Mountain Rescue During the COVID-19 Outbreak: Considerations and Practical Implications

To the Editor:

The World Health Organization (WHO) was informed by the Chinese authorities in December 2019 of the presence of a viral outbreak probably originating from a fish and animal market in the city of Wuhan, the capital of central China’s Hubei province.¹ The responsible virus, a new ß-Coronavirus RNA, was identified in early January 2020 and was named SARS-CoV-2.² The virus causes a flu-like illness that has been called COVID-19. The disease can manifest with mild symptoms or lead to severe pneumonia with hypoxemic respiratory failure, multiorgan failure, and death.^{3 , 4} The WHO declared a pandemic on March 11, 2020, due to the rapid spread of the new virus worldwide.

The diffusion of the COVID-19 pandemic forced governments in many countries to declare lockdowns to slow the spread of the virus and prevent the collapse of public health systems. For this reason, a temporary abolition of outdoor activities has been reported.

The reduction of quarantine restrictions, foreseen as a gradual return to regular activities, will likely lead to an increase in people practicing outdoor sports and could increase the number of accidents related to these activities. The COVID-19 pandemic has led to several issues during rescue operations in the wilderness environment due to concern about viral contagiousness during prolonged close interaction between rescuers and victims.

The National Alpine and Speleological Rescue Corps is a voluntary association in Italy that provides a complete range of rescue operation services in both the mountains and speleological environments. It also contributes to the prevention and surveillance of mountain sports and speleological activities in these same areas. As an operating structure of the national service belonging to the civil protection department, it gives assistance outside the mountain territory during disasters.

SARS-CoV-2 mostly spreads from human to human via droplets, contact, and natural aerosols. Although the transmission route of COVID-19 is primarily through symptomatic patients,⁵ human-to-human transmission also appears to occur during the nonsymptomatic incubation period of the disease. The key considerations during rescues are protecting operators and patients from infection and disinfecting materials and vehicles used during outdoor operations. First, rescue operators should undergo health surveillance: reverse-transcriptase polymerase chain reaction to detect SARS-CoV-2 RNA in nose/throat swab sampling or immunological tests for IgM or IgG. Seroconversion for IgG and IgM can be helpful for the diagnosis of infection in individuals with negative reverse-transcriptase polymerase chain reaction results and for the identification of asymptomatic infections.⁶ In addition, each rescuer, before indicating availability to participate in rescue operations, should perform a self-check through a COVID-19 screening questionnaire (Fig. 1 ). In the case of even 1 positive response, participation in the rescue should be waived.

Figure 1.

Algorithm showing initial approach to the victim.

During the rescue operation, all operators should wear gloves, facial mask, and goggles during the approach to the vehicle. In the approach to a conscious victim by land, rescuers should give the patient a facial mask and gloves while maintaining a 1-m distance. When rescuers reach an injured person, they should also give a conscious victim a COVID-19 screening questionnaire. In the case of even 1 positive response or if the injured person is not conscious, rescuers who approach the victim should wear adequate personal protective equipment (PPE), including particulate respirators (eg, FFP2, FFP3, or equivalent standard), 2 pairs of disposable gloves, goggles, and coverall suit. A rescue operator wearing PPE is shown in Figure 2 . The sequence for putting on and removing PPE is shown in Figure 3 . The environmental scenario and risk-benefit ratio should be considered regarding wearing of coverall suits because they can dramatically worsen working conditions during rescue operations, such as in high heat-stress situations or in complex technical operations. At the end of the operation, the vehicle and nondisposable PPE used for the rescue should be disinfected with sodium hypochlorite (0.1–0.5%), 70% ethanol, or hydrogen peroxide solution (3%) by operators wearing adequate PPE.⁷

Figure 2.

Rescue operator wearing long visor helmet and FFP2.

Figure 3.

Putting on and removing personal protective equipment.

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

In conclusion, during the COVID-19 pandemic, protocols for mountain rescue services should be reassessed to protect both rescuers and victims from possible contagion. Cross-infection among rescue operators should also be considered and prevented by applying adequate precautions and physical distancing.