SAR & COVID19 – PART 2

The following 2 posts were originally sent as emails to La Plata County (CO) SAR, which Dr. Durkin is the medical director. They are shared here for educational interest of other rescue professionals in formulating their COVID19 response. This is not medical advice for use outside of LPCSAR. The COVID19 situation is highly dynamic and recommendations and guidance are changing incredibly frequently. Any policy or procedure regarding COVID19 should be thoughtfully prepared and frequently reviewed with the input of a physician advisor taking into account the most current information and recommendations from local, state and national public health authorities. This is a highly dynamic situation with a very contagious and potentially fatal disease.

Teammates:

As we are just in the earliest stages of the COVID19 pandemic, it is possible we may be called to assist a person in the backcountry who has become symptomatic with this illness. Additionally, familiarity with protective measures may be helpful if the team is asked to provide services in our community such as delivering food or reinforcing other vital services. 

This email will discuss in plain language our strategy to address potential COVID19 patients in a mission setting. This information may change with new research, guidelines or changing equipment availability. It is important that all members be familiar with these concepts, including field, comm and ICS/SMT. Our strategy mirrors that of other agencies and has several key pillars: Screening, Limiting Exposure, PPE, decon procedures and communication. 

Screening will help identify patients at higher risk of transmitting the illness. During the mission initiation stage, whoever is in communication with the patient or reporting party should specifically ask if the patient has any of the following:

Cough

Fever (measured >100 with a thermometer or fever symptoms such as chills, sweats, bodyaches) 

Stomachache/Diarrhea (present before fever/cough in 10% of patients in some studies) 

Contact with anyone sick with similar symptoms in the past 2 weeks. 

This is in addition to the usual questioning about location, plans, experience, gear and medical condition that should be asked routinely. The answers to these questions must be communicated to field teams and any partner agencies responding. The 911 center is conduction this type of screening and should relay this type of information to the mission coordinator. 

Even if no signs of illness have been obtained via telephone interview, the first arriving SAR person should interview the patient from 6 or more feet away, asking about the above symptoms and determining if the patient has indications of medical illness. 

Limiting exposure reduces risk by minimizing the number of persons close to the patient and reducing spread from the patient. Being within 6 feet of the patient or handling their gear conveys risk of getting COVID19. We can reduce the spread of droplets from the patient breathing, sneezing or coughing by having them wear a simple surgical type mask. If this is unavailable, a clean bandana worn “train robber style” over the nose and mouth is better than nothing. The bandana is only appropriate for the patient, and should not be regarded as PPE for rescuers. Nonstandard protection such as a cloth worn over the face by rescuers may increase transmission in some circumstances. If the patient is not willing to cooperate with this measure, we should stay clear of the 6+ foot radius and communicate with the command team for additional resources/guidance. As usual, restraining or subduing non-cooperative patients is not within the scope of SAR. 

The number of responders with close contact to the patient should be minimized – ideally just to 1 or perhaps 2 at. Team members who are older than 60, or who have history of smoking, diabetes, hypertension or other chronic medical conditions should serve in roles distant to the patient as they have greater risk of severe illness. 

While in the past we have gone to lengths to retrieve gear for distressed parties, given that patient gear may be covered in viral particles, it may be best to leave gear in the field for 3+ days to allow the virus to degrade before any attempt at retrieval or recognize that gear retrieval may not be a good use of resources during this time. The actual timeline that the virus can remain infectious on an object is an area of active research and will vary greatly depending on conditions. 

Canine operations. Information from the American Kennel Club states that COVID19 is no or minimal threat to our working canines, HOWEVER, a canine can become contaminated after interacting with an infected person and spread the viral particles to others. 

PPE will reduce the possibility of disease transmission to the responders in close proximity to the patient. Per current CDC recommendations, ideal PPE is a fitted N95 type mask, eye protection or face shield, medical gloves, disposable gown or jumpsuit. The leadership team is actively working to increase our supplies of this equipment and an opportunity for N95 fitting. This equipment is in short supply around the world , so this may be delayed. Given the demand for N95 masks, basic surgical type masks are considered by the CDC as a reasonable substitution if N95 masks are not available. While not ideal, they will provide some protection from large droplets. 

This PPE ensemble should be put on and taken off in the correct order to minimize self contamination. Please see the link attached to review how to accomplish this. PPE should also be worn during equipment decontamination.  As soon as PPE is removed, do a thorough hand cleaning with hand sanitizer or soap and water.

Decontamination of any equipment or surfaces the patient or their possessions came in contact with is relatively straightforward. Wear PPE when cleaning gear or working around potentially contaminated surfaces. Diluted solution of household bleach (see the CDC guidance for specific ratios) can be sprayed and let to sit a few moments before wiping away on solid surfaces. Bleach is not a good choice for ropes, straps and nylon as it can degrade these materials. Commercial or medical disinfectant wipes may also be used on solid items. Clothing and soft goods can be washed in a washer with soap and water and dried in a machine to remove/destroy the virus. Wear gloves and (or at least) thoroughly wash hands after handling laundry. Alternatively, high contaminated materials can be left in a plastic bag for 3+ days before washing as it is thought the virus may not survive outside the body longer than that. While not yet well researched, direct bright sunlight will also degrade the virus. Warmer temperatures and lower humidity are also thought to degrade the virus. How long sun and warmth would take to completely destroy all virus is not known. 

Do not shake out any contaminated clothing or gear as this can launch the virus into the air. 

Lastly, if we are dealing with a patient with possible COVID19 symptoms, communicate early to the EMS team that will be taking the patient so they can prepare their PPE and vehicle to limit contamination. 

Eventually, this difficult time will be over and we will be back to doing our usual missions in the backcountry with only the usual and familiar hazards.

Thanks for being on the team,

Timothy Durkin, DO, FAAEM, CAQSM

Medical Director 

La Plata County Search & Rescue 

CDC EMS Guidance:

https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-for-ems.html

PPE usage:

https://www.cdc.gov/hai/pdfs/ppe/ppe-sequence.pdf

Disinfection and Environmental Cleaning:

https://www.cdc.gov/coronavirus/2019-ncov/community/organizations/cleaning-disinfection.html

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