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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