Photo top: from SNSM April 2020

Click on the following link to download the pdf version of "IMRF COVID-19 Operational Guidelines: Guidance for SAR Organisations".


Introduction 

The main priorities for all SAR organisations are firstly, to minimise the risk of infection for all staff and volunteers and secondly, to continue to provide effective SAR and lifesaving services.

These priorities should underpin all aspects of the provision of SAR services during the COVID-19 or any similar epidemic/pandemic. 

The following guidance is offered to assist organisations in managing their response to the COVID-19 pandemic for all aspects of their SAR service.

This guidance is not exhaustive, but it suggests some of the changes to policies and procedures that organisations may wish to introduce to ensure that the risk to their own personnel is minimised, whilst also maintaining the integrity of the service that they provide.  

This IMRF guidance should always be read in conjunction with any guidance and advice provided by national authorities and the World Health Organisation.


Chapter 1 - Non-Operational Activities

1.1 Non-Operational Activities

Non-operational activities are those activities that are not directly related to the carrying out of safe and effective SAR operations eg public visits, fundraising events, open days and conferences. 

All non-essential activities should be cancelled or postponed and the cancellation/postponement should be clearly communicated to those who need to know, including on websites and social media platforms. 

Consideration should be given to whether any of these events can be delivered in an alternative way, for example on-line conferencing or a web-based fundraising event.


Chapter 2 - Access to Buildings and Lifeboat Stations, Including Travel by Personnel

2.1 Non-Essential Visits

All non-essential visits to lifeboat stations or organisation headquarters should be suspended during the pandemic, including visits from crew members/support staff not on call, members of cooperating organisations or authorities, sponsors, school classes, etc. This should be communicated clearly on websites, social media, etc.


2.2  Public Access

Public access to lifeboat stations, lifeboats and other essential buildings and infrastructure should be suspended.

Public access to gift shop, visitor centre, café and similar sources of income should be determined in accordance with guidelines from local/national authorities.

If such areas are located in close proximity to areas used by crew members or other essential members of staff, public access should also be suspended.


2.3  Restricted Access for Essential Personnel Only

Access to lifeboat stations, lifeboats and operations centres, etc., should be restricted to the personnel directly involved in, or critical to, the ongoing operation.

Crew changes at a lifeboat station, or other operational facility, should be conducted without any physical interaction between the incoming and outgoing shifts.

Markers such as the use of tape could be used on the floor to remind personnel of social distancing and direction of travel for incoming/outgoing shift personnel.


2.4  Physical Presence

All physical presence at lifeboat stations and other organisation buildings should be kept to a minimum.

If possible, only personnel required for essential maintenance, or critical to the conduct of safe and effective operations should be allowed physical access.

Poster reminders on how to wash hands correctly should be displayed around the building, particularly in washrooms.

All personnel who are physically present should take responsibility to help wipe down high transit areas in the boat and in buildings such as table surfaces, cupboard doors, door handles, etc.


2.5  Response Plan for Suspected Infection

The organisation should develop a response plan in case someone exhibits symptoms of infection (e.g. for COVID-19 - dry cough, fever, malaise) while at any of the organisation’s locations.

The plan should identify:

- a room/area where the person can be safely isolated and monitored;
- the requirement to deep clean any areas which the infected person has been in;
- who should be contacted for assistance and how to call for help; and/or,
- how to transport the person home, or to a health care facility if needed, with minimum risk to other personnel.

The plan should also cover procedures for handling staff and crew members testing positive directly after being in contact with other members of the organisation, or partner organisations, or members of the public (eg while responding to an incident).


2.6  Working from Home and Team Meetings

All staff members should be encouraged to work from home wherever possible and should be supported by managers and the organisation in this endeavour.  

With modern technology, most [non-operational] tasks can be performed from home, using a laptop computer and an internet connection.

Both internal team meetings and external meetings can be performed using commercial and/or freely available software solutions.

If a physical meeting is absolutely necessary, consider restricting attendance to the minimum essential personnel only, or splitting the larger group into sub-groups for each topic.

Always start meetings with a gentle reminder of precautions to avoid spread of disease. 

Managers and colleagues should in any event be checking on the mental well-being of all personnel and should provide details of internal and external contacts that can be called upon for advice/support, if required.


2.7  Working Patterns to Maintain Social Distance

Where access to buildings is required, to avoid or minimise contact between personnel, managers should assess whether it is possible to change access arrangements. 

For example: personnel could enter buildings/workplaces in smaller numbers groups, or at specific times, or on specific days, or use separate entrances and exits to buildings.

At least 2 metres distance should be maintained between personnel and everyone should be continually reminded of the importance of abiding by the hygiene measures in place.

Organisations should also provide facilities and hygiene resources so that personnel can wash and dry their hands regularly with the correct equipment.


2.8  Travel Between Lifeboat Stations and other Buildings

The organisation should establish routines for travel between lifeboat stations, crew member homes and workplaces, or any other travel necessary for the operation of the organisation.

Avoid sending employees who may be at higher risk of serious illness (e.g. above 60 years of age, with diabetes, respiratory issues such as asthma, cancer, auto-immune disease or heart and lung disease) by public transportation.

If using rental cars check whether the rental company has any special policies or restrictions in place as a result of the pandemic. 

Ensure that anyone travelling on behalf of the organisation knows what to do and who to contact if they feel ill while travelling.


2.9  Follow Protocols Given by Local/National Authorities

The organisation should be aware of any local/national protocols or restrictions on travel and keep monitoring any changes of policy by the relevant authorities, especially in relation to crew members travelling to respond to a SAR incident.

It is particularly important to monitor this in relation to international travel, as policies may vary between different countries. 

It may adversely impact the organisation’s operations if key employees or crew members are put into quarantine, as a result of poor travel planning.


Chapter 3 - Training

3.1 National Training Activities

All non-essential national training activities that require participants to be physically present should be suspended, cancelled or postponed.

This is to avoid contact between the lifeboat stations and communities, as well as between crew members in a specific station.

Essential training activities that cannot be postponed should be carried out with the minimum number of trainers and trainees in attendance.

Such training should be organised for crew members from one station at a time. 

Theoretical training should be organised using e-learning platforms and online lectures.

The online training and courses should be provided in sufficient quantities during the possibly long quarantine period.


3.2  Station Training Activities

All non-essential local training activities that require physical presence should be suspended, cancelled or postponed.

Essential training activities that cannot be postponed should be carried out with the minimum number of trainers and trainees in attendance.

National organisations should support the stations in finding tools for organising local online training activities. 

National organisations and local stations should consider providing crew members with daily or weekly emails, detailing information on available online trainings or tasks, activities etc that can be completed at home.


3.3 Essential Training

In general terms, essential training is training that is needed for the continued provision of safe and effective rescue operations during the epidemic/pandemic.

Examples of essential training include:

- Familiarisation with a new boat, new equipment or new way of operation;
- Familiarisation with the boat, lifeboat station and operating procedures for replacement crew members (where regular crew are off sick or in quarantine);
- Training with helicopter crews to support them in maintaining essential aeronautic operational qualifications.

If the COVID-19 situation is prolonged, essential training might also include:

- Training of relatively new crew, who have a reasonable level of skill, but who need more experience in order to become independently operational lifeboat crew members;
- Maintaining crew skills, especially for small fixed crews;
- Fitness training of rescue personnel eg beach lifeguards. If swimming training in a swimming pool, or in the sea, is not possible, suggestions for exercises or workouts that can be done at home, together with advice on appropriate nutrition, might be necessary for maintaining the health and fitness levels of personnel.

3.4 Minimising the Risks to Personnel During Essential Training

If a certain training is considered essential, it is important to consider who really needs to participate and what safeguards can be put in place to protect the participants.

The participants should:

- only be from the specific target audience for that training;
- not belong to any risk group (by age, medical status, or otherwise);
- be able to pass on to others what they learn at the training;
- be given: o prior instructions for safe access to the training site, including parking, changing facilities etc;
  o a dedicated crew briefing before going on board, to emphasise protective; measures, including crew placement on board (wheelhouse or outdoor deck), use of personal protective equipment, etc.

The training itself should:

- be delivered online wherever possible;
- have the minimum number of essential trainers and participants present;
- not take place indoors, where more than one person is involved;
- be conducted in accordance with strict social distancing and hygiene protocols (see below).

 

Social distancing and hygiene protocols include:

- No sharing of personal equipment - all gear is for personal use only (eg survival suit, life jacket, helmet, other clothing);
- Keeping a safe distance between participants wherever possible (at least 1 - 2 metres);
- Participants should not attend if they have flu-like symptoms or feel unwell before the training;
- Washing hands before and after the training;
- Wearing gloves;
- Wearing masks - this is a decision that would need to be considered on a case-by-case basis, bearing in mind the prevailing national guidelines and the operational risks posed eg by masks impeding communications);
- Wash and disinfecting boats, equipment and personal gear, once the training is finished.

3.5 Distance Learning

While SAR activities involve mostly practical skills, there are also a lot of topics that can be covered in theoretical lectures – either totally or partially.

Such topics can be covered by e-learning courses on specific platforms, or by online lectures broadcast to the entire crew.

It is also possible to record these lectures and make them available for later use.

The crew can also be provided with traditional learning material, such as documents or publications, by email or post, which they can study at home.

E-learning and social media can also be used to disseminate water safety messages to a wider audience, when social interaction restrictions prevent safety demonstrations and lectures that would normally be given by the organisation’s personnel.


3.6 Operational Training Requirements

If restrictions, whether imposed locally or nationally, prevent external training or operational requirements being met, the organisation will need to consider whether it is safe to continue SAR operations.

If the training requirements are internal to the organisation itself, some consideration should be given to whether these requirements are safety critical, or whether they could be relaxed for the time being. However, the safety of the crew should be paramount.

If the situation is prolonged, training requirements will need to be kept under review to take account of the impact on operational safety.

Training requirements cannot be relaxed for too long a period without compromising the safety of the operations.


Chapter 4 - SAR Activities

4.1 Non-Essential “At Sea” Activities

All non-essential activities at sea (eg SAR exercises and demonstrations) should be suspended, cancelled or postponed, in line with guidance from the national competent authority for SAR.


4.2  Essential SAR Activities

The organisation should provide all rescue stations with detailed instructions on how to proceed with essential SAR operations during the epidemic. 

In general terms, essential SAR activities at sea are those relating to the safety of life at sea, or the prevention of major navigation incidents and accidents, or marine pollution events, and participation would usually be at the invitation of the relevant competent authority.

Examples may include:

- SAR tasks received from the MRCC;
- Giving towage assistance to a vessel in distress;
- Medevac, transportation of casualties, or people who are sick (whether related to COVID-19 or not);
- Operations to reduce the risk of major marine pollution; and,
- Maintenance of safe access to ports and harbours (eg removal of obstructions), where the port or harbour is a key point in the national supply chain.

Where national or local travel restrictions are in place, the organisation should liaise with the relevant national authorities to ensure that duty crew, who are responding to an incident at the request of the relevant competent authority, can obtain the necessary authorisations to enable them to travel to their operational base.


4.3 Minimising the Risks to Personnel During Essential SAR Activities

Where it is necessary to undertake a particular SAR activity (see paragraph 4.2 above), it is important to consider who really needs to participate in the activity and what safeguards can be put in place to protect everyone involved.

The following safeguards are recommended, but should be read in conjunction with national or local guidance:

Participating Personnel
- Only the minimum essential personnel should participate in the activity. That must include personnel with the normal mandatory qualifications and certification (e.g. Coxwain, Radio Navigation, Deck Crew, First Aid, etc.);
- The crew involved should be part of the Duty Crew crew;
- Participants should be clear that they should not attend if they have flu-like symptoms or feel unwell;
- Where possible, crew members should not belong to any of the high-risk group (e.g. medical status, or otherwise);
-
All stand-by crew should be given: o prior instructions for safe access to their operating base, including parking, changing facilities etc
o a dedicated crew briefing before going on board, to emphasise protective measures, including crew placement on board (wheelhouse or outdoor deck), use of personal protective equipment etc.
- All personnel should be aware of any revised guidance on first aid procedures to minimise risk of infection (eg wearing of masks for CPR etc);

Equipment
- Any additional Personal Protective Equipment (PPE) required to minimise the risk of infection from COVID-19 needs to be designed or adapted for service at sea, so as not to impede the safety of SAR personnel or others involved in the activity;
- There should be no sharing of personal equipment - all gear is for personal use only (e.g. survival suit, life jacket, helmet, other clothing);
- Boats, equipment and personal gear should all be washed and disinfected once the SAR activity has ended.
Social distancing and personal hygiene protocols
- Crew members should keep a safe distance between them (at least 1–2 metres) wherever possible;
- Wash hands before and after the activity;
- Wear gloves;
- Wear masks – NB This decision should be considered on a case-by-case basis, bearing in mind the prevailing national guidelines and the operational risks posed (eg. by masks impeding onboard communications).

For advice on the specific precautions needed for dealing with (suspected) COVID-19 casualties or patients, please see Annex A.


Chapter 5 - Maintenance and Deliveries

5.1 Operational Readiness

Keeping rescue vessels and facilities in a state of operational readiness is a key component in maintaining SAR services. This can be challenging and require significant resources in normal circumstances.

During the crisis, it is essential to identify how your organisation can adapt service delivery, appropriate service & inspections intervals and supply chain vulnerabilities in order to sustain safety and reliability margins.


5.2 Maintenance 

Only maintenance and repair activities that are critical to the safe running of lifeboats or other essential services should be performed at this time.

Some inspections can be postponed or, in the case of compulsory time-sensitive inspections, should be carried out with minimum number of people (for example, a lead inspector plus the person responsible for the boat at the station).

For essential maintenance, contact between maintenance staff and crew should be minimised.

The number of personnel required to carry out any maintenance task should be limited to those who are essential to the successful completion of the task.

Sometimes station crew perform maintenance and some repair duties.  However, technical staff, or other commercial boatyard technicians can be required to come “on station” to carry out larger/more complicated repairs. 

In these cases, every effort should be made to limit contact between any external workers and local station crew to what is essential for the task. 

Many boat maintenance activities are used as a learning opportunity for trainee crew.

This type of training activity should be postponed, as most repairs are performed in confined spaces and in close proximity.


5.3 Deliveries 

In order to minimise the number of deliveries to offices and stations, organisations need to identify and prioritise delivery of the spare parts that are essential for any immediate essential repairs, or to the spare parts that most frequently need replacing.

It is worth planning for any potential limits to the availability of some equipment and spare parts, as well as possible delays in delivery, as a result of disruption to international supply chains caused by the epidemic/pandemic.

In order to minimise the contact (and the risk of infection) between delivery staff and the personnel at the receiving location, clear protocols need to be in place. 

For example, items can be left by the delivery driver, without the need for a signature/acceptance.

Most commercial deliveries from logistics companies are likely to have stopped the procedures requiring signing for packages physically, or on digital hand apparatus.


Chapter 6 – Safeguarding the Environment 

6.1 Disposal of Waste

Any waste that is incorrectly disposed of can be potentially harmful, both to the environment and to human health. 

Garbage produced in cities, even far from the coast, can be carried to the sea by wind or rivers, threatening marine life and increasing marine pollution.

This also applies to additional waste that is produced as a result of a health emergency, such as the COVID-19 pandemic. 

For maritime SAR organisations seas, lakes and rivers are the main working environment and it is important to keep it clean. 

Clinical waste produced by hospitals and medical centres follow well-defined disposal routes. 

However, trash that is produced by non-medical establishments or by the general public and that is not recycled or correctly disposed of, can remain in the environment and poses a growing threat. During the COVID-19 pandemic, increasingly quantities of face masks or protective gloves have been abandoned in the street near supermarkets, or have simply fallen from overflowing waste bins.  

In a health emergency (such as COVID-19), when health and personal safety are understandably paramount, the general public can appear to be less concerned about protecting the environment, particularly when people have been confined to their homes for long periods.            

However, the risks associated with the incorrect disposal of potentially infected items are not just about the impact on the natural environment – it can also be directly linked to the spread of infectious diseases, such as COVID-19.


6.2 Safe Disposal of Potentially Infected Waste

During the COVID-19 pandemic, the most common types of waste that are incorrectly disposed of are:

- Facial masks;
- Disposable gloves;
- Plastic bags;
- Food packaging.

Each country has its own waste disposal and recycling rules that, in some cases, have been revised in the light of the risks posed by COVID-19. SAR organisations, like the general public, should always follow their own national waste disposal guidelines. 

However, in general, we can say that:

1. Non-reusable facial masks are not recyclable, so should be safely disposed of with general rubbish;
2. Latex gloves are made with natural material, but are not compostable and so should be disposed of with general rubbish;
3. Nitrile gloves are made with synthetic rubber, so should be disposed of with the general rubbish; and,
4. Vinyl gloves are made with PVC and so recycled as plastic.

Any disposable protective clothing that has come into contact with a (potentially) infected crew member, casualty, patient or member of the public should be disposed of in accordance with the guidelines in Annex A.


6.3   How to Reduce Waste and Minimise the Risk of Infection

-

Don’t leave your home if it’s not necessary.

Whether or not official advice is to stay at home, the more people go out, the more masks and gloves are consumed.

-

Use reusable masks.

After use, they can be washed and re-used, reducing the amount of trash and saving money.

-

Dispose of waste responsibly.

Dispose of all waste – especially potentially infected waste - correctly and avoid overfull bins. Use recyclable material whenever possible.

-

Avoid hand sanitizers if you are at home.

Wash your hands twice and for a longer period instead.

-

Avoid the use of single-use plastic.

Don’t use any plastic cups, plates, cutlery, or bottles at home or on any premises used by your organisation.


Chapter 7 - Communications

7.1 Key Principles

In a fast-moving situation, the delivery of accurate, clear and up-to-date information and advice is an important factor in the delivery of a safe and effective maritime SAR service during a situation like the COVID-19 pandemic. 

Organisations need to have a robust communications strategy in place, to ensure that information gets to the right people at the right time.

The information provided should be factual, timely and targeted. It should support personnel in carrying out their work safely and effectively.


7.2  Key Interest Groups

There are four key groups who need to be communicated with:

- Staff and volunteers – they need to be kept informed of changes in policies and operational guidelines;
- External stakeholders and partners – they need to be kept informed of the situation, particularly how any changes in procedures, or rearrangement of events and activities (e.g. trainings) apply to them;
- Funders and sponsors - they need to know that the organisation still needs support and how they can help; and,
- Press and media – they can help raise awareness of the organisation’s work and help with the dissemination of public safety messages and advice.

IMRF COVID-19 Information Network

27 April 2020


Annex A

Medical/Hygiene Issues Related to COVID-19

Frequently Asked Questions


1. Introduction
Updated: 21 April 2020

This document is for SAR organisations currently facing operating challenges as a result of COVID-19.

It is primarily based on guidelines issued by the World Health Organisation (WHO), existing national protocols provided by IMRF member organisations and consensus of an IMRF expert panel.

Recommendations by ILCOR[1] and national resuscitation councils have also been included.

[1] ILCOR: International Liaison Committee on Resuscitation

Organisations should always adhere to national legislation/regulations or guidelines in cases where recommendations in this document contradict information given by local authorities.

The understanding of the impact from the COVID-19 pandemic is constantly changing, and therefore guidelines and recommendations will also be constantly changing.

Organisations should always seek the most updated information from reliable sources like WHO, Centres for Disease Control, National Health Authorities, etc. 

In this document, the term “lifeboat crew” should be taken to include lifeguards, where they are part of a SAR organisation.

Any questions or suggestions can be sent to: [email protected], marked “COVID-19”.


2. Background
Updated: 21 April 2020

Coronaviruses are a large family of viruses which may cause illness in animals or humans.  In humans, several coronaviruses are known to cause respiratory infections ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS).

The most recently discovered coronavirus causes coronavirus disease COVID-19. This new virus and disease were unknown before the outbreak was identified in Wuhan, China, in December 2019.


3. How Does COVID-19 Spread?
Updated: 21 April 2020

People catch COVID-19 from others who have the virus.

The disease can spread from person to person through small droplets from the nose or mouth, which are spread when a person with COVID-19 coughs or exhales.

These droplets land on objects and surfaces around the person.

Other people then catch COVID-19 by touching these objects or surfaces, then touching their eyes, nose or mouth.

People can also catch COVID-19 if they breathe in droplets from a person with COVID-19 who coughs out or exhales droplets.

That is why it is important to stay more than 1,5 metres (5 feet) away from a person who may have COVID-19.


4. How Can I Protect Myself and Prevent the Spread of Disease?
Updated: 21 April 2020

By following a few simple precautions, you can protect yourself from infection or from spreading the disease to others:

- Regularly wash and thoroughly clean your hands with warm water and soap, or use an alcohol-based hand rub.
Why? Washing your hands with soap and warm water, where possible, or using alcohol-based hand rub, kills viruses that may be on your hands.
- Maintain at least 1,5 metres (5 feet) distance between yourself and anyone who is coughing or sneezing.
Why? When someone coughs or sneezes they spray small liquid droplets from their nose or mouth which may contain the COVID-19 virus. If you are too close, you can breathe in these droplets.
- Avoid touching eyes, nose and mouth.
Why? Hands touch many surfaces and can pick up viruses. Once contaminated, hands can transfer the virus to your eyes, nose or mouth. From there, the virus can enter your body and can make you sick.
- Make sure you, and the people around you, follow good respiratory hygiene. This means covering your mouth and nose with your bent elbow or tissue when you cough or sneeze. Then dispose of the used tissue immediately.
Why? Droplets spread virus. By following good respiratory hygiene, you protect the people around you from viruses such as cold, flu and COVID-19.

5. How Dangerous is the COVID-19 Virus?
Updated: 21 April 2020

Illness due to COVID-19 infection is generally mild, especially for children and young adults.

Hospitalisation rates are higher for those aged 60 years and above (national guidelines in some countries may set this age higher or lower, so follow local recommendations), and for those with other underlying health conditions (e.g. hypertension, diabetes, cardiovascular disease, asthma, or other chronic respiratory disease and cancer).


6. When Should Lifeboat Crew Member NOT Report for Duty?
Updated: 21 April 2020

Lifeboat crew should not report for duty if:

- they themselves are currently in quarantine or isolation;
- they have a fever;
- they are suffering from symptoms of airway infection;
- someone in their household is quarantined/isolated or has symptoms of airway infection;
- they have been without symptoms for fewer than 7 days after their infection has been confirmed/suspected.

7. Should Crews Routinely Wear Face Masks?
Updated: 21 April 2020

There is no need for lifeboat crew members to wear face masks, as a routine, unless required by national guidelines.

The most effective ways to protect yourself and others against COVID-19 are to:

- wash your hands frequently with warm water and soap, or an alcohol-based hand rub;
- cover your mouth and nose with your bent elbow, or a tissue, when you cough or sneeze (the used tissue should then be disposed of immediately); and,
- maintain a distance of at least 1,5 metres (5 feet) from people who are coughing or sneezing.

8. Is it Safe for Our Organisation to Continue to Undertake Medical Calls?
Updated: 21 April 2020

Each organisation should familiarise itself with screening algorithms used by the requesting authorities (medical dispatch, coastguard, J/MRCC etc.) in its area. 

Screening will help determine the level of risk and the precautions that should be taken by responders.

The authority should also advise victims and bystanders on how to behave when responders arrive, including keeping distance, putting on surgical masks and following any other instructions given by the responders.

Ideally medical personnel should join the vessel on all medical calls, but in cases where this is not possible, such as due to lack of time, or where the rescue vessel operates without medical personnel onboard, the crew must undertake the necessary precautions themselves.

If the necessary protective equipment is not available, organisations should consider whether or not to accept the call.

However, every alternative option for providing life-saving treatment and/or medevac should always be explored.

The coxswain should, together with the requesting authority, and/or the organisations medical team, make the necessary assessments in advance of such missions.

With adequate screening, training of crew members and protective equipment in place, it should be safe for crews to continue to do medical calls.


9. How Can Lifeboat Crew Members Carry Out Screening for COVID-19?
Updated: 21 April 2020

A quick way to screen patients or crewmembers on a casualty vessel is to ask these questions from a safe distance (also observe national guidelines):

1. Do you have/ have you had fever in the last few days?
2. Are you coughing?
3. Do you feel any pain or pressure to the chest?
4. Do you have difficulty breathing or shortness of breath?
5. Do you have/ have you had contact with anyone with proven COVID-19?

If the patient answers YES to one of these questions, the person should be treated as if there is a suspected/confirmed COVID-19 infection.


10. When Should We Wear Personal Protective Equipment (PPE) and What Should We Wear?
Updated: 21 April 2020

As part of the standard of care, all providers must perform hand hygiene before and after all patient care activities, regardless of the etiology of the patient presentation.

Gloves are never a substitute for hand hygiene.

All personnel should avoid touching their face while working and should be encouraged to remind other personnel, as people are often not conscious of touching their own face.

When handling and transporting patients with acute respiratory tract infection and/or symptoms such as fever, cough, shortness of breath or suspected/confirmed SARS-CoV-2 infection responders should wear surgical mask, eye protection, gown/coverall and gloves.

All other handling/transport of patients with uncertain infection status should be carried out with a surgical mask, gloves and goggles.

Measures that should be taken to limit exposure in the vessel:

- Have clearly defined roles and responsibilities within the crew so that as few as possible of the crew members has to be in the "patient zone" within 1 metre distance of the patient;
- Let patients wear surgical masks and gloves if possible (explain to the patient);
- Wrap the patient/cover surfaces with infection control sheets;
- Keep the patient (if feasible) isolated in a suitable location during transport;
- Maintain ventilation at a high level of air exchange;
- Next of kin can only accompany the patient if absolutely necessary (except young children);
- Clarify all logistics in the evacuation chain as soon as possible.

Please see the table in Figure 1 (below) for further details of the appropriate items of PPE to be used for different levels of care.

* If the entire crew is involved in treatment of the patient, the bridge team should remove their PPE before entering the bridge (clean zone), but not the mask.


** Bag valve mask ventilation, airway suction, intubation, nebulizer, CPAP/biPAP, CPR.  Most of this would be performed when ambulance crew are on board, where ambulance crew are in attendance. Any ambulance crew in attendance would normally be expected to provide the N95/FFP2 masks to all lifeboat crew.


11. How Can We Ensure Proper Use of Personal Protective Equipment (PPE) Among Crew Members?
Updated: 21 April 2020

Each organisation should establish its own procedures and training for the use of infection control PPE.

As a reference, the European Centre for Disease Prevention and Control has made a very good guideline with an online e-tutorial that can be useful: https://www.thinglink.com/scene/584726288351100929 

The US Centres for Disease Control also has a useful guideline: https://www.cdc.gov/coronavirus/2019-ncov/downloads/A_FS_HCP_COVID19_PPE.pdf

PPE should always be removed in an appropriate doffing area to prevent secondary contamination.

Care should be taken to avoid self-contamination, for example by using a “buddy” system.

If members of the bridge team must be involved in direct patient care, after completing care and prior to entering an open bridge they should remove eye protection, gown and gloves and perform hand hygiene. The mask should remain in place during transport.


12. How Do We Perform Patient Care During Transport?
Updated: 21 April 2020

Crew members should attempt to minimise patient contact during assessment.

It may be permissible, for example, to defer obtaining vital signs if the patient appears stable, has no visual evidence of distress or shock, and transport time is not prolonged.

Individual isolation capsules are not needed to transport COVID-19 patients.

Keeping a mask on the patient is enough for transport. 

After conducting an initial assessment focused on patient’s stability (respiratory distress, altered mental status, etc.), crew members should define appropriate interventions for patient deterioration before and/or during patient transport. 

Any patient belongings should be considered contaminated, placed in a biohazard bag, sealed, labelled and transported with the patient in the patient compartment.

Crew members should avoid opening compartments and cabinets unless essential to patient care.

Equipment needs should be anticipated and the appropriate tools removed from cabinets prior to placing the patient in the vessel. 

After pre-arrival notification, the crew should continue to communicate with the medical dispatch or ambulance with updates on the patient’s condition and ETA to facilitate reception of the patient immediately upon arrival.


13.  Is It Still Safe to Give Cardiopulmonary Resuscitation (CPR)?
Updated: 21 April 2020

Risk of Infection

The risk of infection varies over time and also between regions and countries, and it is recommended that each organisation keeps updated on the specific risk in their own area over time. 

Most out-of-hospital cardiac arrest occur in private homes, where infection status most likely will be well known.

It is also very unlikely that a person will suffer a sudden cardiac arrest at home as a result of COVID-19. 

This is more likely to occur to patients who have already been admitted to a hospital.

 

Mitigate Age as Risk Factor

The health risk from COVID-19 increases with age, and according to the WHO the critical age for increased risk is at the moment 60 years.

National guidelines in some countries may set this age higher or lower, follow local recommendations.

As a mean to mitigate the increased risk for elderly crew members, it is recommended that crew members above the age of 60 years, avoid performing CPR if possible.


14. What Sort of Treatment Is Appropriate for Casualties Suspected of Infection?
Updated: 21 April 2020

1) Adults without clear or proven infection:
- Crew can deploy to incident;
- NO mouth-to-mouth ventilation;
- Chest compressions only (preferably with proper PPE* in place);
- Use of Automated External Defibrillator (AED).
2) COVID-19 positive or strong suspicion:
- Crew can deploy to incident;
- NO mouth-to-mouth ventilation;
- Chest compressions only (only when proper PPE[2] is in place);
  [2] Personal Protective Equipment for CPR: Goggles/face shield, N95/FFP2 respirator, gown/coverall, gloves.
- AED only (when PPE is not available).
3) Children, infants and newborns:
- Crew can deploy to incident;
- Give CPR (including mouth-to-mouth ventilation).

It is rare for children to have cardiac arrest because of heart problems - these are more likely to be caused by primary oxygen deficiency / respiratory problems, which is why ventilation is of the utmost importance for the child's survival.

Although mouth-to-mouth breathing increases the risk of being infected with COVID-19, for children it is currently recommended that normal guidelines are followed ie 5 rescue breathes followed by both chest compressions and mouth to mouth ventilation even in suspected / confirmed cases of COVID-19.


15. Changes to the Basic Life Support (BLS) Protocol
Updated: 28 April 2020

The normal Basic Life Support (BLS) protocol will need to be adjusted to take account of the risks posed by COVID-19.  

Each organisation should develop their own procedures/check card according to national guidelines.

The example in Figure 2 (below) is from the Royal National Lifeboat Institution (RNLI) in the UK.

 

Figure 2 – Example of adapted BLS protocol (source: RNLI)


16. Drowning – Should We Perform Mouth-to-Mouth Resuscitation?
Updated: 21 April 2020

At the moment, there are no specific guidelines for drowning victims during the pandemic, but there are a lot of ongoing research efforts internationally to understand what measures can be taken.

Recommendations for drowning resuscitation are in development and will be available within a few weeks. The IMRF will continue to monitor the situation and will update our recommendations accordingly.


17. How Can We Protect Crew Members Who Are Required to Board Other Vessels?
Updated: 21 April 2020

When boarding a casualty vessel, the lifeboat crew is at potential risk of getting exposed to someone infected with Covid-19. Due to this risk it is important to always consider the necessity of leaving your own vessel.

If it is absolutely required to board a casualty vessel crew should consider:

1. Proper planning - allow as few lifeboat crew members as possible to board a casualty vessel;
2. Perform proper hand hygiene;
3. Wear disposable gloves;
4. Consider wearing a survival suit or infection control coverall (if available);
5. Put on safety goggles;
If not available, you can close the face shield on your helmet;
6. Instruct crew of casualty vessel to stay at least 2 metres away;
7. If not possible to keep distance, consider wearing a surgical face mask;
8. Avoid touching your face while working;
9. Dispose of gloves and perform proper hand hygiene when returning to lifeboat.

18. How Do We Decontaminate a Lifeboat After Transport of COVID-19 Patients?
Updated: 21 April 2020

Recent reports indicate that the virus can survive on certain surfaces for as long as 72 hours, and it is therefore important that no lifeboats are placed back on general service prior to decontamination. 

It is advisable to remove as much equipment from the lifeboat as possible before transporting a patient. This reduces the need for decontamination afterwards. Following patient transfer leave doors and windows open so that sufficient air exchange may occur.

Maintain proper precautions when decontaminating:

- Wear gloves and surgical mask;
- Avoid touching your face while cleaning;
- Avoid exposing more people than necessary during cleaning;
- Wash your hands and face or take a shower when you’re finished;

19. What Supplies Are Needed for Decontamination?
Updated: 21 April 2020

- PPE for personnel performing the decontamination;
- Leak proof biohazard bags;
- Garbage bags;
- Spray bottles;
- Disposable rags;
- Alcohol based hand sanitizer;
- Absorbent towels;
- Bleach or alcohol-based cleaning solution or disinfection wipes.

20. What Precautions Should Be Taken During Disinfection/Decontamination?

Updated: 21 April 2020

All visibly soiled surfaces should be cleaned and then decontaminated starting from the ceiling of the vessel and working down to the floor in a systematic process. 

All surfaces that may have had contact with the patient or materials that were contaminated during patient care (e.g. Control panels, floors, walls, work surfaces, stretcher, rails, etc) must be thoroughly cleaned including the underneath and base of the stretcher. 

To conduct cleaning, providers should follow routine cleaning and disinfection procedures for pre-cleaning. This can be done with water and soap. This pre-cleaning must be followed by the application of a high-grade disinfectant to any potentially contaminated surfaces or objects.

Corona viruses have a lipid envelope which makes a wide range of disinfectants effective.

Disinfectant solution options include:

•  An EPA-registered disinfected that is labelled for emerging viral pathogens. These may have descriptions such as “[product name] has demonstrated effectiveness against viruses similar to COVID-19 on hard, non-porous surfaces. Therefore, this product can be used against COVID-19 when used in accordance with the directions for use against [name of supporting virus] on hard, non-porous surfaces.”;
•  Chlorine-based compounds (bleach, calcium hypochlorite, NADCC tablets) must be at least 0.1% (1000 ppm) for 10 minutes on a clean surface;
•  Alcohol-based compounds (isopropyl alcohol, ethyl alcohol) must be at least 60-70% alcohol by weight or by volume;
•  Regular household disinfectant containing 0.5% sodium hypochlorite (that is, equivalent to 5000 ppm or 1 part bleach to 9 parts water).

Ensure adequate ventilation especially when using chemicals. Doors should remain open while cleaning the vehicle. 

Follow contact times on labels of the products used.

If patient care equipment is reusable, it must be cleaned and disinfected according to the manufacturer’s instructions.


21. How Do We Decontaminate/Disinfect Equipment?

Updated: 21 April 2020

Disinfect the outside of any bags containing unused medical equipment as well as the stretcher.

PPE should be removed under supervision and placed into a final biohazard bag, which is then closed and disinfected.

Pre-Cleaning Technique

- First clean with dry techniques;
- Clean from clean area towards dirty and from "high" (e.g. on top of a cupboard) to "low" (e.g. a floor).
- Dry cleaning of the floor and other surfaces is sufficient if there are no spills or visible contaminations;
- Wet cleaning is necessary for adhering dirt and wet contamination, such as blood, urine and saliva.

Decontaminating the Survival Suit

While still wearing surgical mask and googles, clean the outside of the survival suit with soapy water, using a sponge. Pay special attention to neck cuffs that potentially have to be pulled over the wearers head. Rinse thoroughly with fresh water. 

Follow manufacturer’s instructions if further disinfection is required. 


22. What Do We Do with Waste, Following Decontamination?
Updated: 21 April 2020

All waste, including PPE and wipes, should be considered Category A infectious substances, and should be packaged appropriately for disposal.

- Linen should not be shaken. It should be contained and laundered according to standard operating procedures;
- Wash and disinfect linen: washing by machine with hot water (60-90°C) and laundry detergent is recommended for cleaning and disinfection of linens. If machine washing is not possible, linen can be soaked in hot water and soap in a large drum, using a stick to stir, avoiding splashing. If hot water not available, soak linen in 0.05% chlorine for approximately 30 minutes. Finally, rinse with clean water and let linen dry fully in the sunlight.
- All waste must be disposed of according to organisation protocols as well as local and national regulations for Category A infectious substances (best practice may be to transfer waste to the hospital for disposal).
- Additional cleaning methods may also be used, though are not required (e.g. ultraviolet germicidal irradiation, chlorine dioxide gas, or hydrogen peroxide vapor). However, these should not replace the manual disinfection.


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