CPG R07: Patient Disposition
Created: April 14th, 2020
The role of paramedics around the world is shifting away from transporting all patients and moving towards an “Assess, See, Treat and Refer” (ASTAR) model for appropriate 9-1-1 calls. The BCEHS Influenza-Like Illness (ILI) clinical practice guidelines supports paramedics in identifying patients who may be suitable for continued care within their own home using a combination of thorough assessment, shared decision-making and appropriate safeguarding measures.
Patients with ILI/COVID MAY be eligible for care within their own home if they are between the ages of 17 and 60, have no ‘red flag’ symptoms, no single NEWS2 score of 3 and have a total NEWS2 score of 3 or less.
The ASTAR approach to care does not replace paramedic clinical judgement and transport should still be provided if there are reasonable concerns or doubts about the nature of the patient’s condition, patient or caregiver ability to seek further assistance and any other factors of concern to the paramedic
Consultation with CliniCall is an essential component of this Clinical Pathway to ensure appropriate safeguarding and follow-up, as required
Where patients do not have access to simple analgesics such as acetaminophen, it may be appropriate for paramedics to provide a single dose on scene prior to discharge from care
A NEWS2 score MUST be recorded on the ePCR to support the clinical decision making process employed during patient care
The patient, or their substitute decision maker, should display competency and capacity to provide informed consent, and to be eligible to be included in the ILI Clinical Pathway
ILI Clinical Pathway is for use by PCP, ACP and CCP.
NEWS2 Score of equal to 3 or less in total and no single NEWS2 score of 3
NEWS2 score between 4-6
Total equal to 7 or more
Suitable for clinical pathway consideration
Convey to Emergency Department
Convey to Emergency Department with Hot Response
Patients who paramedics deem that they may be eligible for inclusion in the ILI Clinical Pathway, MUST be referred through the CliniCall service
Use BCCDC Screening tool as part of initial screen
Red-Flag concerns in all ILI patients may include:
Severe dyspnea whilst at rest
Pain or pressure in the chest
Cold, clammy, pale or mottled skin
Altered mental status
Little to no urine output
A systems-based assessment should be recorded within SIREN, including systems such as the Nervous, Respiratory, Cardiovascular, Gastrointestinal, Urinary, Musculoskeletal, Integumentary and Immune Systems
Patients and/or caregivers should be provided with sufficient discharge advice to be able to identify potential deterioration in condition and act accordingly. This should be documented in the care planning section of SIREN.
Unable to practice with clinical guideline or Clinical Pathway
Able to practice guideline and use pathway.