POC Urinalysis

Paramedic practice in Ontario is regulated by the Regulations under the Ambulance Act consistent with the Advanced Life Support Patient Care Standards (ALS PCS), and the Basic Life Support Patient Care Standards (BLS PCS).

Point-of-care (POC) testing, such as urinalysis, are not authorized for use under the current standards and regulatory framework, regardless of the patient's CTAS level. These tools are primarily used to support the conveyance of a medical diagnosis, such as urinary tract infection (UTI) or diabetic ketoacidosis (DKA), which falls outside of the paramedic scope of practice currently in Ontario. As such, Paramedics are not permitted to convey a diagnosis unless delegated under the standards or Patient Care Model, as diagnosis is considered a controlled act under Ontario’s Regulated Health Professions Act.

In addition, test results obtained from these tools require clinical interpretation and follow-up by a regulated health care practitioner, which is not available in the 911 prehospital setting. Without an appropriate care pathway for follow-up and management of results, the use of such tools introduces potential risks without providing clinical benefit within the current scope and structure of paramedic practice.

Paramedics would further need to be trained in how to interpret the results, and importantly, how to counsel the patient about what the results mean. This is not without risk. Let’s use your scenarios as examples.

In the context of using urinalysis for rule in/out UTI: treating a UTI based on a +ve urine test without appropriate urine culture to follow-up would cause significant issues in the determination of alternative treatment in cases of failure to treat. Furthermore, the risk remains that if asymptomatic bactiuria mistakenly becomes treated more often than necessary, it will result in higher resistance patterns in the area in the long run. Moreso, whether the test is +ve or –ve, it could distract from the core complaint or create a tunnel vision in the DDX of a patient presenting with vague abdo symptoms, ambiguous GU complaints or fever - having an impact both on the prehospital management and on the arrival and triage once in the ED.

In the case of suspicion of DKA the treatment in the prehospital or ED settings remains the same whether we have the results of POC testing or not. Fluids, fluids, fluids. The administration of IV insulin cannot be started or accelerated before a VBG is also obtained to interpret the Ph and potassium and make adjustments or additions to the treatment. So here too, there would not be a frank added value.

Ultimately, paramedics are encouraged to use thorough assessments and history-taking to inform clinical impressions and transport decisions, while avoiding tools or procedures that fall outside the approved scope of practice