Updated April 15, 2020
These contents have been adapted from the COVID-19 practice updates and created for your ease of use. They will be updated as new practice guidelines are released. Please refer to the complete guidelines within the linked document(s) for full detail.
We recognize that hospitals and Health Authorities have differing approaches and directives with regards to managing patients during the pandemic. Paramedics are asked to please follow BCEHS procedures whenever possible.
The ventolin MDIs and spacers have arrived and are being sent out to stations in a staged and rationed deployment. There are reports that the adult spacers are showing up with masks. We are following up with the supplier on the status of the adult bite sticks (mouth pieces). Paramedics are reminded the masks, spacers and MDIs are single use and should accompany the patient to the hospital. A training video can be found on BCEHS CPP YouTube Channel.
Due to the significant aerosolization risk of COVID-19, and in an effort to reduce exposure, BCEHS has restricted the use of nebulizing salbutamol (Ventolin), and ipratropium bromide (Atrovent).
Salbutamol Metered-Dose Inhalers (MDI) are being made available to all stations as soon as availability allows. Orders will be distributed on a prioritization basis: ACP and CCP stations; then high-volume PCP stations where ACP support is not available; and then other PCP stations.
If a patient presents with their own prescribed salbutamol MDI (puffers/soft mist inhalers), paramedics are able to use the patient’s own salbutamol MDI. Hospitals are experiencing similar shortages and delivery delays of MDIs. Please ensure when an MDI is used (BCEHS or patient’s own), it is transported with them to the hospital for further use.
Intranasal medication administration is now considered high-risk and is restricted to instances where absolutely necessary as a last resort. The following guidelines apply to all IN administration:
IN route in any patient with signs, symptoms or history of ILI or COVID-19 is now restricted.
Droplet PPE, including N95, must be donned prior to any administration
Crews are encouraged to avoid any use in aircraft, and if absolutely necessary, ensure pilots have donned appropriate PPE including N95.
The threshold for the administration of intra-muscular (IM) epinephrine has been lowered in order to provide further beta agonist therapy after treatment with metered-dose inhalers (MDI) in the absence of nebulizers.
IM epinephrine will now be indicated for treatment of asthma with:
• Moderate to severe symptoms unresolved with MDI administration
• Patient inability to inhale MDI due to bronchospasm
• Inability to comply with MDI due to hypoxia
Moderate to severe symptoms include:
• SpO2 <90%
• Increasing bronchospasm or silent chest
• Accessory muscle use
• Increasing shortness of breath (SOB) after treatments with MDI
• Decreasing level of consciousness (LOC)
If the patient is not improving or deteriorating after treatment with MDI or is unable to use an MDI, contact CliniCall to discuss IM epinephrine.
Paramedic specialists and secondary triage nurses utilizing the Manchester Triage Scale for secondary triage will be advising acetaminophen-use for suspected COVID-19 patients with fever. Until concrete evidence is presented to the contrary, it is reasonable to err on the side of caution and recommend against any new use of ibuprofen or other non-steroidal anti-inflammatory drugs (NSAID). Acetaminophen should be the first line recommendation for patients with pain or fever and based on current opinion, ibuprofen should be avoided
Administration of nitrous oxide is an aerosol generating medical procedure and if used, paramedics must wear droplet protection including an N95 mask and face shield.
Use a new, inline filter for each patient and instruct the patient to inhale and exhale through the mouthpiece and filter to reduce the risk of aerosol generation.