Goggles or Face Shields:
Obviously, certain outdoor activities already require eye protection, which can be repurposed as PPE in a pinch. Those who wear glasses already have some protection, though not as much as wrap-around goggles. Sunglasses are also usually on hand and useful in daylight. It can be very difficult to convince people who don’t wear glasses of the need for clear lens eye protection, but this offers the dual function of BSI and protection from corneal abrasions.
Fogging eyewear is annoying and may even hinder operations to the point where you must weigh the risks and benefits of wearing both mask and goggles at the same time. Anti-fog spray, gel, or wipes might help but often don’t completely solve the problem. In some cases, the best option may be to wear a mask and goggles while engaged in direct patient care, then removing one while moving. As with everything, the mission dictates what you end up doing. For example, during a search & rescue operation on a hot, humid day, one of the authors wore a mask and clear lens glasses during direct patient care, then took off the perpetually fogged glasses while hiking about six feet away from others. On another mission, as the passenger on an ATV during a night SAR, the author reported that it seemed more important to protect their eyes from tree branches, so they lowered the mask while riding.
A gown is simply a barrier impermeable to droplets, so is easily improvised. One park ranger we worked with had a small rain poncho packed on top of her first aid kit to use if needed. Another mountain rescue expert packed a painter’s tarp—cheap, light, and with a large surface area that packs small—as a waterproof layer to pack hypothermic patients for litter transport. This could also be repurposed as PPE. During the COVID-19 peak earlier this year, some nurses who had run out of proper PPE resorted to wearing trash bags. Finally, rain jackets could be used if necessary. Keep in mind that your shell is likely one of the more expensive items in your pack, and that you won’t want to question whether it’s contaminated once the rain starts.
How do we replicate isolation rooms? The first step is to do what we’ve known for the last 6+ months: social distancing, six feet apart or more. To apply this to a wilderness setting, let’s say you are on a SAR mission and make contact with a lost and injured hiker. Size up the scene from at least six feet away. I remember seeing a doctor stand outside a patient’s room and pronounce, “LGFD!” I looked at him questioningly and he explained, “looks good from door.” This is the “Sick or Not Sick” label we are all familiar with.
From this distance you can ask the patient the basic screening questions, “Fever, cough, shortness of breath?” and ask them to put on a mask. Avoid enclosed areas with patients who are sick. Don’t go into a shelter or tent to evaluate a patient. If there happens to be a breeze, try to position yourself upwind of the patient, especially if they have concerning symptoms (NOLS Wilderness Medicine, June 2020). Finally, if you are working in a team, assign one low-risk team member to take the lead on direct patient care.
There are some elements of PPE that can be improvised and some that we simply must bring. Our own awareness, and even simply adjusting our initial assessment position to maintain a bit more distance, can be excellent protection from COVID-19 and other infectious diseases. Ultimately what we use and when depends on the mission at hand, and the context in which we are practicing.