According to the new SWORBHP protocol release May 8th, 2020, IntraNasal Administration is still prohibited (for pain control in the pediatric population & seizure Control) even though it has been deemed as a NON AGMP in said document. 1) Can SWORBHP please re-institute these options since it is no longer an AGMP? 2) Could SWORBHP now consider the addition Midazolam I/N to the combative patient protocol (especially in dealing with the violent post-ictal patient) which would greatly facilitate dealing with these extremely strenuous scenarios while in full Level 1PPE to assists in avoiding PPE breach by venapuncture.

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1) In order to address this, there was a TOTW created to address this (here). The short answer is that although IN administration has not been listed as an AGMP per the Ontario Provincial Infectious Disease Advisory Committee, giving IN medication is now without risk and can put paramedics in closer contact to respiratory secretions compared to other routes of medication administration. It is foreseeable how giving an IN medication, can create aerosolization of viral particles, especially if this irritation causes snorting or coughing. When there are alternative routes for medications to be administered, it is safest to use these non-IN routes. 2) The ALS PCS is provincially legislated medical directives. As such, SWORBHP cannot make changes to these directives unilaterally. As part of the Provincial Comprehensive Medical Directive Review, SWORBHP reviewed the Combative Patient Medical Directive. We put forth the recommendation of adding the IN route for midazolam, which has been endorsed by the Ontario Base Hospital Group Medical Advisory Committee. This route of administration will be permitted when the updated directive is released by the Emergency Health Regulatory and Accountability Branch. Until that time, please continue to utilize the routes as per the most recent version of the ALS PCS Combative Medical Directive and the OBHG Treatment Considerations document.

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