Backcountry rescue during a pandemic - food for thought

[ianpnw]

https://www.outsideonline.com/241086...kiing-covid-19

We all have cabin fever, and we all want to be out there. And we all think that everyone else will be at home and so it’s OK if I go. Here’s an example of what happens when things don’t go according to plan....
I work in a hospital in an infection hot-spot (Seattle) - it’s not a place you want to be if you can help it. 25% of COVID positive people have no symptoms, and we are currently treating all patients as though they are COVID positive if they undergo high risk procedures (like an anesthetic, or an endoscopy).
Please think about risk before recreating outdoors on skis or your mountain bike - and not just your risk, but the hazard you are potentially causing to the first responders (50 in this article), and to those of us working in high-risk areas of the hospital.
Please note I’m not telling anyone what to do, or what not to do, I’m just adding a data point to help you make a decision that may have ramifications beyond impacts on you alone.

[summit]

Covid Ppe does not work well in bc sar

[ianpnw]

Exactly!
All the more reason to think very carefully about levels of risk to oneself and others.
I wear PPE every day at work - as did the 100 Italian physicians who have died from COVID. Maybe it’s not just SAR settings where PPE isn’t great....

[Kinnikinnick]

Exactly!
All the more reason to think very carefully about levels of risk to oneself and others.
I wear PPE every day at work - as did the 100 Italian physicians who have died from COVID. Maybe it’s not just SAR settings where PPE isn’t great....

Well look at those masks - even the n95s. Tight seal lasts about how long when you’re wrestling with a suffocating victim to intubate?

These guys in Durango are testing a PAPR unit Towards FDA approval.

https://www.google.com/amp/s/the-jou...h-care-workers

What do you think of this type of thing?

Maybe have your supply people try to place a conditional upon FDA approval to help them?



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[Kinnikinnick]

Weird selfquote double post

[toast2266]

If it makes you feel any better, everyone in Seattle came to Montana to do their sheltering / recreating, so you don't have to worry about rescuing them.

[Bunion 2020]

Simms Fishing Products has stopped making outdoor equipment in its Bozeman plant and is now producing medical gowns for Bozeman Health.

Simms, which delivered its first batch of reusable gowns on Friday, is one of several local businesses designing and manufacturing personal protective equipment in the face of a nationwide shortage stemming from the coronavirus pandemic.

“In times of need, we want to do what we can,” said community specialist John Frazier. “We want to help the men and women in the medical field stay safe.”

Simms and Bozeman Health worked on the new medical gowns with financial donations from the Yellowstone Club Community Foundation and the Arthur M. Blank Foundation.

“As we all work together to overcome this health crisis, we’re grateful to be able to contribute to this unique community partnership to help those most in need,” said Danielle Thomsen, with the Arthur M. Blank Foundation.

Like Simms, Bridger Aerospace and Ascent Vision Technologies, sister companies in Belgrade, have joined local efforts. The two companies are now making masks at their hangar near Bozeman-Yellowstone International Airport.

This weekend, the companies produced their first mask and plan to donate 1,000 to Bozeman Health and local fire departments. Some may be sent to other places in the state, said Tim Sheehy, CEO of Bridger Aerospace and Ascent Vision Technologies.

The two companies also diverted workers from building their new hangar to constructing additional beds at Bozeman Health Deaconess Hospital and have made aircraft available for Bozeman Health to transport patients and supplies.

“This is small, but every bit helps,” Sheehy said.

Spark R&D, another local manufacturer, has been trying to make it easier for companies to produce masks. The business took a design for a 3D-printed mask — called the Montana Mask — and modified it for injection molding.

“We want to address the shortage, and with injection molding, we can make 1,000 per day instead of three per hour,” said marketing manager Dan Ventura.

Spark R&D has made the injection-molding design available for free on its website. The local business is also using the design to produce masks. Spark R&D delivered its first 2,400 masks to Billings Clinic on Saturday and is making more.

“We are used to making splitboard bindings and accessories, so switching to masks has its challenges, but we are learning as we go and are committed to this,” Ventura said.

Blackhawk, a tactical gear manufacturer in Manhattan, has been preparing to use Spark R&D’s design to make injection-molded masks and is also considering working with a group from the Massachusetts Institute of Technology to produce the masks, said operations manager Lamont Kotter. Production will likely begin in the coming weeks.

“We are trying to do this because we want to help,” Kotter said.

As manufacturers step up to respond to the coronavirus pandemic, more than 35 businesses, nonprofits and individuals formed the Southwest Montana Community Organizations Active in Disaster to coordinate local efforts.

The new group, which includes emergency management officials from Gallatin, Madison and Park counties, has already launched a response fund, coordinated child care for essential workers and created a directory of volunteer opportunities through the Greater Gallatin United Way.

“We recognize that there is only so much government can do, (and) the nonprofit sector of our community plays an important role in emergency response,” said Patrick Lonergan, Gallatin County chief of emergency management, in a news release on Monday. “Often their coordination is what makes a community resilient and contributes to the community’s ability to bounce back from crisis.”

https://www.bozemandailychronicle.co...16e174758.html

Same here in Montana.

[ianpnw]

Impressive efforts and much needed. The PPE we have isn’t designed for multiple use and is in very short supply. Not super reassuring when one is in a age group with a 3% mortality from COVID like me! On second thoughts maybe I should go skiing or mountain biking - the risk for me personally is less than working!!

[EdAbbey]

If I leave my cell phone at home and don't leave a note is it morally acceptable I go climb a mountain? (I don't really care about your opinion when it comes to my business but just curious what people think)

[old goat]

I see no issue with the face shields but as far as masks and PAPRs how do the makers know if their products are actually keeping viruses out, at least as well as a 2 week old used N95. Sounds like the background of most of these people is in making stuff, not virology. Maybe they've been testing them and the articles just don't talk about it.

[Bunion 2020]

If I leave my cell phone at home and don't leave a note is it morally acceptable I go climb a mountain? (I don't really care about your opinion when it comes to my business but just curious what people think)

How about if you just go and don't come back.

[BCMtnHound]

If I leave my cell phone at home and don't leave a note is it morally acceptable I go climb a mountain? (I don't really care about your opinion when it comes to my business but just curious what people think)

As long as you or your family has no expectations, with no info the operational search period should be short.

How about if you just go and don't come back.

And if some poor hiker finds you after the snow melts, body recover is the safest SAR recovery to plan and execute. Still sucks to package human remains for transport though.

[EdAbbey]

I see where the sense of adventure, independence, and human spirit is with most of you. I'm guessing most of you are either from urban and/or east coast judging from your responses (or Colorado which is just as bad)

[TBS]

^^^

[Kinnikinnick]

I see no issue with the face shields but as far as masks and PAPRs how do the makers know if their products are actually keeping viruses out, at least as well as a 2 week old used N95. Sounds like the background of most of these people is in making stuff, not virology. Maybe they've been testing them and the articles just don't talk about it.

Still having to go through testing for FDA but there are expedited approvals and limits on liability special to this.




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[shafty85]

^^^

[sfotex]

Here's my troll bait - I'll post it in the covid thread too:


It was a tough week. Losing John Prine hit hard, then watching someone I was trying to help die in front of me on the mountain..... something that I wouldn't wish on anyone. I wanted to hug my teammate and cry ,and there was that awkward first date moment 'like is this ok? , I said fuck it, I'm human.

The next day was my daughter's birthday. I spent the whole day with my daughter. How awesome.

We had another rescue Friday a skier with a broken ankle. It was. a warm, sunny day. The sun felt warm on my skin, and I felt human.

I saw this interview from John's lifetime guitarist Jason Wilber tonight:

"1. 'How the hell can a person go to work in the morning, and come home in the evening, and have nothing to say?'

From 'Angel From Montgomery.'

I’ve heard John describe his premise for 'Angel from Montgomery' as a song about 'a woman who feels older than she is.' .........We’ve felt it. We’ve wondered about it for someone else, or ourselves. After everything you go through in life, how can you have nothing to say? About your day, or your work, or your feelings?

Life is bittersweet. The joy only intensifies the pain, and vice versa. "

We will get thru this. I've been blessed to go thru these hard times with my wife and kids. I can't wait until we can be humans again.

[summit]

PPE works in hospital if properly supplied and used and there is evidence to prove it. Most healthcare workers are getting sick by self-contaminating during doffing, which is actually much harder than one might think, especially when it comes to doing it right every single time 100 times. Or 1000 times. When you are exhausted working extra shifts it is actually quite easy to contaminate when taking off an N95 and eye protection plus a gown (and maybe more) plus hand hygiene all around. All it takes is one defect in technique and there are many opportunities when combining pieces of PPE. Making healthcare workers reuse disposable PPE magnifies the chances to self-contaminate. When hospitals give only surgical masks, it reduces protection.

BC SAR is not a hospital. Hospitals are climate controlled. BC isn't. You can't wear N95s or PAPRs during precip, and they may only work for a few minutes if it is high RH or cold because the filter layer saturates with moisture (or freezes). Trying to tolerate a N95 at altitude is tough even if you are not performing activity. With activity, they are stifling, intolerable, and if you breath hard enough, you break the seal. So really one can only hope to wear proper PPE at the accident site and not during the rescue. Luckily being outside helps... but switching to wearing a buff during the rescue doesn't help the rescuer (maybe helps others at little bit).

A gown or tyvek suit will shred (f the tyvek even fits over winter gear.. or if it can be tolerated in heat).

I see no issue with the face shields but as far as masks and PAPRs how do the makers know if their products are actually keeping viruses out, at least as well as a 2 week old used N95. Sounds like the background of most of these people is in making stuff, not virology. Maybe they've been testing them and the articles just don't talk about it.

PAPRs are not rocket surgery. They are quite simple in concept. You have a fan that pulls air through a HEPA filter and blows air into a helmet and then the air blows out the bottom of the helmet neck cuff (or shroud as pictured). You don't need amazing seals, just a good way to have it sit on users heads without falling off because the PAPR simply blow enough air (positive pressure) that even when someone is working hard (CPR), they don't suck air back up from the outside. You need a good battery, power indicator, and flow constriction indicator so the user knows if it is working.

It's not so hard to test. You can test qualitatively with something like a portacount (compares PM ambient to inside the respirator) or I imagine you could test qualitatively like most masks using an easily tasted bitter particulate. You probably experienced that latter during your career at some point for an N95. I'm guessing you didn't play with PAPRs since you were in the OR and we don't like them in the OR.

PAPRs are great unless you are trying to auscultate, operate, or communicate. Far more comfortable than N95 or FFMs with P100 cartridges.

[old goat]

Like Summit says--it's a lot easier to doff PPE safely if it's going directly into the trash. The big danger with reusing it is handling it.
I never had to wear an N95 at work. The big risk back then was TB and I was lucky never to have to operate on someone who had it. Never wore a PAPR either.
I was never fit tested and I doubt the old N95 I found in the garage has a good seal.
I would think that the main failure mode of a PAPR would be air getting around the filter.

[covert]

Why is infection hazard different than other hazards like weather and avalanche?

If the exposure to avalanche hazard is unacceptable, don't go. If the exposure to any hazard is unacceptable, don't go.

Isn't that the most basic tenet of incident command?

[Peruvian]

Second hand story of a young man who broke his leg skiing and when his friend drove him to the E/R, they told him to wait in the car until they were prepared to deal with him. He waited 4 hours.

I'd rather not, so I'm trying to keep my activities low on the risk scale.

[old goat]

Why is infection hazard different than other hazards like weather and avalanche?

If the exposure to avalanche hazard is unacceptable, don't go. If the exposure to any hazard is unacceptable, don't go.

Isn't that the most basic tenet of incident command?

I shouldn't have to repeat this over and over but the risk of infection is to you, all the rescuers, the people at the hospital who care for you, the hospital workers who don't have enough PPE because it was used taking care of you. An acceptable level of risk for you is not an acceptable level of risk to impose on others. This is something that we all should do much, much more often--consider the effect of our actions on other people, both people we know and everyone else. This American idea that freedom means being able to do anything you want without worrying about how it affects other people, an idea that is expressed over and over in the Covid threads, has to die, not just for Covid, but for everything.

[total_immortal]

If I leave my cell phone at home and don't leave a note is it morally acceptable I go climb a mountain? (I don't really care about your opinion when it comes to my business but just curious what people think)

Just spent two days on a SAR with this exact circumstance (no phone/note). We had ~200 people volunteer on day 2, and very little social distancing. If someone was sick in that group, they easily could have spread it to dozens of folks. So I'd say you're putting way more people at risk by not having your phone or following normal bc protocol.

[sfotex]

Why is infection hazard different than other hazards like weather and avalanche?

If the exposure to avalanche hazard is unacceptable, don't go. If the exposure to any hazard is unacceptable, don't go.

Isn't that the most basic tenet of incident command?

We are worried about one patient exposing the whole team at the same time and wiping out our ability to respond. We have some team members on the team that are a little older. We got issued one mask each. We were able to round up some more, but trying to wear a mask when your working hard in the mountain with a litter, etc. is a pain.

[Buster Highmen]

Why is infection hazard different than other hazards like weather and avalanche?

If the exposure to avalanche hazard is unacceptable, don't go. If the exposure to any hazard is unacceptable, don't go.

Isn't that the most basic tenet of incident command?

To covert's point, yes.

But in that analysis, there's something about risk versus reward that should factor in the effect of failure or error. And like OG wrote, an avalanche isn't contagious and doesn't have the same ripple effect.

But I still think coverts point is valid, it's just that it has to be applied in context.