key: cord-340590-7jql1ftj
authors: Massullo, Domenico; Fiorelli, Silvia; Rubcich, Patrizio; Romano, Domenico; Facchetti, Gianluca
title: Mountain Rescue During the COVID-19 Outbreak: Considerations and Practical Implications
date: 2020-09-23
journal: Wilderness Environ Med
DOI: 10.1016/j.wem.2020.09.003
sha: 
doc_id: 340590
cord_uid: 7jql1ftj

nan

of the presence of a viral outbreak probably originating from a fish and animal market in the city of 37

Wuhan, the capital of central China's Hubei province 1 . The responsible virus, a new ß-Coronavirus 38 RNA, was identified in early January 2020 and was named SARS-CoV-2 2 . It causes a flu-like 39 illness that has been called COVID-19. The disease can manifest with mild symptoms or lead to 40 severe pneumonia with hypoxemic respiratory failure, multiorgan failure, and death 3,4 . WHO 41 declared a pandemic on March 11, 2020, due to the rapid spread of the new virus worldwide. 42

The diffusion of the COVID-19 epidemic forced governments in many countries to declare 43 lockdown to slow the spread and prevent the collapse of their public health systems. For this reason, 44 a temporary abolition of outdoor activities has been reported. 45

The reduction of quarantine restrictions, foreseen as a gradual return to regular activities, will likely 46 lead to an increase in people practicing outdoor sports, and it could increase the number of 47 accidents related to these activities. The COVID-19 pandemic causes several issues during rescue 48 operations in the wilderness environment due to concern for viral contagiousness during prolonged 49 close interaction between rescuers and victims. In Italy, the National Alpine and Speleological 50

Rescue Corps is a voluntary association that provides a complete range of rescue operations 51 services both in the mountains and in speleological environments. It also contributes to the 52 prevention and surveillance of mountain sports and speleological activities in these same areas. 53

Moreover, as an operating structure of the national service belonging to the civil protection 54 department, it also gives assistance outside the mountain territory in case of calamity. 55 SARS-CoV-2 mostly spreads via droplets, contact, and natural aerosols from human to human. 56

Although the route transmission of COVID-19 is primarily throughout symptomatic patients 5 , 57

human-to-human transmission also appears to occur during the non-symptomatic incubation period 58 of the disease. The key points during rescues are the protection of operators and patients from 59 infection and disinfection of materials and vehicles used during outdoor operations. First of all, reaction (RT-PCR) to detect SARS-CoV-2 RNA in the nose-throat swab sampling or 62 immunological tests for IgM or IgG research. Seroconversion for IgG and IgM can be helpful for 63 the diagnosis of infected subjects with negative RT-PCR results and for the identification of 64 asymptomatic infections 6 . In addition, each rescuer, before giving their availability to participate in 65 rescue operations, should perform a self-check through a COVID-19 screening questionnaire 66 ( Figure 1 ). In the case of even one positive response, participation in the rescue should be waived. 67

During the rescue operation, all operators should wear gloves, facial mask, and goggles during the 68 approach phase to the vehicle. In the approach to a conscious victim by land, rescuers should give 69 the patient a facial mask and gloves while maintaining 1-m distance. When rescuers reach an 70 injured person, they should also give the victim a COVID-19 screening questionnaire if he or she is 71

conscious. In the case of even one positive response or if the injured person is not conscious, 72

rescuers who approach the victim should wear adequate personal protective equipment (PPE) 73 including: particulate respirators (eg, FFP2, FFP3 or equivalent standard), 2 pairs of disposable 74 gloves, goggles, and coverall suit. A rescue operator wearing PPE is shown in Figure 2 . The 75 sequence for putting on and removing PPE is shown in Figure 3 . Environmental scenario and risk-76 benefit ratio should be considered regarding wearing coverall suits since they can dramatically 77 worsen working conditions during rescue operations, such as in high heat stress situations or in case 78 of complex technical operations. At the end of the operation, the vehicle and non-disposable PPE 79 used for the rescue should be disinfected with sodium hypochlorite (0.1-0.5%), 70% ethanol, or 80 hydrogen peroxide solution (3%) by operators wearing adequate PPE 7 . 81

Given that mountaineering has become more and more popular since the 19th century and the 82 number of accidents has correspondingly increased 8 , this novel outbreak could challenge rescue 83 operators worldwide. 84

In conclusion, during the COVID-19 pandemic, protocols for mountain rescue services should be 85 reassessed in order to protect both rescuers and victims from possible contagion. Cross-infection 

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