The Regional Paramedic Program for Eastern Ontario (RPPEO) has released a Clinical Bulletin on Measles Management, developed in response to the 2025 Ontario measles outbreak.

This Clinical Bulletin reflects collaboration with paramedic services across Eastern Ontario, with particular thanks to the Ottawa Paramedic Service for providing valuable feedback on infection control and transport practices.

Measles is a highly infectious disease transmitted in the air. 

The bulletin focuses on core best practices in suspected measles, including:

• Early recognition and patient masking
• Use of appropriate airborne precautions PPE, as outlined by your paramedic service
• Timely and effective hospital notification to minimize system disruption
• Operational reminders about running the ambulance’s internal exhaust system during and after transport, in outdoor areas only

These elements are recommended for any scenario where airborne transmission of infectious disease, such as measles, is suspected. 

Reminder on Infection control

Paramedics should be familiar with your paramedic service's policies and procedures on infection control. These are developed in consultation with provincial guidance including:

• Public Health Ontario – Routine Practices and Additional Precautions

• Ontario Ministry of Health – Patient Care and Transportation Standards (PDF)

Routine Practices

Routine Practices are the standard infection prevention and control measures applied to all patient care, regardless of suspected or confirmed infection status. They include:

• Hand Hygiene: Perform before and after patient contact, after contact with potentially contaminated surfaces, and after removing gloves.

• Personal Protective Equipment (PPE): Based on a point-of-care risk assessment, select appropriate PPE to prevent exposure to blood, body fluids, secretions, excretions, mucous membranes, non-intact skin, or contaminated equipment. This may include gloves, gowns, masks, and eye protection.

• Environmental Controls: Implement measures such as proper cleaning and disinfection of equipment and surfaces, safe handling of sharps and waste, and appropriate patient placement.

• Administrative Controls: Ensure policies and procedures are in place for infection prevention and control, staff education, and monitoring compliance.

Airborne Precautions

Airborne Precautions are additional measures used for patients known or suspected to be infected with pathogens transmitted by the airborne route (e.g., measles, tuberculosis). They include:

• N95 Respirator: Wear a fit-tested, seal-checked N95 respirator when entering the patient care area.

• Patient Placement: Place the patient in an enclosed room with the door closed. Hospitals may place patients in an airborne infection isolation room (AIIR), if available.

• Patient Transport: Limit patient movement outside a defined space. If transport is necessary, have the patient wear a surgical mask to minimize dispersal of infectious droplets. Inform the receiving hospital of the incoming patient suspected to have infectious disease (i.e., measles)

• Additional PPE: Depending on the situation and risk assessment, additional PPE such as gloves, gowns, and eye protection may be required.

It is important to note that PPE requirements may vary based on the specific clinical situation and the results of a point-of-care risk assessment. Healthcare providers should always assess the risk of exposure and select appropriate PPE accordingly.

The Clinical Bulletin on Measles Management is now posted in the RPPEO Clinical Bulletin Library and can also be accessed directly here: RPPEO Clinical Bulletin on Measles Management.