns/restrictions, we will continue to treat people with broken legs and cardiac chest pain. The difference is that they might be able to spread the virus. Until there is widespread testing in the community or a
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NOTES: In the context of this article, the term ‘casualty’ refers to anyone who we have been called to assist — so from a fallen climber to a missing person who appears uninjured at the ‘find’ and everything in between. MRT denotes Mountain Rescue Teams. 11, 12 https://moodle.mountain.rescue.org.uk/ 13 It is advised that teams source yellow clinical waste bags, double bag all clinical waste and either dispose of it through NHS resources if available to them. Or, leave in a safe area at base for at least 72 hours and then dispose of in the domestic waste (based on ‘COVID-19: cleaning in non-healthcare settings outside the home’: https://tinyurl.com/ya54fw2k https://tinyurl.com/vzud9k5 Symptoms include: severe shortness of breath, rapid shallow breathing, tiredness, drowsiness/confusion and feeling faint. 8 The term is used to refer to shedding from a single cell, shedding from one part of the body into another part of the body, and shedding from bodies into the environment where the virus may infect other bodies. 9 These need to be surgical masks and conform to EN1463 for Type2R masks. This means they will be FFP2 as a minimum standard. 10 If there is contamination it will mainly be on the patient’s clothes so examination under the clothes is low risk REFERENCES 1 A coronavirus is so called because under a microscope the individual virus cell surface resembles a crown. 2 Any disease that is passed from animals to humans is known as zoonotic transmission. Lyme disease is zoonotic in nature. 3 ‘COVID-19: guidance for first responders’: https://tinyurl.com/tgsxkfz 4 This varies on the type of surface: Copper up to 4 hours, cardboard 24 hours and hard plastic or steel surfaces 72 hours. 5 It is the surfactants in the soap that break down the lipid layer and allow the virus to be killed. 6 Wash items in accordance with the manufacturer’s instructions. Use the warmest water setting and dry items completely. Dirty laundry that has been in contact with an unwell person can be washed with other people’s items. Do not shake dirty laundry – this minimises the possibility of dispersing virus through the air. Clean and disinfect anything used for transporting laundry with your usual products. ‘COVID-19: cleaning of non-healthcare settings outside the home’: https://tinyurl.com/yx4ervgy 7 NHS ‘Acute respiratory distress syndrome’:
but we must keep them safe. Wearing PPE is always hot and exhausting even in hospital so we must expect and manage this problem during strenuous activities in mountain rescue. Deliberately wearing lightweight clothing under outer garments should be considered. Changing, isolating and then washing clothes could be considered for the stretcher party. Wrap around sunglasses could replace helicopter goggles or glasses. A dynamic risk assessment is useful but apply the essential principles to keep team members safe. KEEPING SAFE We start the process of casualty care by emphasising the safety of ourselves, others and the casualty. In most MR situations the objective danger from steep ground or an approaching helicopter can be easily seen and its effects are immediate. This is not true for the risk of Covid-19. This requires the same but, arguably, a more thoughtful approach. The first decision point is before you leave home. If you have a medical problem that places you in a higher risk group you should not go on call-outs at the moment. If you have vulnerable family members or family who are in a period of isolation you should stay at home. Discuss attending call-outs with your family — your actions can seriously effect other family members. When you attend a call-out, ensure you fully understand the new operational polices and be aware that rescues will need more ‘command and control’ in this climate. Please be patient with your team leaders. You must be responsible for your team members and keep to social distancing and minimise interaction during the call-out. Think through each action during the rescue and have a plan and routine for decontamination when the job is finished. We want to see you and your family safe and well. Mountain rescue will always be there on the ‘other side’. ‘Climb if you will, but remember that courage and strength are nought without prudence, and that a momentary negligence may destroy the happiness of a lifetime. Do nothing in haste; look well to each step; and from the beginning think what may be the end.’ These familiar words of Edward Whymper, from his ‘Scrambles Amongst the Alps’ are just as true today as then, but Whymper had never considered this might one day apply to Covid-19.
vaccine we need to adapt our mountain rescue operations to this situation. The MREW Moodle site has further resources and three specific guides on how to approach, treat and evacuate a casualty during Covid-19 (reproduced here on pages 4-6). This information changes from time to time and you should continue to check the MREW Medical Covid-19 section of the site once a week for updates. There are also videos and documents from teams across MREW detailing how they are approaching these issues 11 . PROTECTION FROM COVID-19: PPE AND RESCUE EQUIPMENT All MRT members should be carrying medical gloves, goggles for helicopter ops and waterproof clothing. These items form the absolute minimum basis of your PPE for Covid-19, and must be supplemented by team PPE, in particular fluid-resistant surgical masks. It is strongly advised that team members practise how they will put on (don) and remove (doff) PPE. Using a ‘buddy’ system is recommended because, when in a hurry, you can make mistakes. Pre-planning how you will respond from home/team base and what you need in your vehicle is vital. There are video and documentary resources on the MREW Moodle site about all these aspects of preparing for a call-out, and post call-out procedures 12 . Don’t forget that when you get home — you also need a routine, so you don’t place your family in harm’s way. At the casualty site, establish a kit dump that is at least two metres and, wherever possible, upwind from the patient. Now more than ever the casualty carer(s) and the site manager/team leader must think in advance to minimise the number of drugs, equipment and personnel that will be required to assess, treat and evacuate the casualty. Remember whatever you use will either need to be disposed of as clinical waste 13 or decontaminated. This should not compromise treatment but will minimise the kit that needs decontamination. Stretcher evacuations present a challenge. Carrying a stretcher does bring you within two metres of a casualty. The casualty should be wearing a face mask. Wearing full waterproofs, eye protection and masks would be Level 2 PPE for all those on the stretcher. These team members are not anticipated to have the intimate contact that those delivering casualty care would have
* First published in May 2020
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FIND US AT: MOUNTAIN.RESCUE.ORG.UK WINTER 2021 MOUNTAIN RESCUE MAGAZINE
MREW PRESIDENT AND OPS DIRECTOR NAMED IN THE NEW YEAR HONOURS Patterdale team member Ray Griffiths (MREW president since 2017) was appointed MBE. Mike Margeson, of Duddon and Furness MRT, (MREW Operations Director and currently in the national chair) gained an OBE. Both were recognised for their service to mountain rescue.
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Ray joined the Patterdale team in January 1976 when he moved to the Eden area of Cumbria to teach at Ullswater Community College. He has served in a number of roles with the team, including deputy leader for many years, as well as both regional and national work. ‘Massive congratulations from all the team and everyone you have helped over the years Ray,’ said Patterdale team members. ‘You join a growing but small number of amazing people in mountain rescue who have been recognised for their efforts over many years. We are all proud.’ Mike is former team leader for the Duddon and Furness team. Fellow team members believe the award is well-deserved. ‘Mike has dedicated over forty years of his life to mountain rescue, carrying out more than 1,000 rescues during this time. He has a lifetime of experience in the mountains which is called upon during rescues, but Mike also plays a pivotal role in imparting his knowledge to the team and mentoring newer members. Congratulations Mike, from all your DFMRT colleagues. Keep up the brilliant work!’ Elsewhere in mountain rescue, Richard Paskell of Western Beacons MRT also gained an MBE. A serving police detective, he received the honour for his services to mountain rescue and to the community in south Wales. As well as his work with Western Beacons, he is also involved with St John Ambulance Cymru. And Kevin Hindle was awarded a British Empire Medal for his work with Bowland Pennine MRT. His colleagues congratulated him for his recognition in the New Year Honours list. ‘Well done from us all’.
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Top: MREW President Ray Griffiths © Dave Freeborn.
USE OF TEAM EMAIL ADDRESSES MARK LEWIS MREW ICT OFFICER
TESTED, TRUSTED, CHOSEN BY MOUNTAIN RESCUE FOR OVER 15 YEARS Did you know the Páramo Mountain Professional Scheme is available to certified Mountain Rescue team members? You will receive a membership card entitling you to the top tier discount of 20% off RRP and a further 10% back in loyalty points to spend on future purchases. Buy direct from Páramo via email, telephone or from our Brand Stores, receive special deals and clearance offers, and benefit from opportunities to trial pre-production kit. Visit our website to discover more and complete the online application form, detailing which mountain rescue team you volunteer with. If you are equipping a whole team, please contact Páramo’s Contract Sales staff to discuss bulk orders, custom designs and colours, plus badging and branding garments. ANY QUESTIONS, CALL 01892 786 446 OR EMAIL CONTRACT.SALES@PARAMO.CO.UK PARAMO-CLOTHING.COM
Over the years we’ve asked teams to use email addresses from within their team or regional domains, for example teamleader@ myMRT.co.uk and forname.surname@myMRT.co.uk. There are several reasons for this but, primarily, it helps with data protection. When someone leaves your team you can just turn their email address off. We often have ex- team members moan at us that they are still receiving emails from MREW. If the team uses teamleader@myMRT.co.uk, when your officers change, you just need to give the email account to the new officer. A simple change of password and the correct person receives the information and MREW will always be sending the information to the people you, the team, want to receive it. If you use forname.surname@myMRT.co.uk, it helps us identify that people are members of mountain rescue when trying to access services. When we enter discussions with organisations such as Bluelight Card (and others) they normally ask us for a list of team domains so they know who to accept for membership, discounts etc. After discussion with, and the agreement and support of the MREW management team, regional chairs, Operations group and ICT subcommittee, from 1 February, the email list will be updated, and we will ONLY be using the team email address. No team email address, you don’t get the email . All teams and regions need to update their contact details for their team officers and key contacts by 29 January. If you need support with this, please email ictofficer@mountain.rescue.org.uk or assistant-secretary@mountain.rescue.org.uk.
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MOUNTAIN RESCUE MAGAZINE WINTER 2021
MIKE MARGESON ACTING SEO AND OPERATIONS DIRECTOR
I was not at all surprised to hear from Yasmin, at the Scottish Mountain Rescue office, of the many messages received on the passing of the legend that was Hamish MacInnes. It was somehow very fitting that the week of his funeral heavy snows fell across the Scottish Highlands. In close succession came the sad announcement that Doug Scott had passed away peacefully at home. While the mountain rescue legacy of Hamish is widely known, perhaps less so with Doug. He was no stranger personally to rescues and, through his charity CAN (Community Action Nepal), set up three porter rescue stations in Solu, Khumbu. I remember the generosity of our teams donating used and unneeded rescue equipment back when I was equipment officer, to help Doug set these up. How we got the donated mountain of equipment out there was thanks to our RAF MRT friends and that’s a whole other story. After such a challenging year the mountain rescue service should be proud of its resilience, professionalism and teamwork. Looking ahead there are now real reasons for optimism that later in 2021, with the roll out of a vaccination programme, some form of normality can begin to return to our lives. However, before then, the coming winter months clearly provide potential resilience pressures on our teams. Maintaining safe operations whilst managing the Covid risks with added challenge of winter weather, longer rescues with less hours of light, reduced air ambulance support, all whilst having to operate in full PPE, clearly remain a significant challenge. The operations group and medical subcommittee are acutely aware that although there is light at the end of the tunnel with the vaccination programme, it is critically important that we keep to our protocols and guidelines for safe working. We need to continue to guard against over-familiarity or any complacency in the coming months to keep our team members and families safe. Training and skills fade have been discussed extensively. As frontline rescue volunteers we are legally allowed to undertake training activities. A national guidelines document on ‘back to training’ has been produced by the training subcommittee. Teams have made their own risk assessments and put in place plans of what face-to-face training is required and what can wait. Teams have followed best practice and guidance and kept to small groups or team bubbles for training and applied dynamic risk assessment for their own team as situations have changed locally. The medical subcommittee has reviewed the concerns and worries about the training and examining process of our Casualty Care Certificate and potential impact on operational capabilities. Although temporary modification of the assessment process has been made and some assessments have successfully taken place, it was recognised that with the second lockdown and pressures on medical professionals, a further extension for expiring certificate holders was provided until 1 September 2021. It is expected that those concerned will keep up to date with the required skills. Full details are, of course, on the medical area of Moodle. The monthly Covid meeting and the collection of data and reports from the regions has been incredibly useful. Its continuation will be reviewed at the Operations Group meeting on 9 January. Thanks to the regions for the feedback and data collection. The central provision of PPE for teams that need it will continue with a slight difference. Ordering will be through the shop not through Julian. This allows for a more efficient accounting process. Despite the present challenges, many of our projects and work streams continue to move forward. For full details see the officer reports from the November online main meeting. I will, however, mention that our excellent new website is up and running with its emphasis on educating and engaging with the public audience. The material in the old members area has been moved to Moodle. I am informed by David Coleman, chair of the selection panel for CIO member teams and regions, that this is on track for the end of the year completion, with a recent flurry of activity. I would like to thank David and the panel on your behalf, for this not insignificant task with the huge volume of material they have received and reviewed. I know that many teams have appreciated the guidance and advisory feedback provided. I would like to finish following the resignations recently announced of the National Officers Mike France, Mike Greene and Mike Gullen in thanking them all for their significant contributions. And, on a positive note... in December, we completed the interview process for the MREW Medical Director role and member teams voted to appoint Dr Alistair Morris. I know that once restrictions ease, Alistair is very keen to visit regions and meet with teams. ✪
CALDER VALLEY TEAM MEMBER ALISTAIR MORRIS APPOINTED MREW MEDICAL DIRECTOR So who is he, what’s his background and what are his thoughts and plans for his new role? We asked Alistair to say a few words here, by way of introduction... I’ve led an active outdoor life – rock climbing, mountaineering, caving, expedition cycling, ultra running and adventure racing – and joined Calder Valley on the back of my outdoor skills rather than my medical qualifications. I’ve been an active team member and have also trained in water rescue and am on the extended list for cave rescue with CRO. I have been team medical officer, regional medical officer for MPSRO, assistant and deputy team leader. My day job is as a paediatrician and has gravitated more recently to emergency and ambulatory care. Through my experience with prehospital care in mountain rescue I have expanded my training and knowledge through the West Yorkshire prehospital scheme. I have management experience within my hospital trust, being an associate medical director for digital health leading on the implementation of an electronic patient record. Medical education has been an area of particular interest throughout my career and I have trained and worked on projects including developing e-learning packages, designing electronic portfolios, producing and delivering paediatric training in the West Bank. I am a course organiser for an MSc at the University of Leeds and a trustee for a charity for medical education training health workers in Africa. I aim to bring my knowledge, skills and experience to build on and develop the hard work of my predecessors, John Ellerton and Mike Greene, to keep all teams providing the excellent care we currently do to those in distress. I would like the opportunity to listen and learn from teams around the country and hope I can be invited to come to regions and teams in 2021 when Covid allows safely. I look forward to meeting and working with all of you and it is a privilege to be appointed to this post and to represent all the teams and MREW.
Above: New MREW Medical Director, Dr Alistair Morris © Alistair Morris.
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FIND US AT: MOUNTAIN.RESCUE.ORG.UK WINTER 2021 MOUNTAIN RESCUE MAGAZINE
The majority of us have never attended an ICAR conference but being able to sign up for the virtual 2020 congress was a great opportunity. The conference was due to have been held in Greece and, like most other events since the start of the Covid-19 pandemic, it was postponed and is scheduled for October 2021, in Greece. Chris Cookson attended from the comfort of his desk at home.
you see that presenter Renaud Gillermet works in the mountains around Grenoble. DAY 2 The second day, moderated by Stephanie Thomas (ICAR AvaCom Vice President), began with a review of avalanche accidents during the 2019/2020 season, from around the world, including Scotland. Next, Cody Lockhart and Jen Reddy, from Teton County SAR, used a case study to illustrate the importance of a specific approach to giving psychological first aid to avalanche victims and their companions. This could also be applied to rescuers and other types of rescues, not just avalanches. Dr Malin Zachau took an in-depth look at avalanche accidents in New Zealand, looking at the implications for mountain rescue and next up was AvaLife, a survival chance optimisation decision-support tool and avalanche patient protocol. The rather sombrely-titled ‘Death Registry’, saw Dr John Ellerton provide an update on the ICAR Rescuers’ Fatality Project. The aim of this project is twofold: firstly to enquire and analyse rescue fatalities during training and rescues and secondly to provide a ‘Line of Duty’ to give respect to mountain rescuers who die during service. At the Chamonix ICAR conference there was agreement to add near-misses to the data collection. The review looked at whether the project was required, what the challenges are and what the next steps should be. The last presentation was a case study of an avalanche rescue on the Dachstein mountain in March 2020, in which five people died whilst snowshoeing. This was a large-scale operation involving lots of rescuers and quite a number of helicopters. DAY 3 The third day was moderated by Gebhard Barbisch (ICAR TerCom President). ‘Near Miss Reporting: Improving Risk Assessment by Sharing Lessons Learned’, from Dale Wang (MRA), looked at what a near-miss was, why reporting is important and the associated objectives, some case studies and consideration of how we can better risk- manage training and rescues in the future. Closer to home, Alan Carr of Mountain Rescue Ireland (MRI) talked about ‘Risk and Assurance’ and the development in Ireland of the National Search and Rescue Plan for air, land and sea, search and rescue. I was impressed with the bigger picture this plan looks to address, the joined-up way they’re going about this and their desire for assurance from all stakeholders.
Registering was easy, with no cost and you can still catch up with the presentations at vimeo.com/alpinerescue , along with video highlights from previous ICAR conferences. It’s well worth a look, a good flavour of what ICAR is about and what it might be like to attend in person. The 2020 virtual conference ran over two weekends in October and was very well put together, with the presentations themselves pre-recorded. Presenters were available to answer questions live via the chat, and also on camera for a few minutes following the presentation. These Q&A sessions follow the presentation in the recordings, where some very relevant questions are asked and answered. DAY 1 The first day was moderated by Charley Shimanski, president of the Air Rescue Commission. Following an introduction and welcome by ICAR President, Franz Stämpfli, the first presentation — not unexpectedly, given the year we’ve had and the reason the conference took place online — was titled ‘Covid-19 Effect on Mountain Rescue’. Dr John Ellerton, currently president of the ICAR Medical Commission, provided a great resumé of how Covid has impacted mountain rescue globally, and the PPE use and guideline changes required, with a particular focus on what’s happened within MREW and his own team, Patterdale MRT. This included a critique of Covid-19 risk assessments, with a case study. Other commission presidents contributed with the impact of the pandemic for their own commissions. The avalanche commission report, presented by Stephanie Thomas, looked at the lessons learned and also looked forward to the next winter season from the point of view of forecasting avalanches, prevention work, educators and guides, highway patrol/road work and ski patrol, as well as search and rescue. It finished with a look at mental health strategies. The Air Rescue Commission report, presented by Charley Shimanski, looked at the use of PPE in helicopter rescue operations, along with protocols for protecting the crew and patient transport
and, finally, decontamination of the aircraft. ‘Accidents and Incidents in Helicopter Rescues’ covered accidents and incidents from the last twelve months or so, along with recently published air accident investigation reports. If you’ve ever heard people say things like, ‘helicopter accidents account for the highest death toll amongst rescuers’, this presentation may give some context to that, and perhaps explain why, as aviation in general, there is such focus on investigating and learning from air accidents and incidents. It also demonstrates that it’s not just rescuers who get killed in these accidents. Some really good learning points were covered, that make sense to consider further afield than air rescue. Well worth a watch. And to highlight the issue of rescue helicopter safety, since the ICAR Virtual Conference, a further five people died in a rescue helicopter crash in the French Alps in early December. In conclusion, the sharing of incident and accidents reports was seen as a strength and key to improving safety. It was also noted that around 50% of accidents/incidents involved winching. The third presentation about the role of the European Union Aviation Safety Agency and the relationship between ICAR and the EASA included an interesting section (36:16) on drones and the ICAR Interdisciplinary Drone Working Group — more of which later. The session on dynamic winching operations was intriguing, and presented an approach to stopping people being winched into a rescue helicopter from spinning by quickly moving to forward flight, so the downwash falls behind those being winched rather than not acting upon them. Great footage of this technique in operation by Air Zermatt. An organisation called Lifeseeker provided what they refer to as an airborne phone location system (25:21). This looks to be a very exciting system, with a version for use from helicopters and drones, that locates people via their mobile phone. The final presentation was about Instrument Flight Rules (IFR), in flights for rescue operation, for use when visibility is poor and Visual Flight Rules (VFR) can’t be used, or for specific flight corridors. This all makes sense, even to the layperson, when
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MOUNTAIN RESCUE MAGAZINE WINTER 2021
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