Date Published

April 1, 2020

Updated For

ALS PCS Version ALS PCS Version 5.2


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!


First question: The Provincial Equipment Standards for Ontario Ambulance Services v 3.4 require that each ambulance carry a high concentration/low flow oxygen delivery system with the ability to attach a hydrophobic sub micron filter. Some models such as the Flow2Max have this filter built in to them. These systems are designed to act as a closed system that can run on a low flow of oxygen to deliver higher concentrations of oxygen than nasal prongs. There may be some leak around the mask, usually at the bridge of the nose and tape can help reduce this leak

Second question: As for options after nasal cannula, the next step in oxygen delivery would be use of a high concentration low flow system. If high concentration high flow systems are required to achieve adequate oxygenation, then a NRB mask can be used. Given a NRB is high concentration high flow, it is considered an Aerosol Generating Medical Procedure (AGMP) and proper PPE should be worn.



AGMP, Coronavirus, COVID-19

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