Important Note
As of November 2023 mask wearing requirements have been re-introduced to WA public health facilities. Officers should comply with any local requests from public and private facilities that may exceed the Department of Health directive. St John WA advocates having a low threshold to apply full respiratory protection given increasing community transmission.
This guideline is for patients ≥ 16 years of age with Confirmed or suspected COVID as primary complaint. Patients must be fully assessed to exclude other serious conditions, particularly as the disease has the potential to cause or exacerbate other pathologies. Patients under 16 years old should be treated as per the current Patient Not Transported guideline.
COVID-19 is the illness caused by infection with SARS-CoV-2. It usually presents with symptoms similar to other acute respiratory infections. SARS-CoV-2 can cause more severe disease including pneumonia, acute respiratory distress syndrome (ARDS), complications affecting other organ systems, and long-term sequelae (e.g. post COVID-19 condition).
Confirmed or suspected COVID-positive patients must be fully assessed to exclude other serious conditions, particularly as the disease has the potential to cause or exacerbate other pathologies.
Similar to other acute respiratory infections. Recent onset of new or worsening:
- Cough
- Breathing difficulty
- Sore throat
- Runny nose/nasal congestion
Other symptoms may include:
- Headache
- Muscle aches
- Fatigue
- Nausea, diarrhoea &/or vomiting
- Loss of sense of taste &/or smell (less likely with newer variants)
- Fever (≥37.5⁰C) – less common in older adults
- Older adults – new or increased confusion, change in baseline behaviour, falling, or exacerbation of underlying chronic illness
Based on your assessment of the patient, they can be categorised into 3 groups:
| Mild | Moderate | Severe / Critical |
|---|---|---|
Ensure that you have performed a NEWS2 AssessmentNEWS2 Calculator | ||
| Management Advice | ||
Symptoms | Symptoms | Symptoms |
NEWS2 Score 0-4, with:
and:
If the patient has any significant risk factors (see below), they should be moved into the moderate risk category | NEWS2 Score 5-6 or any single observation in RED (score 3) area OR any of the below clinical criteria:
If the patient has any significant risk factors (see below), they should be moved into the severe/critical risk category | NEWS2 Score 7+ OR any of the below clinical criteria:
|
Self-care | Emergency department review | Urgent prehospital care |
| VEM Ambulance referral where applicable OR Transport Escalate as per Recognising and Responding to Acute Deterioration and manage as per Clinical Practice Guidelines | Transport to Emergency department (upgrade to priority one if required) and consider:
Escalate as per Recognising and Responding to Acute Deterioration and manage as per Clinical Practice Guidelines |
- Patients referred by Primary Care Practitioner for transport to hospital
- Children <16 years of age
Shortness of breath is one of the strongest predictors of deterioration to severe illness.
Many patients with COVID-19 will have typical viral gastrointestinal symptoms such as nausea, vomiting, diarrhoea and abdominal cramping. Abdominal pain is often related to diarrhoea and is typically benign. However, maintain a high index of suspicion for a surgical or gynaecological causes co-presenting with COVID-19.
SARS-CoV-2 has evolved over time, resulting in variants of COVID-19. It is important to consider that some mutations may result in individuals experiencing vastly differing symptoms.
There is no specific number or type of risk factors that dictates transport vs non-transport. The greater the number of risk factors, the higher the overall risk. Where there are multiple significant risk factors present and little support available, consider transport if there is no other way to address risk.
High risk factors include:
| Demographic | Comorbidities | Environmental |
|---|---|---|
|
|
|
Management is outline above based on specific presenting clinical condition, the following is general guidance for all patients
- When approaching any scene, ensure you comply with current Personal Protective Equipment
- Conduct, where possible, a distanced or "From the Door" assessment as outlined in the COVID-19 Quick Reference Guide
- Manage in line with relevant Clinical Practice Guidelines, including RAT if indicated
- If transporting, refer to current hospital processes for assigned destination as outlined on Connect for Metropolitan Hospitals and Country Hospitals
PPE requirements for both Driver and Attendance |  |  |  |  |  |
|---|---|---|---|---|---|
P2/N95 respirator (fit tested and checked) | Surgical mask | Eye Protection | Coverall/gown | Gloves | |
High risk patients/procedures
| ✅ Fit tested and checked | ❌ | ✅ When driving: Only if able to wear without impairing safe vision of road | ✱ Not to be worn when driving | ✱ Not to be worn when driving |
Lower risk patients who do not meet the above criteria | ❌^ | ✱^ | ✱ | ✱ Not to be worn when driving | ✱ Not to be worn when driving |
| ✅ | Yes |
| ❌ | No |
| ✱ | Risk Assess |
| ^ | Any officer can continue to wear a respirator (fit tested and checked), face mask in any setting if preferred |
| AGPs | ie. Nebulisation, airway management |
| AGBs | ie. Singing, spitting |
NOTE: HAVE A LOW THRESHOLD FOR WEARING A RESPIRATOR
PPE Grab Bag
PPE Grab Bags are individualised packages of PPE that make quick-access and donning of PPE occur as quickly as possible.
| Donning | |
|---|---|
| 1. | Hand hygiene |
| 2. | Gown / coverall |
| 3. | Respirator (fit tested and checked) |
| 4. | Eye protection / Face shield (face shield recommended if high risk of splashes and sprays of blood and body fluids e.g. trauma, haemorrhage) |
| 5. | Gloves |
Use a buddy check where possible when donning your PPE
| Doffing | |
|---|---|
| 1. | Gloves |
| 2. | Hand hygiene |
| 3. | Gown / coverall |
| 4. | Hand hygiene |
| 5. | Eye protection / Face shield |
| 6. | Hand hygiene |
| 7. | Respirator |
| 8. | Hand hygiene |
Use a buddy check where possible when doffing your PPE
Setting up an appropriate area
The pre-hospital environment is unique and environmental factors (for example strong wind, rain, hot areas) may make donning and doffing in some locations more difficult. Some basic principles apply however to all locations:
- Position yourself away from high-risk patients and environments
- Factor in, where possible, environmental factors and position your vehicle as a wind break and find a shaded spot
- Ensure you have access to:
- For donning: PPE supply (likely from your PPE Grab Bag)
- For doffing: Waste waste bag
- For both: Alcohol Based Hand Rub (ABHR)
PPE Buddy Check
When practicable work with a buddy to help with correct donning and doffing practice.
Buddy to visually check PPE if fitted corrected:
- Respirator is covering nose and mouth, head straps not twisted
- Safety eyewear correctly worn and not fogging up
- Gown or coverall is fastened
- Correct size gloves are worn
Safety is everyone's responsibility - if you see PPE being worn incorrectly speak up to keep each other safe!
| Level of Breach | Example | What to do |
|---|---|---|
| Low Risk Breach |
|
|
| Moderate Risk Breach |
|
|
| High Risk Breach |
|
|
Examples of PPE breaches or failures
- Low risk: Damaged gloves; not wearing gloves when indicated and not performing hand hygiene; damaged gown; not wearing gown when indicated.
- Moderate risk*: Wearing a surgical mask when respirator indicated, respirator displaced or no longer fitting correctly (e.g. knocked/slipped out of position, becomes damaged); not wearing safety eyewear; wearing prescription eyewear or sunglass only; eyewear becomes displaced or damaged; contamination of uniform.
- High risk*: Wearing a non-fit tested respirator or one that did not pass fit test; exposure of mucous membranes of nose and mouth by direct droplets from a patient with COVID-19 (e.g. a person spitting directly onto face); gross contamination during doffing.
* There is no set criteria to differentiate between moderate or high-risk breach. Factors include (but are not limited to) location of patient (e.g. inside/outside/house or ambulance), presenting condition, whether AGP’s were performed. The Infection Prevention and Control team can assist with assessing level of risk.
0 Preparation - start of shift
- Check that you have all required personal PPE in your PPE grab bag
- Ensure that your vehicle has an adequate extra stock of PPE including:
- Gowns / Coveralls
- Eye protection (Safety glasses or Face shields)
- P2/N95 Respirator
- Surgical face masks
- Check that the vehicle has an adequate supply of cleaning equipment including clinical waste bags, hand hygiene items and Clinell universal wipes
1 En-route to call
- Assess the information on the call card to formulate a plan and consider risks
- When infective respiratory conditions are considered, discuss with your crewmate and formulate a plan for patient contact. This includes discussing alternatives if the primary plan cannot be followed.
- Anticipate what PPE may be required by the patient and the crew
2 Don initial PPE
- Based on your initial risk assessment, patient symptoms and epidemiological criteria, don PPE to allow a safe approach to scene to conduct a "From the Door" assessment
- Ensure a PPE Buddy Check is completed as well as a respirator fit check
3 On scene
- Adopt a cautious approach and assess all risk
- Consider whether both officers need to approach the scene
- Conduct a "From the Door"/physically distanced assessment if this is possible and appropriate based on patient priority
or for inter-hospital transfers
- Is there a clinical concern around an infection?
- Has the patient been tested for any infectious illness?
- Establish the clinical complaint, urgency, risk of infective respiratory illness and the possible need for high risk procedures that may cause aerosolising of the virus
- Don additional PPE as required based on your risk assessment, if both officers are required to don PPE (if not already done) etc.
4 Patient Care
- Patient to wear surgical mask (if tolerated and clinically appropriate) and carry out hand hygiene
- Limit assessment to those necessary to minimise close contact time
- Treat per SJA Clinical Practice Guidelines, perform RAT if indicated
- Limit aerosol-generating procedures (AGPs) where possible using alternate treatment methods (for example, MDI + Spacer as opposed to nebulisation) where available and clinically appropriate
- Call CSPSOC for clinical advice if required
- Encourage patient to mobilise and do as much for themselves as possible - attempt to limit moving and handling, again, where patient condition allows
- If patient able, consider the following when administering oral medication (e.g. Ondansatron wafer, Paracetemol, Olanzapine)
- Place the medication in the patient's hand
- Instruct the patient to self-administer
- Replace the mask
- Provide hand sanitiser to the patient
- When completing your ePCR / PCRF include reference to suspected Infectious illness and PPE worn
5 Transporting the Patient
Treating officer
- Maintain appropriate PPE
- Avoid AGPs where appropriate inside vehicle
- Setup treatment compartment airflow per WIAMB22 relating to ambulance airflow
Driver
- Partially Doff prior to entering front cabin/drivers seat
- Remove Gown and Gloves
- Perform hand hygiene
- Maintain P2/N95 respirator and, if able to without impeding road view, eye protection
- Transport with good ventilation (see WIAMB22 linked above)
6 Doffing
- Doff per the PPE Doffing Guide
Doffing is a high-risk time for potential contamination - use a buddy check method and support your crew mate to ensure they doff safely
7 Cleaning
Vehicle Cleaning and Spills Management
WA Health (2023) Coronavirus Disease - 2019 (COVID-19) Infection Prevention and Control in Western Australian Healthcare Facilities (version 17)
National Clinical Evidence Taskforce COVID-19 (2022) Pathways to Care for Adults with COVID-19 (version 4.4)
Communicable Disease Network Australia (2022) Coronavirus Disease 2019 (COVID-19) CDNA National Guidelines for Public Health Units (version 7.4)
Document Control
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