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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