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.

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, including cardiac arrest, 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.

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,
  • new onset of cough,
  • worsening chronic cough,
  • shortness of breath,
  • difficulty breathing
  • sore throat,
  • hoarse voice,
  • difficulty swallowing,
  • decrease or loss of sense of smell,
  • chills,
  • headaches,
  • unexplained fatigue/malaise,
  • diarrhea,
  • abdominal pain,
  • nausea/vomiting,
  • Pink eye (conjunctivitis),
  • runny nose/sneezing without other known cause, or
  • nasal congestion without other known cause

• If the person is over 65 years of age, are they experiencing any of the following:
  • delirium,
  • unexplained or increased number of falls,
  • acute functional decline, or
  • worsening of chronic conditions

• What epidemiological factors are present:
  • close contact with anyone with acute respiratory illness in the past 14 days
  • travelled outside of Canada in the past 14 days
  • confirmed case of COVID-19
  • had close contact with a confirmed case of COVID-19

Paramedics should continue using the Ministry of Health’s Ambulance Call Report codes for COVID-19 patient screening. A patient who presents with conditions outlined in the screening tool is POSITIVE.

• 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)