Question: Why is SGA preferred over ETT during the pandemic? Will I be penalized if I have to intubate someone?

Question: With the new recommendations for oxygen during the pandemic, Im a bit confused as to what to do if my patient needs >5L NP?

Question: hello, in regards to COVID 19, are paramedics using surgical masks or N-95 when applying Flo2max? will it depend if our patient is screened negative or positive or pending? I understand in AGMP’s we are to use N-95. it is my understanding that Flo2max is a high concentration/ low flow mask system. a second question, would you advise to proceed with applying flo2max rather than NRB masks on all patients who are FREI positive and/or Covid 19 screened positive?

Question: Was just reviewing the SWORBHP document that came out yesterday, just hoping for a little clarification RE bronchoconstriction. In the document it states that we should consider IM administration of Epinephrine for severe respiratory distress w/ cough, hx. asthma. It also states that we should consider using MDI salbutamol only for severe respiratory distress without a cough… My understanding of it would be that we want to keep a surgical mask on the pt. to minimize risk of droplet transmission via cough which you cant do while administering medication via MDI. I understand that if the pt. Has a cough we should use epinephrine as our first line medication same as we normally would if the pt. Is apneic but Are we to be considering these two separate cases for use of these medications and not giving them concurrently during this pandemic? Just wondering as I did not see it specify whether or not we should considering withholding ventolin if there is a cough.

Question: Who can receive IM epi under the new COVID-19 considerations?

Question: Why did we receive the latest OBHG recommendations today (Monday, Apr 6th) when they are dated April 3rd?

Seeking clarification for salbutamol administration down ETT based on the Ask MAC posted April 3rd regarding ETT administration: Are we still able to use our MDI-adapter wherein the MDI canister is inserted and left in, creating a closed-system circuit?

Question: Can you clarify for medications down the ETT (is it only referring to Cardiac Drugs?) : if use of ventolin admin via MDI & BVM in pre-arrest /unconscious state, can follow-up doses with ventolin be administered down ETT post intubation?

Question: Where do I find a COVID19 + resource through SWORBHP OR MOH of a chart…of when a pt with potential Positive (as mine was) should be suggested to stay home for no service or be transported due to risk factors. I am specifically looking for vital parameters, comorbity inclusion/exclusions…?. the only current available is verbally on the WHO.

Two questions First: Piggbacking on the question regarding nasal cannula vs NRM. Should the service be equipped with a filtered NRM is there a BETTER option between the filtered NRM or low flow nasal cannula. Keeping in mind that the filtered NRM fits large on many pt’s faces and isn’t like CPAP where a good seal is provided. Second: Is high flow oxygen considered aerosol generating where we should be wearing an N95 when providing or no? Thanks!

Questions regarding intubation. Should we be opting for aggressive airway management with intubation or SGA on VSA patients as well as severely obtunded non-asthmatic patients where patient presentation would allow? Should this take precedence over ACLS drugs during cardiac arrest? When intubated with inline filter in place are we permitted to BVM an normal rate?

In light of the COVID 19 crisis occurring and recent posting from the service about the use of the NRB in patients that are experiencing FREI symptoms and potential exposure to COVID 19 with low O2 sats and difficulty breathing, would the paramedics be supported by the Base Hospital if the patient only received a nasal cannula application at max flow rate of 6 lpm or if they were to use high concentration-low flow masks (Hi-OX, FloO2 system).

1)In regards to the bronchoconstriction medical directive with the indication to give epinephrine (severe respiratory distress and cough, with or without BVM, and hx of asthma), does this only apply to patients who screen COVID- POSITIVE? or all patients. 2) Does the new indications for BVM (RR <6 or <40 and SPO2 less than 85% on oxygen) only apply to COVID POSITIVE patients? 3) All other "IN ALL CASES" for medications sent out by SWORBHP (ex. no CPAP, no neb Ventolin, no suctioning) does this only apply to patients screen POSITIVE? OR ALL patients (even if they don't screen positive).

*Updated: Are ACPs still required to complete 24h of CME for 2020, given the COVID pandemic?

In response to COVID-19 I have two main questions Intubation: With intubation should we be switching to airborne precautions for PPE? NSAIDs: I have read multiple reports from credible sources about withholding NSAIDs from COVID-19 patients. Will this be something coming down the pipe for people who screen positive? Nasal Intubation: Due to removal of CPAP (one of the main reasons nasal intubations became rare) will be seeing nasal intubation reintroduced to services that just removed it as another alternative as we dont know truly when we will be returning to practice as normal?

What is a hydrophobic submicron filter? What does it do and does it have other names? FYI – Equipment standard has it listed on page 57

Are sublingual medications part of the considerations, since IN and buccal are?

What is a closed suctioning system?

Does the suctioning restriction apply to all forms of suctioning?

With regards to considerations for Bronchoconstriction it says that with severe resp distress and a cough (with or without need for BVM) that we can consider IM epi as per the bronchoconstriction medical directive. Does that mean they still need to have a hx of asthma?

Are we entitled to the scientific reasoning why we are no longer providing CPAP to patients? What is the expectation when I am unable to confirm COVID-19 and my immediate presentation would improve with CPAP administration?

I am seeing information from sources I trust discouraging the use of BVMs (even with filters) and BIPAP for suspected COVID-19 patients with respiratory distress (due to the danger of aerosolizing the virus). NRB use (also not ideal) with early (Safe) intubation (no pre oxygenation with BVM) is encouraged. the last update from SWORBP stated that CPAP should be avoided with suspected Corona virus patients (Im assuming for the same reason), but continuing to advocate for assisted ventilations. Any update on BVM use?

With respect to the Suspected Adrenal Crisis Medical Directive from the ALS PCS, I’m wondering what specific medical conditions would fall under this umbrella because the only one I am familiar with is Addison’s?

As PCPs are we allowed diluting Narcan 0.4mg/ml 1:9 with NS when giving it IV route? (0.04mg/10ml) titrate to effect.

Is a suspected pelvic fracture a contraindication to IO in the tibia?

My question comes from the Medical Cardiac Arrest Directive and specifically in relation to the clinical considerations section. I have two questions relating to this.

First of all, the medical directive lists medication overdose/toxicology as a circumstance where the paramedic can consider very early transport after the 1st analysis. My question is can this also apply to overdoses from recreational drugs? It touches on cardiac arrest with associated opioid overdose but doesn’t go into great detail besides the role of naloxone in these circumstances.

Secondly, it lists pediatric cardiac arrest as a situation where we the paramedics are to plan for extrication and transport after 3 analysis. However due to the rarity of this circumstance and the likelihood of its origin resulting from a reversible cause would the paramedic be correct in transporting these patients immediately following the 1st analysis?

For a VSA patient who is in refractory vfib after 3 analyses, can we call BHP for double sequential defibrillation if we have a second PCP unit?

For pediatric patients, are we supposed to get orders solely from pediatric physicians or can we get orders from physicians an adult ED? Are the pediatric physicians also in the base hospital program?

How does SWORBHP suggest measuring the correct dose of Hydroxycobalamin to a pediatric patient? The Cyanokit is provided as vials that are to be reconstituted with normal salient diluent. The pediatric dose is 70mg/kg, given over 30 minutes. Unlike our other pediatric-dosed medications, this system does not allow for us to easily measure the exact dose given as there are no mL markings on the bottles. Sny help is greatly appreciated.

Do we HAVE to take a 12 lead to diagnose SVT?

If I am in a first response truck and have no shocks, do I have to wait until the transporting unit gets there to call for a TOR or can I call when I meet all the criteria?

The ALS PCS 4.5 STEMI directive follows the BLS V3.0.1 criteria and no longer has a pulse rate of <50 as a contraindication for bypass. Does this mean a bradycardic patient with a pulse in the 40s can now be transported on a STEMI bypass? In the past medics where taught differing regions would have slightly different STEMI receiving acceptance criteria. Are there any considerations we as medics should consider for STEMI receiving hospitals in our governing region?

Are there any tools that we can use to differentiate Bells palsy from a CVA to prevent us from an unnecessary stroke bypass?

When considering Gravol, if the pt has taken any antihistamines, anticholinergics, or tricyclic anti depressants should we withhold Gravol or only if they already appear to have overdosed? For example, would it be o.k. to give the patient Gravol if they take a daily antihistamine for allergies?

If the modified valsalva works & then they revert back into an SVT, can I perform the modified valsalva again? Is it only 2 attempts or 2 per episode if safe and feasible to do so; being sure not to perform more than 2 on scene delaying transport?

Is it acceptable to cannulate an umbilical cord, if required, during resuscitation of the newborn?

Can Ketamine be used on a combative post-ictal patient or would Midazolam be the drug of choice in this case?

Do we really need to get a blood glucose on an overdose patient prior to administering Naloxone?

Is there really a priority with the delivery of Ketorolac over Tylenol/Ibuprofen in the new pain protocol?

Does wheezing have to be present in the patient assessment to administer Ventolin?

Wondering what your thoughts are in regards to administering nitro to a patient with atypical angina symptoms and no presentation of chest pain. For example, is it ok for us to administer nitroglycerin if a medic is presented with a female patient who states she becomes nauseated from angina and explains she is prescribed nitro for the symptom? I discussed this question with my colleagues and I have found there is a 50/50 split in regards to those of us who would use nitro or not. I think it is a good question to ask given the differencing of opinion in the field.

If patient receives ASA from a certified provider, such as but not limited to other paramedics, doctors/nurses from clinics, are we required to administer another dose of ASA to the ACS patient. Also, does the patient have to have chest pain to administer ASA?

How do I properly patch for rolling medical TOR or cease resuscitation order, especially in instances involving a public place?

If I am in a first response truck and have no shocks, do I have to wait until the transporting unit gets there to call for a TOR or can I call when I meet all the criteria?

Our directives state that we are allowed to administer 2 doses of epinephrine to a patient suffering from a severe allergic reaction and 1 does to a VSA patient who is expected to have become VSA secondary to anaphylactic shock. Does this mean we are allowed to give a 2nd and possibly 3rd dose of epinephrine to a patient by following the moderate to severe allergic reaction medical directive post ROSC?

Are there any expected changes coming in regards to transporting an organ donor VSA patient? Is there a more appropriate receiving facility to consider and what should we do with an organ donors body after obtaining a TOR?

I was told during my I.V. course that it is O.K. to give dextrose immediately after Glucagon if an I.V. was achieved after Glucagon administration (failed I.V. attempts – give Glucagon – try another I.V. and succeed – give dextrose). Is this true? If so, would I have to record a new sugar reading prior to dextrose administration even if Im prepared to give dextrose immediately after glucagon? Would there be any changes to the number of max doses of either drug I could administer in this case.

Do we really need to get a blood glucose on an actively seizing patient?

Why isn’t there a “febrile medical directive” to give Tylenol? having something like this especially around flu season would enhance patient care.

Are we allowed to give acetaminophen and ibuprofen to someone who has a headache under the pain directive? I had 2 different patients not too long ago and both were complaining of a headache. One patient just ended up having just a headache while the other patient whom had a headache over several days with no facial droop, slurred speech, equal pupils and equal bilateral grip strengths turned out to be a bleed. Would it be ok to just give acetaminophen to our patients complaining of a headache and hold off on the ibuprofen? Headache is not a contraindication for the pain directive so this is why I am asking.