With the lifting of most provincial mask requirements on June 11, 2022, the Chief Medical Officer of Health (CMOH) has revoked all remaining directives, including Directive #4. The ministry has released a new document titled COVID-19 Guidance: Personal Protective Equipment (PPE) for Health Care Workers and Health Care Entities to provide updated guidance on the required PPE for the care of patients with suspected or confirmed COVID-19. A summary of the document is below.

Point of Care Risk Assessment (PCRA)

The PCRA must be completed by Paramedics before every patient interaction and task to determine whether there is a risk to the Paramedic of being exposed to an infection, such as COVID-19. The PCRA should also include the probability of aerosol generating medical procedures (AGMPs) being required.

Minimum Required PPE (passed PCRA)

A fit-tested, seal-checked N95 respirator or equivalent (APR) mask must be worn at all times when providing patient care and/or in patient care areas.

 Required PPE for Patients with Confirmed or Suspected COVID-19 (failed PCRA) or when AGMPs are anticipated / required

Paramedics are to wear a fit-tested, seal-checked N95 respirator, eye protection (goggles, face shield, or safety glasses with side protection) when:

• Providing direct care to or interacting with a patient with a suspected or confirmed case of COVID-19, or
• AGMPs are anticipated or required.

** Effective immediately, safety glasses with side protection are permitted for use in Operations**

Note: Patients may fail the PCRA for reasons other than COVID-19 (e.g., monkey pox, TB, MRSA, etc.).  Paramedics should don additional items of PPE (e.g., gowns, hoods, booties) as required.

Patients who pass the PCRA must be reverse isolated with a surgical mask as long as it is tolerated.

Remember that vaccination – with a booster dose – remains your best protection from serious illness.

Thank you for all that you continue to do!

Sincerely,
(Original signed by)
Jennifer Shield

DOWNLOAD PDF – COVID-19: Update on Personal Protective Equipment (PPE) – Eye Protection

Monkeypox is a rare disease that is caused by infection with monkeypox virus.  The natural reservoir of monkeypox remains unknown, however, African rodents and non-human primates (like monkeys) may harbour the virus and infect people. Monkeypox is endemic in certain parts of Central and West Africa, but it does not occur naturally in North America.  Prior reports of sporadic cases in non-endemic countries were linked to international travel to or imported animals from endemic countries.

Since the beginning of May 2022, there have been over 100 cases of monkeypox virus reported outside of Africa, including Spain, the United Kingdom, Israel, Canada, the USA, and Australia. It is not clear how individuals were exposed, and no source of infection has been confirmed. On May 20, 2022, public health authorities confirmed two cases of monkeypox in Quebec, with a third case in Massachusetts (USA) in an individual with travel history to Quebec.  Further cases have been subsequently confirmed in Canada.

Ontario’s Chief Medical Officer of Health issued an order requiring physicians and nurses to report to their local Public Health Unit any patient who meets the case definition for monkeypox so that appropriate investigation, case and contact management can occur.

While the risk of exposure is low at this time, it is important that paramedics be aware of the signs and symptoms of monkeypox so that they can take appropriate measures to protect themselves and the community. The existing precautions, including appropriate use of PPE, will mitigate the risk of infection. The linked Qs & As provide additional information about monkeypox symptoms, transmission and precautionary measures.

Please continue to take care, and stay safe.

(Original signed by)
Jennifer Shield

Link to Monkeypox Q and A

Colleagues,

It is my pleasure to provide the following updates to the Sunnybrook Regional Base Hospital Medical Council effective Match 7, 2022.

First, I’m pleased to announce that Dr. Taylor Bischoff has been appointed interim Base Hospital Medical Director for the Toronto Fire Services Program.

Dr. Bischoff is a practicing emergency physician at both Sunnybrook Health Sciences Centre and Royal Victoria Hospital in Barrie.  After completing her degree at McGill University, she went on to study medicine at the University of British Columbia. During her residency at the University of Toronto, she completed EMS subspecialty training at Sunnybrook Health Sciences Centre and Ornge.

Further, Dr. Morgan Hillier will complete his transition from Medical Director, Toronto Fire Services that he has held since 2017, to become Base Hospital Medical Director, Toronto Paramedic Services. Morgan is an attending emergency physician and trauma team leader at Sunnybrook Health Sciences Centre, and is the academic director for the University of Toronto emergency residency program EMS rotation.

Finally, my thanks to Dr. Michael Feldman who has served as interim Base Hospital Medical Director for Toronto Paramedic Services since October 1, 2021. Dr. Feldman will continue in his role as Medical Director for the County of Simcoe, District of Muskoka, Rama and Beausoleil First Nations.

Please join me in offering our congratulations and thanks!

Sincerely,

Download a PDF version.

Please find (attached below) the updates to the Ambulance Service Communicable Disease Standards on behalf of Steven Haddad, Director, Emergency Health Regulatory and Accountability Branch.

These updates have also been posted to the EHS – Paramedic Practice Documents website. Please note, until the Ambulance Service Communicable Disease Standards v2.1 has been converted to meet the requirements of the Accessibility for Ontarians with Disabilities Act, 2005, it is posted as an email link to request a copy of the standards. The document will be posted online as soon as possible.

Kind regards,
Certification and Patient Care Standards
Emergency Health Regulatory and Accountability Branch
Ministry of Health

DOWNLOAD PDF:
Communicable Disease Standards v2.1

Sunnybrook Regional Base Hospital has been notified that calcium gluconate 10% is currently out of stock and unable to be supplied to Toronto Paramedic Services. This will mean that Advanced Care Paramedics (ACPs) will have zero supply of calcium gluconate for administration to patients with suspected hyperkalemia.

Prehospital treatment of life threatening hyperkalemia is a multipronged approach which includes the administration of salbutamol and calcium gluconate.

Advanced care paramedics should continue to utilize salbutamol as per the Hyperkalemia Medical Directive even if calcium gluconate is not available for administration.

Additionally, ACPs should consider patching to the BHP for consideration of sodium bicarbonate administration.

If you have any questions, please contact Scott Gorsline at scott.gorsline@sunnybrook.ca .

Sincerely,

Michael Feldman MD, PhD, FRCPC
Interim Medical Director, Toronto Paramedic Services
Sunnybrook Centre for Prehospital Medicine

Download a PDF version.

Toronto Paramedic Services (TPS) has been made aware of a supply shortage of “single strength” dopamine in the 200mg/250mL (800mcg/mL) bag format. It is currently unknown when this concentration will become available again. In the interim, the Base Hospital has authorized the use of “double strength” dopamine, 400mg/250mL (1600mcg/mL).

TPS has purchased this new concentration and, for a short period of time, will have both concentrations in circulation. Paramedics should continue to utilize the Medication Administration Cross Check to verify the concentration of dopamine prior to administration.

To support Paramedics, the Ontario Paramedic Clinical Guide app has been updated with a dosing chart for the new concentration.

Download a copy of this memo as a PDF.

The following changes/updates have been made to the May 6^th, 2020 Considerations document and the recently released January 4^th, 2021 memo.

Introduction

A paragraph has been added to reinforce the availability and opportunity to consult with a Base Hospital Physician regarding these complex situations.

Part A – ALS PCS Medical Directives with COVID-19 Treatment Considerations

3. Bronchoconstriction Medical Directive

Salbutamol:

The document has been updated to withhold the administration of MDI salbutamol ONLY in the  setting of mild respiratory distress. Previously the restriction was for mild to moderate respiratory distress.

Salbutamol:

The restriction regarding a cough has been removed. In the setting of moderate or severe respiratory distress, MDI salbutamol may be administered in the presence of a cough or not.

Epinephrine:

This was updated in the January 4^th, 2021 memo and remains in place that IM epinephrine is to be withheld for patients ?50 years old. The rationale is based on the risk of increasing risk related to cardiovascular complications. The complete rationale and reference document is provided in the updated, February 10^th considerations document under the Bronchoconstriction Medical Directive (Section 3, Page 4).

A clarification is provided regarding the indicated use for IM epinephrine in bronchoconstriction – ie: less than 50 years old, BVM ventilation required and a history of asthma.

Considerations for Paramedics Managing Patients during the COVID-19 Pandemic_ Summary of Change

Sincerely,

Download a PDF version of this memo.

On January 11, 2021, the Basic Life Support Patient Care Standards (BLS PCS) version 3.3 come into force. This updated version includes changes to the Paramedic Stroke Prompt Card (PSPC). The updated PSPC now includes a secondary screening tool, the Los Angeles Motor Scale (LAMS), to assist Paramedics in determining if the patient may be suffering from a large vessel occlusion (LVO) stroke.

This memo is a modification to the Bronchoconstriction Medical Directive, within the May 6th, 2020 version of the Paramedics Considerations in Managing Patients with COVID-19 during the Pandemic document.

The change is specific to the section found on Page 3, Part A (ALS-PCS Medical Directives with COVID-19 Treatment Considerations), specifically Section 3c: Bronchoconstriction Medical Directive: Administration of IM epinephrine for severe respiratory distress with cough in known asthma patients.

Effective immediately, IM epinephrine should not be administered in this setting, to patients equal to or greater than 50 yrs. of age.

Download a PDF version.

Paramedics in Ontario will begin utilizing the newly released ALS PCS version 4.8 on Monday, November 23, 2020.

The specific changes and impact on paramedic clinical practice have been outlined in a Provincial OBHG educational memo attached to this message.

Please note that although the ALS PCS v4.8 includes the auxiliary COVID-19 Medical Directive, it is not mentioned in the OBHG educational memo, information specific to this directive will be communicated to paramedics at a later date if implemented.

As a reminder, up-to-date medical directives are available to you by downloading the Medical Directive App, Ontario Paramedic Clinical Guided (OPCG). The OPCG App will be updated for the go live date of November 23, 2020.  Additionally, the PDF version of medical directives will be available for download on the PPO once the documents have been updated.

Attachments:
OBHG ESC communication ALS PCS 4.8_FINAL – PDF
2020 Nov. 18 All Services_ALS PCS 4.8 Release – PDF

If you have any questions about the ALS PCS v4.8, please contact your Paramedic Practice Manager.

Sincerely,
(Original signed by)
Dr. Verbeek , Dr. Cheskes, Dr. Feldman