IN BRIEF

Updated March 23, 2020 @ 18:00

The COVID-19 pandemic is an extenuating circumstance. Paramedics in this circumstance may not be able to provide all treatment that they’ve considered.

Paramedics should act as though all respiratory patients are COVID-19 positive while continuing to use the COVID-19 Screening Tool

For all patients with respiratory symptoms or where paramedics are considering respiratory interventions MAC has identified procedures that are deemed high risk for potential transmission of COVID-19. MAC gives these additional considerations and guidance which applies to all patients regardless of COVID-19 Screening Tool result:

Withhold Nebulized Medication Administration

Withhold Endotracheal Medication Administration

Withhold Endotracheal and Tracheostomy Suctioning via an endotracheal or tracheostomy tube unless using a closed system suction unit

Withhold Use of CPAP

Withhold tracheostomy reinsertion

Consider withholding intra-nasal (IN) and buccal administration of all medications when alternative routes exist.

Consider donning PPE for all airway procedures (BVM, SGA, etc) and all Cardiac Arrests.

Consider Paramedic Services communicate with local receiving facilities for pre-alerting the hospital if patient’s COVID-19 screen is positive.

Paramedics should continue to screen all patients using the Ministry of Health's COVID-19 Screening Tool for Paramedics

Continue reading for more clinical guidance for paramedics.

Familiarize yourself with guidance prepared by the RPPEO Medical Director, the Ministry of Health (MOH) and the Ontario Base Hospital Group - Medical Advisory Committee (MAC)

MEDICAL ADVISORY 2020-01: NEBULIZED MEDICATION ADMINISTRATION

CONSIDERATIONS FOR PARAMEDICS MANAGING PATIENTS WITH POSSIBLE NOVEL CORONAVIRUS (COVID-19)

TRAINING BULLETIN 120: NOVEL CORONAVIRUS (COVID-19)

BULLETIN DE FORMATION 120 : NOUVEAU CORONAVIRUS (COVID-19)

COVID-19 SCREENING TOOL FOR PARAMEDICS

OUTIL DE DÉPISTAGE DU COVID-19 POUR LES AMBULANCIERS PARAMÉDICAUX

Clinical Guidance for paramedics on 2019 novel coronavirus

Please read the Ontario Base Hospital Medical Advisory Committee’s “Memorandum: Considerations for Paramedics Managing Patients with Possible Novel Coronavirus (2019-COVID-19),” the Ministry of Health’s “Training Bulletin 120: Novel Coronavirus (COVID-19),” and the Ministry of Health's COVID-19 Screening Tool for Paramedics for all the details.

For current information about 2019 Novel Coronavirus, visit Public Health Ontario.

PATIENT ASSESSMENT

For each patient, one paramedic should approach and use the COVID-19 Screening Tool. The result of this screening will help you orient your infection control precautions and care approach.

The COVID-19 Screening Tool is a simple question and answer algorithm for paramedics that combines clinical and epidemiological information to identify patients whose condition should be investigated for 2019 novel coronavirus. It is based on the case definition from the Public Health Agency of Canada.

A positive result to the screen means that the patient is a Person Under Investigation for COVID-19.

Note that Central Ambulance Communication Centres are screening callers for 2019 novel coronavirus.

TREATMENT

Paramedics should continue to care for all patients including those with respiratory symptoms according to Medical Directives, except where special guidance is given. The ALS PCS recognizes that in extenuating circumstances paramedics may not be able to provide all the treatments that they’ve considered. MAC considers the COVID-19 pandemic as an extenuating circumstance.

For patients with respiratory signs or symptoms, you may need to adapt your care plan. MAC advises additional considerations and guidance for care in the interventions where aerosolized pathogens may be a concern.

See the MAC Memorandum: Considerations for Paramedics Managing Patients with Possible Novel Coronavirus (COVID-19) for more information.

NOTIFICATION

When caring for patients who screen positive, paramedics should notify the receiving facility that the incoming patient screened positive on the 2019 Novel Coronavirus Screening Tool.

Paramedics may also indicate, or the emergency department may ask for, the following summary information:

Which clinical symptoms are present: fever, coughing or difficulty breathing?
What epidemiological factors are present:
1. the patient received public health or medical advice to self-monitor or self-isolate OR
2. in the last 14 days, the patient either
  1. traveled outside of Canada,
  2. had close contact with a confirmed or probable case of novel coronavirus OR
  3. had close contact with a person with an acute respiratory illness who has traveled outside of Canada

DOCUMENTATION

Paramedics should now be using the Ministry of Health’s Ambulance Call Report codes for COVID-19 patient screening.

Miscellaneous Procedures - “407.02 - COVID-19 Screening POSITIVE”
Miscellaneous Procedures - “407.03 - COVID-19 Screening NEGATIVE”

Documentation of your clinical and epidemiological findings and considerations is always very important. Include information about extenuating circumstances such as respiratory symptoms, a positive screen for COVID-19 or the considerations that led to your assessment and treatment in the Remarks section of your ACR. This is especially important if you modify care from that in the Medical Directives.

As a reminder, you should also document on your ACR what routine practices and additional precautions you used. Guidance on infection prevention and control is available in the Training Bulletin and in version 2.2 of the Patient Care and Transportation Standards (PCTS) .