Latest MAC COVID-19 Considerations Memo

21 October 2021

On October 19, 2021, the Medical Advisory Committee (MAC) released an update to the memo Considerations for Paramedics Managing Patients during the COVID-19 Pandemic. Paramedics should familiarize themselves with the memo since it contains important changes.


  • MAC removed previous advice about nebulisation since the Advanced Life Support Patient Care Standards already speak to the pandemic context we are in. The ALS PCS explains in the Bronchoconstriction Medical Directive that, during a declared febrile respiratory illness outbreak, nebulisation is contraindicated.
  • The brief temporary pauses previously suggested for CPR inside congregate living areas or hospitals have been removed. Compressions during CPR are not considered Aerosol Generating Medical Procedures (AGMP) and therefore the COVID-19 risk to providers and bystanders is low.
  • Considerations specific to the Croup Medical Directive are removed. Again, nebulisation is contraindicated during the pandemic.

When paramedics are in a situation where they would normally provide what is considered in the pandemic context to be higher risk interventions, paramedics should assess whether risks of viral transmission for themselves and others in proximity outweigh the benefits of intervention. Depending on the risk mitigation strategies that paramedics are using (PPE, vaccination status, treatment in ventilated area, etc.), treatment such as nebulisation or CPAP may be appropriate.

When using treatments that are currently considered contraindicated or those that have increased risk as AGMPs, it is important to note on the ACR how your point of care risk assessment indicated the intervention. Paramedics are encouraged to consult with a base hospital physician when there is uncertainty in the risk assessment or treatment,

Should you have any practice-related questions about the latest memo, we invite you to submit them through MedicASK. Note also that our COVID-specific Q&A forum, while no longer in regular use for new questions, has been updated to reflect this most recent memo. The responses you'll find there or in MedicASK are up to date.

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