TEAM GUIDANCE

Update 20th June 2022

June 2022 – PPE Guidance
June 2022 – Equipment Decontamination

Please find above some updated guidance around PPE and decontamination of kit. UK Search & Rescue (UKSAR) are working on updating the national guidance but we are aware it has been a while since any changes have been made.

As with previous guidance this is not law and simply advice based on best practice cobbled together from various NHS boards and other rescue organisations. We (UKSAR) are trying to amalgamate the covid PPE guidelines into an infectious disease guideline that can be used across all of the rescue organisations.

Scottish MR Team guidance: Guidance and Q&A Version 1.4 updated 12/04/20 (updates are highlighted)

Covid-19 – Guideline 1: Initial Approach to the Casualty
Covid-19 – Guideline 2: Changes to Casualty Management
Covid-19 – Guideline 3: Evacuation and end of Rescue 
Covid-19 – CPR Guidelines: CPR for Casualty Care Certificate Holders
Covid-19 – PPE Guidelines: Using PPE in Mountain Rescue

Team Response Capability (Last updated: 17/11/20)

PPE Poster  – Our PPE Poster demonstrates how to put on (don) and take off (doff) PPE.  If you wish it can be printed off and laminated for team members to carry or have in bases and vehicles.  It has been produced by Dr Naomi Dodds with the SMR medical faculty and available to share with anyone who wishes it.  We are aware how difficult it is to do this safely and whilst there are some excellent videos out there we felt it was useful to have an extra resource that could be referred to at the time. (updated 9th June 2020)

Update: 4.00pm – 26th March 2020

Audio playback from Tuesday night meeting with team leaders/team contacts:

7.30pm meeting with Northern Teams

8.30pm meeting with Southern Teams

Update: 4.00pm – 17th March 2020

USEFUL LINKS:
Guidance is changing on a daily basis, please ensure you refresh these pages when you use them to make sure you have the latest information.

Scottish Government – for information on current statistics – and advice to Public  and new news updates

Health Protection Scotland HPS – the key site for Scottish Public Health Advice –

NHS Inform – the public facing site for information – ideal for individual Team Members for the usual questions

Public Health England – go here for more specific Guidance on ‘smaller print’ topics if not covered adequately in HPS Guidance – eg social distancing, Employees etc.

Update: 1.00pm – 17th March 2020
Unfortunately due to current circumstances around Covid19 all SMR training courses & Casualty Care Assessments are cancelled until further notice. We will continue to review this decision as the ongoing situation changes. We apologise for any inconveniences this causes.

Update: 9.00am – 16th March 2020
Frequently Asked Questions

What is Coronavirus?
Coronavirus is a group of viruses’ which are common around the world. Covid-19 (which is the name of the current virus) is just one of these¹.

Generally, a coronavirus will cause more severe symptoms in the elderly, those who are immunocompromised and those with long-term underlying medical conditions such as heart disease and chronic lung conditions.

Covid-19 is a respiratory virus, spread in a similar way to colds and the flu. Symptoms include a cough, and acute respiratory illness, with or without a fever².

It is highly infectious and is spread through large respiratory droplets in respiratory secretions by coughing/ sneezing. These droplets can settle on horizontal surfaces and be picked up on hands².

What are the signs / symptoms of Covid-19³?
For many people they will present with symptoms similar to a common cold.

The symptoms of Covid-19 are:

–  Cough
– High temperature / fever
–  Shortness of breath

Not all persons who present with these symptoms will have this illness.

How does Covid-19 spread^3,4?
This is still a very new illness so the exact transmission routes are not fully understood. It is believed that the main transmission route from person to person is via respiratory droplets, spread through coughing and sneezing.

Until recently it was believed that transmission was through direct contact with an infected person, however we are now aware that there appears to be social transmission where there is no direct contact with anyone who has travelled to a ‘high risk’ country or with someone who has a confirmed diagnosis.

With this in mind, we now believe that transmission is possible where someone spreads respiratory droplets onto a hard, horizontal surface which is then touched by a different person who therefore ‘picks up’ the virus – It is for this reason that very good hand hygiene is recommended as the most effective way to reduce / slow transmission.

What is the current risk of contracting Covid-19?
The current risk is stratified as ‘LOW’⁴.

What should I do to reduce the risk of catching or spread this illness³?
You should:

• Cover your nose and mouth with a disposable tissue (or the sleeve of your clothing) when coughing or sneezing. Do NOT cover with your hands
• Dispose of all tissues into the bin immediately and then wash your hands with soap and water
• Wash your hands with soap and water, often. Do this for at least 20 seconds and always upon arrival at work and home
• Avoid close contact with anyone who has symptoms of respiratory illness
• Where possible, exercise social distancing – Maintain a distance from others of around 2 meters

You should NOT:

• Touch your face, nose or mouth

Is Covid-19 an epidemic or pandemic?
Covid-19 was initially described as an epidemic – An epidemic is an increase in the number of reported cases of a disease above what is expected in that population⁵.

A Pandemic refers to an epidemic which has spread to several countries or continents and affecting a large number of people⁵.

Covid-19 was officially classed by the World Health Organisation as a Global Pandemic on 11/03/2020

Are we likely to see Covid-19 in the mountain rescue setting?
The number of confirmed cases of Covid-19 in the UK is growing on a daily basis and there are varying predictions of the overall likely cases and when we will see the peak number of reported cases.

It is likely that this will be an ongoing pandemic for many weeks / months.

Some predictions suggest 50% of UK residents may contract this virus, however the majority of those infected will likely only present with very mild (or no) symptoms.

Based on this prediction, it is possible that mountain rescue teams may be in contact with patients who have this illness (whether they know it or not).

Should we take any additional precautions when undertaking a mountain rescue?
The majority of mountain rescue activity does not expose rescuers to an increased risk of contracting this virus.

Where a casualty is presenting with ANY respiratory symptoms it is recommended that the number of casualty carers / those with direct contact with the patient is limited. All other rescue team members should remain 2 meters away from the patient where possible³.

NHS public health guidelines recommended that healthcare professionals carry moisture resistant surgical masks for use with this patient groups – The mask should be passed to the patient at arms length and they should put this on prior to team members moving closer.  However there is likely to be a shortage and whilst in the ideal world teams would carry them, it would not be advised to bulk buy or store them reducing stocks that are required by frontline NHS staff.

If the patient requires treatment for their respiratory complaint (i.e. Salbutamol nebulisation) the this raises the risk of cross-infection and this should be done in an open setting.

Salbutamol nebulisation should not be undertaken in a closed environment as this may increase the risk of cross infection.

Should you need to undertake nebulisation, the following process is recommended:

• Confirm the treatment is necessary
• Construct the nebuliser at a distance from the casualty
• Pass the nebuliser to the patient and ask them to put the mask on their own face
• Keep the oxygen bottle at a distance and turn on
• Once the treatment is complete ask the patient to remove the mask
• Ask the patient to put the surgical mask back on

Throughout all casualty care, ensure normal PPE is utilised and gloves are worn.

Should a Cascarer need to be close to the patient to assist then they too should wear a surgical mask, taking care when fitting / removing to reduce the risk of cross-contamination from gloves. If you are to wear a mask, it is recommended that you put it on prior to approaching the casualty and that you are wearing 2 x pairs of gloves. When you wish to remove the mask, remove the outer pair of gloves, then remove the mask with the inner pair of gloves and then remove the inner gloves – all PPE should be treated as contaminated and disposed of using a clinical waste bag⁶.

As soon as practically possible after any equipment is used, it MUST be wiped down with anti-bacterial wipes for 60 seconds and allowed to air dry.

After patient contact, all hard surfaces should be wiped down with anti-bacterial wipes and left to air dry.

What should I do if I develop symptoms?
If you have had contact with someone who has presented with respiratory symptoms and who may have been I contact with an infected person you should immediately self-isolate and then access the NHS 111 online self-assessment tool.

This will provide you with the relevant advice.

Do NOT go to your GP or your local hospital as this risks further spreading the virus if you are infected.

Should I wear a face mask to prevent myself from catching this virus?
There is currently no evidence to show that wearing a face mask will prevent you from contracting this virus; There is some evidence to suggest that wearing a mask will increase your risk of contracting the virus as it is believed that people touch their own faces more when wearing a mask and therefore increasing the risk to yourself.

Should teams stop training?
It is recommended that teams consider what training is essential, and this should continue however it is recommended that all non-essential training be cancelled until further notice.

The reason behind this advice is to ensure operational resilience for your team.

Is the advice consistent across the UK?
The current advice is consistent across the UK and based on the UK Government advice. The information on the Health Protection Scotland website for First Responders / Emergency Responders points directly to the Health Protection England advice.

This is the information used by UK Ambulance services to develop their strategies.

Who put this information together?
This document was collated by members of the SMR Medical Subcommittee, authorised by Dr Alastair Glennie, SMR medical officer.

When will this information be updated?
Covid-19 guidance is being updated on a daily basis by Public Health England (PHE). Should there be any relevant changes then this guidance / FAQ sheet will be updated and the version control will be amended. Please check regularly to ensure you are aware of the latest guidance.

Where can I find further information?

• Health Protection Scotland

https://www.hps.scot.nhs.uk/a-to-z-of-topics/covid-19/

• Public Health England

https://www.gov.uk/government/topical-events/coronavirus-covid-19-uk-government-response

• NHS 111 Online self-assessment tool

https://111.nhs.uk/covid-19

• World Health Organisation

https://www.who.int/news-room/q-a-detail/q-a-coronaviruses

• Department of Health – Guidance for Ambulance Trusts

https://www.gov.uk/government/publications/covid-19-guidance-for-ambulance-trusts/covid-19-guidance-for-ambulance-trusts

• NHS – Corona virus guidance

https://www.nhs.uk/conditions/coronavirus-covid-19/

References

1 – Public Health England, January 2020 [Online]. Accessed at: https://publichealthmatters.blog.gov.uk/2020/01/23/wuhan-novel-coronavirus-what-you-need-to-know/ Accessed on: 11/03/2020

2 – World Health Organisation, February 2020 [Online]. Accessed at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public Accessed on: 11/03/2020

3 – Coronavirus (Covid-19) Overview. National Health Service, March 10^th, 2020 [Online]. Accessed at: https://www.nhs.uk/conditions/coronavirus-covid-19/ Accessed on:11/03/2020

4 – World Health Organisation, February 2020 [Online]. Accessed at: https://www.who.int/news-room/q-a-detail/q-a-coronaviruses Accessed on: 11/03/2020

5 – Centre for Disease Control and Prevention, 2012. [Online]. Accessed at: https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section11.html Accessed on 11/03/2020

6 – Department of Health, UK Government, February 2020 [Online]. Accessed at: https://www.gov.uk/government/publications/covid-19-guidance-for-ambulance-trusts/covid-19-guidance-for-ambulance-trusts Accessed on: 11/03/2020

Update: 9.00am – 13th March 2020
Message from Dr Alastair Glennie, SMR Medical Officer:

It will not have escaped anyone that the preparations for the covid19 pandemic are escalating at am exponential rate.  Whilst we have cancelled the general meeting and issued advice about training, I would like to hold off making a decision about the casualty care exam on 29th March 2020, as it is very important we keep the ability of teams to deliver drugs.

I am aware there are a couple of teams who are down to a critical number of cas carers in date, and we are making contingency plans for you should we need to cancel the exam in a few weeks.  If we do have to cancel this, it will either be because the risk of infecting everyone attending is too high, or that the assessors are unable to attend because they are required to do their day job in the various healthcare settings they come from.

You will appreciate there are not enough medical, nursing and paramedic staff to go round at the best of times, the next few months could become critical.

I will be assessing the situation on a daily basis as we are having to do at work, but wanted to reassure everyone that whilst we are thinking about your and our safety, we are aware how important it is to have in date casualty carers to maintain our resilience.

Update: 11.00am – 12th March 2020

We have had a few queries regarding using MR vehicles as Ambulances, here is our advice:
Essentially we are not an ambulance service. SMR are not here to tell teams what they can or can’t do, but we can advise you on things like insurance.  The insurance SMR has does not cover SMR teams for ambulance purposes. We have also checked with police Scotland who likewise do not feel MR should be used for this purpose (SAS will have their own contingency plans and there are other voluntary agencies set up to support them) so therefore will not currently cover us from an insurance point of view either.

To respond as an ambulance response there are several areas that would have to be met such as:

• Appropriate training
• Appropriate PPE
• Appropriate insurance for team members and vehicles
• Dispensation for ambulance use if needed
• Appropriate decontamination procedures for afterwards
• Confident it won’t degrade the hill response.

Given some teams are in a very remote areas, teams could argue that if you were to pick up someone from a hill and there is no or limited ambulance availability then taking them to the nearest hospital or emergency centre counts as closest available medical support, but this is different to being used as an ambulance asset. Should the situation deteriorate it may be that police Scotland change their position but the other points above would still need to be met.

Ultimately it is up to the team to decide what feels best but we hope this information can be useful to you.

Update: 5.00pm – 11th March 2020

Advice to teams on Training and Events:
We have had several enquires about team training and what this means for teams regarding the coronavirus. We would suggest teams think about keeping training, meetings and gatherings to a minimum  and keep activity to only the essentials to minimise the risk of any diminished operational response capability. As this situation is ongoing we suggest teams review training plans/meetings on a weekly basis.

Glenmore Lodge Office
We have decided out of precaution to close the office and ask staff to work from home from Thursday 12^th March 2020. This is to ensure the organisation can continue to run on a daily basis. We will review this decision on Monday. Please contact Al Rose on: secretary@scottishmountainrescue.org if you have any questions regarding this.

Update: 10.00am – 11th March 2020
Message from Dr Alastair Glennie, SMR Medical Officer:

The situation with coronavirus continues to develop rapidly with significant uncertainty.

Individual team members should follow the advice provided by the UK and Scottish government in respect to the prevention of infection.

This involves:

• Attention to hand washing.
• “Covering” coughs and sneezes.
• Attention to surface cleaning.
• Avoiding touching eyes, nose and mouth areas with unwashed hands.
• There is no need to wear a facemask.

Volunteers who are travelling abroad should follow government travel advice on category 1 and 2 areas.

Up-to-date information is available on government web sites.

As the situation develops, Teams should consider developing contingency plans around the main risk, which is the unavailability of volunteers.  We suggest that a mutual aid arrangement between teams and where necessary across areas are considered.

Many statutory services and localities are considering their resilience plans.

The primary focus for Mountain Rescue must be our capacity to provide a robust service to the public in need of help in remote and mountain environments areas.

SMR teams are not registered to provide “ambulance services”.  We provide mountain rescue services in the remote environment only and are not insured to convey patients to hospital once we have recovered them to a place where the ambulance service can take over. Teams should therefore not provide such services even when the statutory ambulance service becomes short staffed or under significant demand. There are other voluntary organisations who are specifically able to provide this support. Teams in SMR are not insured for either team members or vehicles to participate in these activities.

Assistance from teams for resilience purposes may be requested through Police Scotland, but consideration of insurance would need to be undertaken at that point through the police.