How might a mountain rescue play out during the COVID-19 pandemic?

Why were Coniston Mountain Rescue Team so concerned about the relaxation of the Government’s travel to exercise rules? To explain, the team’s Duty Team Leader Jeff Carroll outlines how a rescue might play out during the COVID-19 pandemic…

When the Prime Minister stated that it is now okay to drive any distance to take your exercise, it was music to the ears of many, including those desperate to get their Lake District ‘fix’. However, the relaxation of the Coronavirus lockdown came as a total surprise to us as a Mountain Rescue Team (MRT), Cumbria Police, Cumbria Tourist Board, The Lake District National Park and also The National Trust. Simply, the Lake District is NOT ready for a large influx of visitors. The hospitality sector remains closed, some car parks may be re-opening, along with some toilet facilities, but this is an enforced opening due to this announcement to cater for those that do decide to come, rather than an invitation.

To explain the concerns, here’s how a rescue might play out during the COVID-19 pandemic…

Firstly, we are all volunteers – most of us have day jobs from which we take time off to deal with incidents during work hours, or time out of the rest of our lives ‘out of hours’, and, secondly, most of us have families who we need to protect.

Imagine the following scenario…

Paul and Sarah travelled up from Preston, and have summited the Old Man of Coniston, had their lunch and set off down towards Goats Water.

Paul slips and hears a crack from his left ankle; Sarah tries to help but Paul can’t put weight on his ankle, which is at a funny angle anyway. Paul is 15 stone and 6ft 2 tall. Sarah is fit but no way could she help Paul back down.

Sarah dials 999, remembers to ask for Police and then Mountain Rescue; the operator takes the details and asks a lot of questions to assess the COVID-19 risk posed by both Paul and Sarah to the MRT, and subsequently to ambulance and medical staff that will need to treat Paul.

In the meantime, four groups of people come by, they all say they’d love to help but haven’t got any Personal Protective Equipment (PPE) and must socially distance themselves by at least 2m.

The Police alert Coniston MRT to the incident via SARCALL, and the Duty Team Leader (TL) calls Sarah, having sent her a link by text for her to click on to confirm their exact position, and asks more questions, to work out the resources needed.

The TL then calls other members of the Leader Group to discuss the requirements and decides a 10 member group is required on the hill, and alerts the Team to that requirement.

The Team numbers are depleted anyway, we have a number of people who contribute massively to the Team generally but who are over 70 years old, ie higher risk group; we have people who may be shielding a family member, or at risk themselves due to underlying medical conditions that normally wouldn’t be an issue. So a team of 10 assemble at the MRT base, plus someone to run the base – this person is important as it helps with coordination of other services letting the hill party get on with the job.

All members are briefed regarding the incident, and check all are happy with the unknown invisible risk posed by the incident; the risk of walking up the fell is taken as read and a baseline anyway. All PPE is checked.

Team members climb aboard two of the Team’s three vehicles. Why only two when social distancing could be better in three vehicles? The need to decontaminate the vehicles on return probably outweighs the advantage of social distancing, and it leaves another vehicle able to respond to any other incidents.

Usually, the Team would mobilise within 10-15 minutes of this type of call. However, due to all the pre-checks, personnel checks etc, time elapsed thus far is 45 minutes.

The vehicles arrive at the road head, one last check on PPE and kit for the incident, including radios, and the Team sets off for the casualty site. Walking time to site is around 45-60 minutes.

Unfortunately, the air ambulance is unavailable on this occasion so cannot support. It’s a similar story for HM Coastguard helicopters.

On site, one casualty carer and one assistant will approach the casualty with as much PPE on as possible, and may well apply PPE to the patient before carrying out a full primary survey. In this case that’s simple, Paul’s ankle is (probably) broken, and there are no other underlying medical factors like a head injury, multiple other injuries or catastrophic bleeding.

The casualty carer and helper would normally give Paul some Entonox (pain-killing gas) while they straighten his ankle to ensure a pulse at the foot and also maybe a pain-killing injection. The injection takes 15 mins or so to work, but Entonox is not given because of the potential risk of contamination. However, the foot needs straightening ASAP to restore the pulse in Paul’s foot. Paul screams as the casualty carer re-aligns the foot (it’s called reducing the injury) to restore circulation and allow for splinting.

Paul’s ankle is splinted and although he’s still in pain, it’s less than it was and the pain-killing injection is starting to take effect. Time elapsed since Paul fell is now two hours 15 minutes.

The Team moves in and helps Paul on to the stretcher, which is made from stainless steel and heavy – it is about 2.5m long and maybe 0.6m wide. It usually it takes eight people to carry a loaded stretcher; they cannot socially distance.

The Team carries Paul down to the Walna Scar Road, where they’ve asked a North West Ambulance Service land ambulance to meet them to reduce potential contamination at base. The carry down has taken two hours, so now it’s 4 hours and 15 minutes since Paul fell. Paul is transferred to the ambulance and taken to Furness General Hospital. Sarah can’t drive, but can’t go in the ambulance either. How can the Team get Sarah re-united with Paul? And then how do they both get home to Preston when Paul is fixed? What happens to their car? In normal circumstances we can fix these issues, but it’s not so easy during the COVID-19 pandemic.

The Team returns to base and starts to decontaminate the stretcher, the vehicles, the non-disposable medical equipment, the splint and themselves. Jackets and other clothing are all bagged ready to go in their washing machines when they get home, which takes a further one hour and 15 minutes. Total time elapsed is now five hours and 30 minutes. Total man hours = 10 personnel on the hill plus one running base = 60.5 man hours.

Paul is admitted to Furness General Hospital after a wait of one hour at A&E. He is taken to a cubicle and X-Rayed to understand his ankle injury better. He is also routinely tested for COVID-19. Paul’s ankle needs an operation to pin it as the break is a bad one.

Paul’s COVID-19 test comes back positive. Oh dear! Paul is asymptomatic; he has the virus but is either naturally immune or has not yet developed symptoms. The message is passed back to Coniston MRT, who then have to check the records of those on the incident. Every one of them, the 10 people on the incident and the base controller, must now self-isolate and so must their families. So now we have maybe 35 people all having to self-isolate. Plus, possibly, the ambulance crew and their families.

Three days later, Eric from Essex decides he wants to come to Coniston to do the 7 Wainwrights in the Coniston Fells. He sets off, and completes Dow Crag, the Old Man, Brim Fell along to Swirl How and Great Carrs and across to Grey Friar, then on up to Wetherlam. Eric puts his foot down on a rock, the rock moves and Eric is in a heap on the floor, his foot is at a funny angle…he gets his phone out and dials for Mountain Rescue… but there are only three people available from the Coniston Team now, so the decision needs to be taken by the Coniston MRT duty leader which Team to call to support. The neighbouring teams are Langdale-Ambleside and Duddon & Furness MRTs. The issue is, they’re in the same situation as Coniston, with people self-isolating due to potential contamination, or their members are keyworkers in the NHS and can’t deploy on MRT incidents.

So – I kindly ask you to think twice, even three times before you embark upon travelling to the Lake District for your exercise. The risk, however small, is real, and I write this as a MRT member for over 30 years with probably around 1000 incidents under my belt, I know, accidents happen.

Coniston Mountain Rescue is a voluntary organisation in the UK. Charity No. 504923. To maintain this valuable community service it relies solely on the support and generosity of the public. There are several ways you can support the work of Coniston Mountain Rescue. To find out more, or to make a donation online, simply click on the links here.