Last update: February 22, 2021

On February 22, 2021 the Medical Advisory Committee (MAC)released the memo Considerations for Paramedics Managing Patients during the COVID-19 Pandemic.. This memo includes several updates to clinical practice that MAC outlines in this Summary of Changes memo.

Information about COVID-19 and clinical intervention on this site that is dated February 22, 2021 or later is valid until the release of new considerations.

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 February 22, 2021

In brief

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 consider withholding the following interventions:

• Nebulized Medication Administration
• Endotracheal Medication Administration
• Endotracheal and Tracheostomy Suctioning via an endotracheal or tracheostomy tube unless using a closed system suction unit
• 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 During the COVID-19 Pandemic Revised February 22, 2021

TRAINING BULLETIN 120: NOVEL CORONAVIRUS (COVID-19) Last update October 1, 2020 to version 1.6.

COVID-19 SCREENING TOOL FOR PARAMEDICS  Last update June 17, 2020

OUTIL DE DÉPISTAGE DU COVID-19 POUR LES AMBULANCIERS PARAMÉDICAUX Dernière mise à jour le 17 juin, 2020

Clinical Guidance for paramedics on COVID-19

Please read the Ontario Base Hospital Medical Advisory Committee’s Memorandum "Considerations for Paramedics Managing Patients During the COVID-19 Pandemic,” 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 COVID-19, 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.

Note that Central Ambulance Communication Centres are screening callers for COVID-19.

Treatment

Paramedics should continue to care for all patients including those with respiratory symptoms 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 the COVID-19 pandemic as an extenuating circumstance and provides additional guidance for paramedics managing patients within these circumstances.

For patients with respiratory signs or symptoms, including cardiac arrest, paramedics may need to adapt their care plan. MAC advises additional considerations and guidance for care in interventions where the paramedic risk of exposure to the virus is increased.

See the MAC Memorandum: Considerations for Paramedics Managing Patients During the COVID-19 Pandemic 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 COVID-19 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,
  • difficulty swallowing,
  • decrease or loss of sense of taste or smell,
  • chills,
  • headaches,
  • unexplained fatigue/malaise/muscle aches (myalgias)
  • nausea/vomiting,
  • diarrhea,
  • abdominal pain,
  • Pink eye (conjunctivitis),
  • runny nose/ nasal congestion without other known cause

• If the person is over 70 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:
  
  • travelled outside of Canada in the past 14 days
  • had close contact with a person with a confirmed case of COVID-19 while not wearing adequate PPE

Transfer of Care

For all patients receiving assisted ventilation by BVM, paramedics should consider briefly pausing BVM ventilation while maintaining a tight face seal during the ED transfer of care.

Documentation

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 the Patient Care and Transportation Standards (PCTS) .