Mountain Rescue Magazine Winter 2021

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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.


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 2

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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