See all changes below within the documents contained on the intranet here.
This update is intended to provide ACPs with information about the recent changes to advanced airway management during COVID-19.
To further protect paramedics and patients from potential asymptomatic carriers, effective immediately, BCEHS requires paramedics to wear a face shield in addition to a procedure mask and gloves for all patient contacts. In addition, because the exhalation valve on elastomeric half face respirators (EHFR) is not filtered, effective immediately, paramedics are required to wear a procedure mask over the EHFR exhalation port in order to protect patients, caregivers and our colleagues.
A point of care risk assessment is used to determine the risk of COVID-19 and Influenza Like Illness (ILI). In situations where there is a negative screen, paramedics can revert to standard PPE as per the BCEHS Exposure Control Plan. Based on this risk assessment, paramedics will have the option of wearing a procedural mask and following routine practices and any additional precautions as per the Exposure Control Plan for non-COVID-19 specific reasons. A comprehensive frequently asked questions document was posted on October 1, 2020.
BCEHS is endorsing the CAEP guidelines that recommend that patients transported to hospital without return of pulses, despite efforts of resuscitation by paramedics, should be assessed in the ambulance bay at the emergency department by a physician wearing appropriate PPE.
ACP/CCP: Needle Thoracentesis Aerosol Generating Medical Procedure (AGMP) (Resuscitation)
Prehospital needle thoracentesis should be considered AGMP. If this procedure is needed, crews are directed to proceed with full PPE including face-shield, N-95 mask, gown and gloves.
ACP: Advanced Airway Management Video (Airway Management)
BCEHS Learning has produced a video on best practices for tracheal intubation in the setting of the COVID-19 arrested patient using video laryngoscopy.
ALL: COVID-19 Updates to Siren (Communication)
On Wednesday April 29 an update was released to Siren which includes important changes around COVID-19 documentation. When logging into Siren, you will receive a prompt to install the update; please ensure you follow the instructions to install the release.
To assist paramedics in easily locating content on the BCEHS Clinical & Professional Practice YouTube Channel during the pandemic and beyond, a number of playlists have been created for easy reference. These channels include Education, COVID-19, Lecture Presentations and Clinical Rounds.
ALL: i-Gel ® Tips, Tricks and Troubleshooting Video (Airway Management)
Our paramedic practice educators have put together a short video outlining tips and tricks for the i-Gel ® as well as advice around troubleshooting the rare occurence of a poorly performing device
ALL: Dofficer Checklist (Personal Protective Equipment)
BCEHS Learning has developed a PPE Doffing Checklist.
ACP: Advanced Airway Management in Cardiac Arrest during COVID-19 (Airway Management)
The procedure of tracheal intubation places the paramedic at very high risk for exposure to the virus and is therefore only indicated only when an SGA is not effective.
In cases where effective ventilation and oxygenation cannot be achieved with a SGA, and where two-person bag-valve-mask technique may not be suitable, tracheal intubation can be considered using video laryngoscopy (VL), when it is safe to do so.
ALL: Approach to Pediatric Cardiac Arrest - COVID-19 (Resuscitation)
To ensure a consistent and safe approach to pediatric cardiac arrest during the COVID-19 pandemic, a guideline has been produced for all staff potentially involved
ALL: COVID-19 Cardiac Arrest Checklist (Resuscitation)
To provide support to paramedics managing cardiac arrest an updated cardiac arrest checklist is now available in the BCEHS Handbook which will assist in improving team situational awareness, leadership, and communication during the resuscitation.
ALL: BVM-Only Airway Management (When an SGA is unavailable) (Airway Management)
As a reminder for crews where a supraglottic airway is not available (FR/EMR), crews are asked to take several steps, listed in the linked practice update.
ALL: Safe Care of Deceased Persons (Responder Safety)
Recommendations on safe handling of deceased persons, based on current guidance from the BCCDC which apply to ALL patients who undergo recognition of life extinct (ROLE) on scene.
ALL: Covid-19 Patient Exposures & Contact Tracing (Responder Safety)
Please view the short video explaining the processes for paramedic COVID-19 exposure tracing and positive staff testing.
ALL: MDI Spacer Update (Medications & Drug Administration)
Update on the arrival of MDI spacers & their use.
PCP: iGel Suction Port Practice Update (Airway Management)
PCPs are now permitted to use a modified approach to the in-built suction port available on all iGel supraglottic devices to provide pharyngeal suction during cardiac arrest. Specific indications and cautions are outlined in the full update linked above. The clinical procedure can be found here.
ALL: PPE Requirements in Postnatal Care (Personal Protective Equipment)
Recommendations on how to mitigate risk of asymptomatic transmission to neonates after birth.
ALL: Aerosol Generating Medical Procedures FAQ (Airway Management)
A frequently asked questions document has been created regarding oxygen flow rates and aerosol generating medical procedures.
ALL: Telecommunicator CPR Practice Update (Responder Safety)
The instructions provided to bystanders by Emergency Medical Call Takers (EMCTs) for patients who are suspected to be in cardiac arrest have been updated to align with the Heart and Stroke Foundation of Canada Guidelines for COVID-19.
ALL: Fraser Health redirect Practice Update (Transport)
Fraser Health redirect for Fraser Canyon, Mission Memorial and Delta Emergency departments
CP: Community paramedic practice guidelines for virtual health (Community Paramedics)
Zoom (preferred) & Facetime now available for connecting with patients.
ALL: Siren notes - COVID-19 questions (Communication)
Crews have requested that COVID-19 screening questions and answers be included in the information available from patient lookup, however, because of technical restraints within Siren this is not possible. An alternative method to ensure this information is available for subsequent paramedics is to use the ‘BCEHS Note’ option within the past medical history section.
ALL: CliniCall Discontinuation Orders Practice Update (Resuscitation)
CliniCall guidance for discontinuation of adult resuscitation attempts during the COVID-19 pandemic.
ALL: Changes in First Responder protocols (Responder Safety)
Fire first responders will not be sent to any potential COVID-19 events. They will only automatically be sent on Purple, some Red, and specific events requiring technical rescue or lift assist, as requested.
Updated best practices for out-of-hospital airway management during COVID-19, superseding previous direction. Included maximum 5 lpm for nasal cannula and 15 lpm for non-rebreather face masks.
ALL: Use of Patient Salbutamol (Medications & Drug Administration)
Salbutamol MDIs being distributed to PCP stations. Use patient's own MDI when available and bring to hospital due to low stock availability.
ALL: South Island COVID-19 Transport Directive (Transport)
South Vancouver Island paramedics directed to transport all confirmed/suspected COVID-19 patients to RJH or NRGH. Certain exceptions apply.
ALL: This Clinical Dashboard was released (Communication)
ALL: CO detector location (Responder Safety)
While wearing PPE gowns, paramedics should consider placing the detector in a location where the sensor is not blocked, even if the alternative location is not ideal.
ALL: Intranasal medication administration alert (Medications & Drug Administration)
By the nature of the delivery, Intranasal (IN) medication administration poses a real risk of aerosolization. IN medication administration is now considered high-risk and is restricted to instances only where absolutely necessary and as a last resort.
ALL: Podcast - Summary of COVID-19 practice changes (Podcasts)
This podcast captures and summarizes the COVID-19 practice changes to date.
ALL: EMALB | COVID-19 Special Message from the Board and Registrar (Communication)
Thank you from EMALB during this challenging time.
ALL: Indications for intra-muscular epinephrine in asthma (Medications & Drug Administration)
Lowered threshold for Epinephrine administration in Adult & Pediatric Asthma.
IM Epinephrine is temporarily indicated for treatment of asthma with: Moderate to severe symptoms unresolved with MDI Ventolin (Salbutamol) administration, patient inability to inhale MDI due to bronchospasm, and inability to comply with MDI due to hypoxia.
ALL: Podcast - PPE, precautions and paramedic safety (Podcasts)
This episode reviews best practice regarding PPE precautions to be taken on COVID calls
CP: Community paramedics: Practice updates (Community Paramedic)
ALL: Supra-glottic airways (Airway Management)
Clarification that the reference to Supra-glottic airways include both the King Airway and i-Gel.
ALL: CPR and bag valve mask use (Resuscitation)
If a SGA is not being utilized in a cardiac arrest (EMR / FR), crews are asked to:
Maintain a good seal with two-person bag valve mask (BVM) even when not actively ventilating, pause chest compressions to ventilate (30:2), and to ensure viral filter is in place
Yesterday, a new modified risk assessment was added to support decision making when entering patients homes. Additional questions and caution should also be applied upon entering homes where patients may have home nebulisers or CPAP devices.
ALL: On-scene doorway assessment (Transport)
ALL: Contact to CliniCall - ePCR notification (Communication)
Given the current situation and changes to practice, as well as clear PPE guidance, the notification to paramedic specialists no longer needs to occur.
ALL: Telephone CPR - Advice to callers (Assessment)
Instruction to Cover Patient’s Mouth and Face: Dispatchers will be advising callers to cover the patient’s mouth and face prior to commencing compressions.
Video to support paramedic education with regards to the use of Metered-Dose
ALL: Influenza-like illness call pre-departure flight paramedic checklist (Transport)
A pre-departure checklist has been created for flight paramedics to undertake prior transport of suspected or confirmed COVID-19 patients
Before beginning CPR, paramedics should don PPE, and place a surgical mask over the patients’ face. This is to avoid aerosolization and droplet transmission during chest compressions.
ALL: Clinical Pathway (Bypass) - Status Quo (Transport)
There is no change of practice to the clinical pathways for STEMI, Major Trauma and Stroke.
Some regional differences exist between Health Authorities, Partner Agencies etc., and crews are reminded to follow BCEHS procedures as they are directed towards the pre-hospital environment.
ALL: Airway Management Practice Update v6 (Airway Management)
No Nebulization of Medications
CPAP: Extreme caution, Full PPE and only when necessary. Discontinue CPAP when entering hospital
Use lowest oxygen flow to achieve an SpO2 of 90% (max recommended flow is 6 lpm 5 lpm)
Ensure a tight-fitting seal (2-person) when ventilating patients with a BVM and filter
Suction only when necessary and exercise caution (endotracheal and oro/nasogastric)
The N95 mask can be used for up to 8 hours of continuous or intermittent use, unless soiled or wet.
CIS Team: Paramedics may be experiencing moral distress during this pandemic and are encouraged to reach out to the CIS team at: 1-855-969-4321
BCEHS Clinical Rounds have been suspended until further notice.
ALL: Scene Assessment Reminder (Responder Safety)
A reminder that ALL crews independently assess every call for ILI risks before entering. Crews should feel empowered to complete their own risk assessments and decide when to don appropriate PPE.
ALL: Secondary Triage: Acetaminophen (Medication & Drug Administration)
Acetaminophen should be the first line recommendation for patients with pain or fever and based on current opinion, ibuprofen should be avoided.
ALL: BCEHS Best Practice Reminders (Best Practice)
Many crews are receiving feedback from receiving hospital and staff on best practice around out of hospital therapies and treatments. Crews are reminded to adhere to the current BCEHS best practice procedures as there are many contextual differences that exist between the hospital and out of hospital environment.
ALL: All calls are infectious until proven otherwise (Responder Safety)
Paramedics to complete a “front door assessment” prior to entering the scene.
ALL: Pandemic non-conveyance guideline - Secondary triage (Transport)
Paramedic specialists and secondary triage nurses are actively calling back a great number of low-acuity 911 patients to ensure these patients remain in their homes. These actions have diverted a tremendous number of patients away from emergency departments reducing exposure for paramedics and optimizing limited resources.
ALL: Safety update - Ambulance cab and patient care area divider (Transport)
Use of slider window between ambulance cab and patient compartment during transport will reduce the risk of COVID-19 transmission.
ALL: Advance notification to hospitals (Transport)
Paramedics are reminded to give advance hospital notification for patients that may require advanced airway.
ALL: Acetaminophen use in suspected COVID-19 patients with fever (Medications & Drug Administration)
For Secondary Triage Patients, Acetaminophen use is first-line recommendation for patients with pain or fever.
ALL: New PPE education videos (Personal Protective Equipment)
BCEHS Learning has created instructional videos for donning and doffing and hand-washing.
ALL: EMALB notification regarding continuing professional development credits for 2019/2020 (Communication)
Recognizing the special circumstances presented by the COVID-19 pandemic, the Board will not require EMAs to complete their continuing competence requirements for the current reporting period.
ALL: CPR practice changes to prevent exposure 3.0 (Resuscitation)
Paramedics to don full PPE and place a surgical mask over the patient prior to commencing CPR/Defibrillation. Manage airway early with SGA to prevent COVID-exposure of paramedics.
CCP: Critical care paramedic mechanical ventilator best practice (Airway Management)
Best practice guidelines for the mechanical ventilation of suspected or confirmed COVID-19 patients
Paramedics must wear droplet precautions including an N95 face mask and face shield when administering Entonox.
Suspension of all non-essential aeromedical escorts.
Temporary removal of nebulized Epi from practice. Crews are asked to follow the treatment guidelines for pediatric respiratory distress.
ACP: ACP management of foreign body airway obstruction (Airway Management)
Clarification that ACPs wear full PPE and perform video laryngoscopy when removing FBO.
ACP & PS: Patient Safety and Learning System and intubation restriction (Airway Management)
Crews are encouraged to complete a Patient Safety and Learning System (PSLS) form if they believe patient care was affected as a result of not securing the airway with an endotracheal tube. If you are presented with a patient or a situation where your care plan does not align with a current guideline, please call CliniCall. The paramedic specialists are able to approve interventions that may be outside clinical practice guidelines, providing the direction is within the paramedics’ legal scope of practice.
CP: Community paramedic practice update (Community Paramedic)
Pre-visit safety call with pre screening
All CP community events cancelled
Stay connected with local health teams to support where needed – additional support may be asked.
Support any increase in Home Health Monitoring requests.
ALL: Restriction on Nebulized Medications vs metered-dose inhaler spacer (adults and children) (Medications & Drug Administration)
Paramedics should avoid nebulizing medications where possible. This includes Salbutamol, Ipratropium Bromide and Epinephrine. MDI’s and aerochambers will be provided.
ALL: High Flow Nasal Oxygenation (HFNO) (Airway Management)
HFNO may be used in a staged approach and placed under an existing oxygen mask, CPAP or BVM at a maximum flow rate of 5 litres / minute
ACP & PS: Intubation practice by ACPs and Paramedic Specialists (temporarily suspended) (Airway Management)
Temporary suspension of ETI. Alternative airway management with SGA.
CCP: Intubation practice by CCPs (to be done with extreme caution) (Airway Management)
RSI preferred method of managing airway
Temporary suspension of Frontier trial
ALL: Secondary triage – Pandemic Non-Conveyance (Transport)
PS’s are utilizing the Manchester Triage System to prevent the dispatching of ambulances to patients with suspected COVID-19 who meet the criteria for self-isolation and non-conveyance to ED.
Due to the extenuating circumstances with COVID-19, we have worked with the Ministry of Health and the EMALB to get a six-month extension for outstanding credit submissions.
Temporary suspension of ECMO trial