We have not changed our clinical guidance since the release of the latest Paramedic Considerations memo from the Medical Advisory Group on May 6, 2020. Information about COVID-19 and clinical intervention on this site that is dated May 6, 2020 or later is valid until the release of new considerations.While new cases of COVID-19 have slowed, the RPPEO continues to follow MAC's prudent clinical guidance because it mitigates potential increased viral spread. Community spread of the virus is still happening. Public health authorities continue to urge measures that limit the spread of the virus while they are monitoring for its potential second wave.
Read MedicNEWS Issue 1.4 for May 18, 2020 to go into depth on COVID-19 issues important for paramedics.
As the pandemic progresses, the RPPEO will continue to promote the adaptation of clinical guidance as needed. The key considerations for us are paramedic safety and patient clinical needs. Evidence, including what has happened in other places or at different times, is what we are using to inform changes. The changes are coming in phases, based on the epidemiology of COVID-19 in our region and in Ontario.
We are very closely monitoring the pandemic. The RPPEO is looking to Public Health Ontario, the Ministry of Health and the Ontario Base Hospital Group - Medical Advisory Committee for their direction on clinical practice or moving to another phase of response. As soon as we have new guidance we will inform paramedics. If we find a need for specific guidance for our region - again, based on epidemiology and other factors in this region - the RPPEO's medical direction team is at the ready to provide clinical guidance for Eastern Ontario paramedics.
As always, we are counting on paramedics to provide the excellent, compassionate care that the public has come to expect. We realize that continuing to follow the Patient Care Standards while applying the additional considerations and medical direction is challenging. We are here to help. If you have any questions about the additional considerations issued to date, do not hesitate to reach out to us through MedicASK, by email or by calling.
We are answering paramedic questions as quickly as possible and updating answers regularly given the speed at which the pandemic is evolving.
Thank you for your commitment to paramedicine and your devotion to the patients who need our help during this exceptional time.
UPDATED May 13, 2020
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. Please read MAC's guidance for the complete list of considerations.
Paramedics should withhold the following interventions:
- 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
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.
CONSIDERATIONS FOR PARAMEDICS MANAGING PATIENTS WITH POSSIBLE NOVEL CORONAVIRUS (COVID-19) Revised at RPPEO May 12 (May 6)
TRAINING BULLETIN 120: NOVEL CORONAVIRUS (COVID-19) Last update April 8, 2020, to version 1.5.
COVID-19 SCREENING TOOL FOR PARAMEDICS Last update May 8
OUTIL DE DÉPISTAGE DU COVID-19 POUR LES AMBULANCIERS PARAMÉDICAUX Dernière mise à jour le 8 mai
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.
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:
- 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,
- unexplained fatigue/malaise,
- abdominal pain,
- 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:
- 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
Transfer of Care
For all patients receiving assisted ventilation by BVM, paramedics should briefly pause BVM ventilation while maintaining a tight face seal during the ED transfer of care.
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) .