UPDATED February 11, 2020
Familiarize yourself with guidance prepared by the Ministry of Health (MOH) and the Ontario Base Hospital Group - Medical Advisory Committee (MAC)
Training Bulletin 120: Novel Coronavirus (COVID-19) Updated Feb 11! Mainland China is now the travel history questioned in the Screening Tool.
Continue reading for more information on clinical guidance for paramedics.
Paramedics should screen all patients using the Ministry of Health’s COVID-19 Screening Tool available in Training Bulletin 120
MAC indicates in the Memorandum: Considerations for Paramedics Managing Patients with Possible Novel Coronavirus (2019-nCoV) that a positive screen to the Screening Tool represents an extenuating circumstance. Paramedics in this circumstance may not be able to provide all treatment that they’ve considered.
MAC has identified additional considerations for patients who screen positive to Screening Tool for the following interventions
Nebulized Medication Administration
Endotracheal Medication Administration
Endotracheal and Tracheostomy Suctioning
Use of CPAP
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-nCoV)” and the Ministry of Health’s “Training Bulletin 120: Novel Coronavirus (COVID-19)” 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 in the Training Bulletin. 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 who screen positive to the COVID-19 Screening Tool according to Medical Directives. The ALS PCS recognizes that in extenuating circumstances paramedics may not be able to provide all the treatments that they’ve considered. MAC considers a positive screen on the COVID-19 Screening Tool as an extenuating circumstance.
For patients who screen positive, you may need to adapt your care plan. MAC advises additional considerations for care in the following interventions where aerosolized pathogens may be a concern:
- Nebulized Medication Administration
- Endotracheal Medication Administration
- Endotracheal and Tracheostomy Suctioning
- Use of CPAP
See the MAC Memorandum: Considerations for Paramedics Managing Patients with Possible Novel Coronavirus (2019-nCoV) 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, coughing or difficulty breathing?
- What epidemiological factors are present: in the last 14 days, the patient has traveled to mainland China, has had close contact with a confirmed or probable case of novel coronavirus or has had close contact with a person with an acute respiratory illness who has been to mainland China?
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 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) .