About & Disclaimer

this Guide

The purpose of this guide is to provide a unified step by step guide to personnel in rural regions for implementing changes to Facilities, Staff and Procedures for the COVID-19 outbreak. This guide recognizes the reality of working with limited resources in austere environments.

For Whom:

Public Health, MDs, Nursing, Administration and staff who are reorganizing and working to get Rural facilities and communities ready.


Unlike a Code Orange Mass Casualty Incident (MCI), a Pandemic is a Long Term Event. Things do not change for a few hours and then return to normal. The infectious component necessitates urgency and being Proactive.

If you are Reacting in a Pandemic - you are too slow, and too slow is dead.

This document is longer than I would like and I disdain long documents. But it’s length is based on this:

You will have to fundamentally reorganize EVERYTHING you do.

This guide is designed to break your work planning down into concepts that you can then apply locally with your particular realities of infrastructure and resources.


While this Guide was created from a specific rural region, it is designed to be adaptable by any village or city with your own local knowledge. Much of this is based on precaution and past epidemic experience until evidence accumulates.

Public Health has a role but they need your help. This is a societal issue. You must be aware of what is happening Outside your community, Inside your community & Inside your facility.

  • Address or mitigate all factors and work with other community organizations.

  • Things done poorly outside the facility will lead to it being overrun too quickly.

By Whom:

Medical providers with decades of experience in rural, emergency and overseas medicine.

Thanks to Colleagues at numerous hospitals and facilities.

About Us

This Guide was developed primarily by :

  • an MD with extensive rural & International experience, who became very concerned with the slow response to planning for the pandemic.

  • Colleagues who have firsthand experience in the Congo Ebola outbreak; Rwanda post genocide; India.

  • China & Western Africa colleagues who were consulted.

  • Emergency medicine MD’s and nurses.


This document describes measures and processes related to the COVID-19 crisis being adopted in a facility in proximity to the Authors.

The measures presented here may not be applicable to your environment and may not describe the best course of action for you. Use your professional experience and judgement when considering its applicability to your reality.

There is no evidence for much of what is written. It is based on experience, opinion, Level 3 evidence, and changing as we go. Remember though - absence of evidence is not evidence of absence. No one has studied the effects of not using a parachute when jumping from a plane. It is still a good idea to use one.

Please consult and discuss with your local Healthcare leadership when in doubt or as needed. We’re doing our best and learning as we go. Updates are done as often as possible as clinical work is still the top priority.

Disclaimer of Liability

The Authors of this document are not subject to any Liability to any person, moral person or property arising from any injury or consequence related to the use of, communication, transmission or implementation of any aspect of this document. No person is entitled to receive any damages of any kind.

The Authors of this document make no representation with respect to accuracy, effectiveness, quality of protection or level of preparedness described by any aspect of this document.