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:
Other symptoms may include:
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 |
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.
Demographic | Comorbidities | Environmental |
---|---|---|
|
|
|
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 |
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
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:
When practicable work with a buddy to help with correct donning and doffing practice.
Buddy to visually check PPE if fitted corrected:
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 |
|
|
* 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.
or for inter-hospital transfers
Treating officer
Driver
Doffing is a high-risk time for potential contamination - use a buddy check method and support your crew mate to ensure they doff safely
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)
St John Ambulance Western Australia Ltd (ABN 55 028 468 715) (St John WA) operates ambulance and other pre-hospital clinical services. St John WA’s Clinical Resources, including its Clinical Practice Guidelines (Clinical Resources), are intended for use by credentialed St John WA staff and volunteers when providing clinical care to patients for or on behalf of St John WA, within the St John WA Clinical Governance Framework, and only to the extent of the clinician’s authority to practice.
The content of the St John WA Clinical Resources is provided for information purposes only and is not intended to serve as health, medical or treatment advice. Any user of this website agrees to be bound by these Terms of Use in their use of the Clinical Resources.
St John WA does not represent or warrant (whether express, implied, statutory, or otherwise) that the content of the Clinical Resources is accurate, reliable, up-to-date, complete or that the information contained is suitable for your needs or for any particular purpose. You are responsible for assessing whether the information is accurate, reliable, up-to-date, authentic, relevant, or complete and where appropriate, seek independent professional advice.
St John WA expressly prohibits use of these Clinical Resources to guide clinical care of patients by organisations external to St John WA, except where these organisations have been directly engaged by St John WA to provide services. Any use of the Clinical Resources, with St John WA approval, must attribute St John WA as the creator of the Clinical Resources and include the copyright notice and (where reasonably practicable) provide a URL/hyperlink to the St John WA Clinical Resources website.
No permission or licence is granted to reproduce, make commercial use of, adapt, modify or create derivative works from these Clinical Resources. For permissions beyond the scope of these Terms of Use, including a commercial licence, please contact medservices@stjohnambulance.com.au
Where links are provided to resources on external websites, St John WA:
Your use of any external website is governed by the terms of that website, including any authorisation, requirement or licence for use of the material on that website.
To the maximum extent permitted by law, St John WA excludes liability (including liability in negligence) for any direct, special, indirect, incidental, consequential, punitive, exemplary or other loss, cost, damage or expense arising out of, or in connection with, use or reliance on the Clinical Resources (including without limitation any interference with or damage to a user’s computer, device, software or data occurring in connection with such use).
Please read this cookie policy carefully before using Clinical Resources from St John WA.
The cookies used on this site are small and completely anonymous pieces of information and are stored on your computer or mobile device. The data that the cookies contain identify your user preferences (such as your preferred text size, scope / skill level preference and Colour Assist mode, among other user settings) so that they can be recalled the next time that you visit a page within Clinical Resources. These cookies are necessary to offer you the best and most efficient possible experience when accessing and navigating through our website and using its features. These cookies do not collect or send analytical information back to St John WA.
Clinical Resources does integrate with Google Analytics and any cookies associated with this service enable us (and third-party services) to collect aggregated data for statistical purposes on how our visitors use this website. These cookies do not contain personal information such as names and email addresses and are used to help us improve your user experience of the website.
If you want to restrict or block the cookies that are set by our website, you can do so through your browser setting. Alternatively, you can visit www.internetcookies.com, which contains comprehensive information on how to do this on a wide variety of browsers and devices. You will find general information about cookies and details on how to delete cookies from your device. If you have any questions about this policy or our use of cookies, please contact us.