Survey response rate & pattern

Survey responses were provided by 10 of the 31 RCMSAR and 23 of the 78 BCSARA local stations (overall 30.3% response rate). The province is divided into 6 regions by Emergency Management BC (see map, https://www2.gov.bc.ca/assets/gov/public-safety-and-emergency-services/emergency-preparedness-response-recovery/embc/embc_regional_office_map_by_regional_district.pdf). Responses were received from local stations in large urban and smaller rural locations throughout all six regions.

Survey answers

Except for eye protection (face shield or safety goggles), all had PPE protective against all routes of COVID-19 transmission initially thought possible (Tables 1–3). However, volunteers differed from professionals in mask selection criteria (Tables 4 and 5). Also, not all SAR stations have replaced latex with nitrile gloves, unlike hospitals, which started replacing latex as an allergy safety issue about 25 years ago.

Table 1. Proportion of stations equipped with personal protective equipment (PPE) items and how they were procured

Note. Percentages total more than 100 because many stations used more than 1 source of acquisition to procure any given item type. Denominators are doubled for respiratory protection and skin protection because these items’ numerators are tallied from 2 separate variables (surgical & N95 masks; latex & nitrile gloves).

Table 2. Extent to which stations had surgical masks and/or N95 respirators

Table 3. Extent to which stations had latex and/or nitrile gloves

Table 4. Criterion for selecting to wear surgical mask vs. N95 respirator

Table 5. Criteria among stations that reported having both surgical & N95 masks

Beyond BCSARA and RCMSAR, COVID-19 information was available from the Provincial Health Officer, the BC Centre for Disease Control (BCCDC), the Public Health Agency of Canada (PHAC), and elsewhere (Figure 1). Differences in distribution of rankings by BCSARA versus RCMSAR (Figure 1) are not statistically significant (p > 0.05, normal approximation to Wilcoxon rank sum test with Bonferroni and Finite Population Correction Factors applied). ^{Reference Anderson, Sweeney and Williams3,Reference Remington and Schork4} Reasons given for considering some more helpful than others include being issued in sufficiently timely manner, containing up-to-date information and coming from a reputable source; clarity; having content specific to SAR activities (although one commented it was not clear whether documents labelled as advisories were mandatory or simply recommendations); and ease of access (“push” modalities like emailed updates and television broadcasts favored over “pull” modalities like having to visit websites). Some commented that monitoring websites is not only time-consuming but also could be subject to individual interpretations. Headquarter mailings were, by far, the source most frequently reported by station leaders and always shared with their members. Update information from health officers was also watched less consistently but still relatively frequently. Health officer updates broadcast often (relating weekly case counts and trends, periodically announcing new precautions), while headquarter update frequency was intermittent (issued only when it was deemed necessary to announce changes in precautionary SAR practices), so it is not surprising that more respondents reported sharing all headquarters updates with their members versus sharing health officer information only if it contained important changes.

Figure 1. Perceived utility of various information sources.

Among the 33 responses, 20 provided a usefulness ranking for “other” source(s) of guidance (the other 13 left that line blank). Within those 20, 8 ranked “other” sources as highly useful (scoring as 1–3); 6 of the 8 identified use of news media, local healthcare professionals or their regional health authority, an epidemiologist, or foreign websites (CDC, WHO); the remaining 2 did not identify any “other” source as having been used. Thus, of the 6 identifying the use of specific “other” sources, 50% rated them as highly useful. At the other extreme, 9 of the 20 ranked “other” sources as least useful (scoring at 6–8), 2 indicating using information shared from other workplaces; however, 7 indicating no other source was actually used. Among all 20, the most common other sources used (listed from most to least frequent) could be classified as:

1. 1. Local, regional, or national broadcast news [22%];

2. 2. Other workplace policies (e.g., local hospital, other industry) [18%];

3. 3. Regional health authority [18%];

4. 4. Internet websites (government agencies, social media) [18%];

5. 5. Local healthcare professional (e.g., doctor, nurse, health & safety specialist) [15%];

6. 6. Communication with neighboring SAR teams [4%] or an epidemiologist on staff [4%].

Only one instance was sharing information between local stations mentioned, and there was no indication of BCSARA or RCMSAR headquarters enlisting advice from the few infectious diseases epidemiologists identified by local stations.

Regarding COVID-19 impacting operational readiness, constraint of training was a common refrain. Several mentioned this delaying attainment of advanced specialization certification and making it more difficult to maintain communication, morale, proficiency, and/or recruitment. Some used virtual modalities when in-person training was prohibited; while some virtual sessions may have been recorded for future use, there was no indication of sharing archived locally produced resources outside of individual stations. Fifty-four per cent of respondents reported no loss of active members due to pandemic concerns; others reported from 2% to 25% loss due to individual concerns about personal risk, someone contracting COVID-19, or, in a few cases, refusing to divulge vaccination status or frankly expressing anti-vaccine and anti-masking behavior. In some, this resulted in losses among the limited number of leadership-level team members. Dedicated volunteers enabled the vast majority of local stations to remain available for all emergency taskings throughout the pandemic, although some noted having to respond with fewer than the usual size crew on SAR missions. Only 12.1% had to stand down at times, being unavailable for periods ranging from 1 day (2 stations), a couple of weeks (one station), to months (one station).

Presuming our respondents are representative of all BC’s local volunteer SAR stations, these estimates can be made for percentages among all 109 local stations across the province (95% confidence interval calculated by Poisson ^{Reference Hanley and Lippman-Hand5} or binomial approximation, with Finite Population Correction Factor ^{Reference Anderson, Sweeney and Williams3} applied):

• Able to remain in service without interruption: 79%–97%

• Having PPE including eye protection (goggles or visors): 67%–90%

• Having PPE including skin protection (disposable gloves): 92%–100%

• Having PPE including respiratory protection (disposable masks): 92%–100%

• Using PPE in a manner consistent with professional counterparts: 0%–13% (due to inconsistencies in eye protection; recognition of aerosol-generating procedure as reason to switch from surgical to N95 mask; replacement of latex with nitrile gloves).

Comparison of BCSARA, RCMSAR, & professional first responder update documents

On 11 March 2020 BCSARA and on 12 March 2020 RCMSAR initially alerted their members. Within a few days, the 2 organizations diverged on information sources (both relying on provincial websites oriented for the general public, RCMSAR also taking Canadian Coast Guard circulars, only BCSARA citing the provincial update website dedicated to keeping emergency first responders informed). BCSARA and RCMSAR also diverged in emphasis (one quicker to prohibit large or non-essential gatherings; one quicker to encourage stockpiling essential supplies in recognition of coming supply chain disruptions; etc.). One organization seemed, early in 2020, to mandate wearing a mask when in close face-to-face contact (as in rendering first aid) as standard operating procedure while the other encouraged mask usage when social distancing cannot be maintained but initially stipulated that it remained a personal choice (later changing usage to a station-level choice until months later changing it to a headquarters-level universal requirement for all personnel). National shortages of medical grade masks prompted hospitals and ambulance services to develop instructions for safe storage and individual reuse of disposable N95 masks by their professionals; conversely, volunteer SAR members received instruction to not reuse masks. As mutant virus variants of concern arose and understanding of transmission dynamics grew, periodic infection prevention advisory updates were issued by federal and provincial officials in public health and other government agencies. Nongovernmental organizations, like BCSARA and RCMSAR, contextualized these updates in notices for their members. British Columbia Search and Rescue Association and RCMSAR’s updates differ in format. British Columbia Search and Rescue Association each address 1 specific topic (e.g., mask use) or audience (e.g. incident commander); RCMSAR duplicate the previous comprehensive coverage of all topics, with section headings indicating date of an update to that individual section. Table 6 summarizes the crux of all these updates in the order they were issued.

Table 6. Timeline of infection prevention guidance document revisions and updates

On 13 February 2020, the Canadian Coast Guard instructed its crew members when boarding vessels in response to medical distress to wear an N95 mask (and implies fit testing) plus place a surgical mask on the patient among airborne & contact precautions to be taken. ⁶ On 19 March 2020, because of COVID-19 concerns, BC licensed paramedics were instructed to wear “airborne PPE” including N95 mask and face shield when performing cardiopulmonary resuscitation (CPR) and cover the patient’s face with a surgical mask or viral-filter-equipped airway management device. On 22 March, they were cautioned to “use the lowest oxygen flow rate possible to achieve a SpO₂ of 90” and on 23 March 2020, their emergency call takers were instructed to “advise the public to provide hands-only CPR for adults in cardiac arrest and to cover the patient’s mouth and face.” ⁷ On 1 April, professional first responders were instructed to “perform compression-only CPR and defibrillation as necessary with no oxygenation or airway management until paramedics arrive” (memo from BC Emergency Health Services Chief Medical Officer to The Fire Chiefs Association of BC, https://fcabc.ca/index.php/covid-homepage). Volunteer SAR first responders received no such advice from their organizations to change from full CPR to chest compression only (likely because those organizations assumed their contracted first-aid training providers would intercede).

Neither BCSARA nor RCMSAR volunteers were designated with official emergency first responder status by the provincial government (personal communications, BCSARA, & RCMSAR). There was no communication or requests for information between these 2 volunteer SAR organizations and the Provincial Infection Control Network of BC (personal communications, PICNet). Thus, neither had official direct connections to channels of information that regularly provide infection control advice to the province’s professional first responders and healthcare professionals.