Hello! Question about using CPAP during this time. I've had a two instances where my patients could've potentially benefitted from the use of CPAP, however they had went into cardiac arrest during transport and ended up pronounced at the hospital. I was wondering what you're thoughts are now, in terms of applying CPAP to a patient who fits all the criteria as long as we wear the right PPE. In our service Level 1(Tyvek Suit, P100, safety goggles, and gloves) is indicated whenever we are to perform an AGMP. Cardiac arrests are one of these scenarios where we utilize the BVM with a HEPA Filter. I was just wondering, since CPAP is withheld do to it being an AGMP why can't we use it to our discretion with a HEPA filter and wearing Level 1 PPE. The concern is obviously depending on where the patient is located and having CPAP on a patient and then transporting across public space to get to the ambulance is a risk for transmission to others. How do you feel during that instance if we just get on High Flow o2 @15L/min and then once in the back of the ambulance with the exhaust on and having Level 1 PPE on to be okay to use CPAP? Also giving the hospital a pre-alert to have a negative pressure room ready. Sometimes 5cm of H2O(which is 8L/min or can be helpful to a patients breathing. Also just to confirm anything greater than 15L/min of oxygen is considered an AGMP, according to the new research?

Although prehospital CPAP has a proven mortality benefit in some disease processes, the COVID-19 pandemic represents an extenuating circumstance in which the usual care of the ALS-PCS is not clinically justified, possible or prudent.  As such, the provincial Medical Advisory Committee has provided considerations for care to protect yourselves and the public to help limit spread of the virus.  The OBHG MAC continues to monitor the current situation and treatment considerations, including the use of CPAP that balances provider and public safety with patient benefit. We will be sure to let you know when it is decided, provincially, to lift some of these procedural restrictions, including the use of CPAP.

You are correct (and highlighted in the most recent,4^th iteration of the Considerations for Paramedics Managing Patients During the COVID-19 pandemic) that oxygen flow rates using a Non-Rebreather Mask (NRB) <16L/min are not considered an AGMP (here). 

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