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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MOUNTAIN RESCUE MAGAZINE WINTER 2021
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