Once training is complete, the CP may respond to a Health Authority or Primary Care Provider request for a maximum of a 4-hour period on regularly scheduled workday to assistance with COVID Testing of patients over age five. Referrals will follow one of two COVID Testing SOPs:
1. SOP 1 (Phase 1) Surge Support to a Health Authority Testing Center
2. SOP 2 (Phase 2) Home testing at the request of a Health Authority or designated Practice Provider.
This practice guideline will focus on the required clinical skills and knowledge required for COVID testing.
REFER to and FOLLOW the British Columbia Center for Disease Control (BCCDC) for best practice guideline for viral testing the Elsevier requirements, as mandated in the order.

Procedure

     1. OBTAIN
a. The necessary supplies, including PPE, testing materials, and if necessary, cooling materials, and transport materials. If intending on using self-performed gargle sampling, access to both methods should be available in case the patient has not properly prepared for the gargling method. A supply check list will be available for home-based testing (Phase 2).
b. The test requisition and confirmation the patient is at 5 years or older. If not connect with the referring provider/or testing site leader. Acceptable requisitions may be from BCCDC (paper) or the Health Authority (electronic).

     2. DON PPE for COVID 19 protection. BCEHS PPE Poster

     3. CHECK using 2 or 3 Factor–ID that the patient and requisition match. Add any missing requisition information to the requisition, such as the patients GP or NP for follow-up. Refer to PHSA Policy and BCEHS Policy

     4. EXPLAIN the purpose of the test and ASSESS patient’s /caregivers understanding of procedure and discuss any concerns the patient may have prior to COVID 19 Testing. This constitutes your verbal consent to proceed.
a. REFER to: COVID-19: Adult Viral Testing Guidelines for British Columbia
b. REFER to: COVID-19: Pediatric testing guidelines for British Columbia

     5. CHECK for test eligibility or contra-indications
a. Confirm the presence of COVID symptoms (this may have been done already at the testing site)
b. Complete the ILI screen for COVID symptoms
c. Confirm required preparations were accomplished: i.e.
   • Gargle tests requires one hour - no eating or drinking. If not properly prepared a nasopharyngeal swab may be substituted if no contraindications.
   • If nasal passages for the Nasopharyngeal swab are not blocked/ active epiglottitis (Figure 1).

     6. INVOLVE THE PATIENT
a. Nasopharyngeal swabbing is invasive, set up a system of notification if the patient finds it too painful to proceed.
b. Explain to Caregiver how they help with sample collection or positioning a child. Do a test gargle with young children.

     7. COMPLETE the appropriate TEST
a. Nasopharyngeal swab
b. Self-administered gargle for children and adults
c. Self-administered nasal swab (use of this test is pending)

     8. MANAGE any unintended consequences. (i.e. nasal bleeding)

     9. REVIEW with the patient/caregiver post testing
a. The need for Isolation and Home management for an isolated family member
   • BC COVID-19 Symptom Self-Assessment Tool for COVID-19
   • FAQ’s from patients

     10. PROVIDE patient/caregiver with any HA hand out materials

     11. VERIFY patient/caregivers understanding of:
a. Follow-up for COVID symptom health care.
b. How to obtain test results.
   i. If Positive Public Health Contact tracer will call within in 3 days (may be longer due to access to labs).
   ii. If Negative, the patient must contact their GP Or NP or review the BCCDC web site if they have no primary health care provider.

     12. DOCUMENT as directed by the Health Authority (Paramedics will document on all paper requisitions; HA will work to develop an alternative solution for computerized records such as the support of an administrator.

     13. LOCATE the specimen in the provided biohazardous sample container(s) in an appropriate temperature-controlled environment as directed by the HA requirements.

     14. TRANSPORT (applicable in Phase 2 Home Testing only): follow the guidelines for safe transport to a HA drop off site for transfer to a lab.

     15. COMPLETE iScheduler record including number of patients seen.

TESTING SPECIFICS:
     A. PPE
As per Work Safe requirements BCEHS will be conducting a Risk assessment for CP PPE use at HA authority testing sites, the assessment may result in a change of the PPE required, until then CPs will follow PPE requirement for COVID 19 which is known to meet or exceed the requirements. It is noted that BCEHS PPE requirements may differ from the Health Authorities.
CPs will follow the latest procedure for use PPE according to the latest BCEHS standard when doing Home visit testing.

     B. COVID TESTING
     INVASIVE NASOPHARYNGEAL SWAB:
 1. Inform the patient of the process of sampling, possible discomfort and a warning signal if the patient needs the paramedic to stop.
 2. Inspect the throat for evidence of Epiglottitis, if uncertain, invite an additional review by another Health Provider.
 3. Provide Kleenex to the patient to clear the airways.
 4. Insert the swab as per learning: Adult BCCDC video (A&P) and basic swab technique)
 5. Ensure specimen is secured and labeled as per Health Authority guidelines.
 6. Ensure there is no bleeding from the nose or pharynx.
 7. Document sampling time, etc. on requisition
 8. Store sample in the provided temp controlled storage. (Swabs are stable at room temperature for 24 hours.

     SELF Testing GARGLE SAMPLING: (Child or Adult)
 1. Assess for the patient’s compliance with 1-hour food restrictions.
If not compliant: inform the patient of the need to sample using the nasopharyngeal approach (see above).
 2. Review the gargle sampling process – ensure the patient understands not to swallow ANY sampling fluid. Young children may need a practice session first. Children's Hospital video
 3. Ensure specimen is secured and labeled as per Health Authority guidelines. This specimen must be kept at fridge temperatures. Place on an ice pack if any delay.
 4. Inform the patient of the timing and process of obtaining results (1 – 3 days; may vary by HA or sampling process).
 5. Provide a HA handout about results reporting if available.
 6. Document sampling time, etc. on paper requisition or request.
 7. Insert into bio/hazard bag or other appropriate storage devise.
 8. Store in provided temperature-controlled storage. Samples must remain at fridge temperatures.

     C. TRANSPORT TO LAB
In both Phases, it is the responsibility of the hosting Health Authority clinic to arrange for storage according to cold chain requirements and arrange for transportation to the appropriate lab.
In Phase 2 (Home based COVID testing), the related SOP will contain information regarding safe packaging for transport between the patient’s home and the HA drop off location.