The purpose of these COVID-19 Interim Guidelines is to provide short-term advice to manage the risks associated with COVID-19 in the community and to protect patients and St John WA staff from potential exposure whilst maintaining the highest possible standards of clinical care to the community of Western Australia.


All Clinical Practice Guidelines not addressed in this document remain unchanged and still apply in full. Staff should ensure that they stay up to date with the latest information regarding COVID-19 on Connect.

This update is provided in the setting of very low penetration of COVID disease in Western Australia and zero or close to zero community transmission.



  • MDI: Metered Dose Inhalers (‘puffers’)


Please review Interim Guideline – Nebulisers.

Ipratropium Bromide may now be administered via a nebuliser although MDI / spacer is preferred.

Ipratropium Bromide is considered a critical list item due to limited availability.

Crews should allow the patient to administer their own Ipratropium Bromide MDI via spacer wherever possible.

Allow the patient self-administer the Ipratropium Bromide; stand clear and wait a minute before approaching the patient.

If you have to use SJA supplied Ipratropium Bromide MDI, assess whether it can be reused and wipe with Clinell wipe after use. Discard the MDI if the patient is very unwell or highly symptomatic of infectious respiratory condition.

Advice regarding nebulisers is found here.

Both the officer and the patient should perform hand hygiene after use.

Crews may tolerate lower oxygen saturations in patients with infective respiratory symptoms prior to considering intervention, as the use of MDI’s may precipitate a cough. See Interim Guideline – Oxygenation for specifics regarding SpO2 tolerance.

Note: If administering St John supplied medication, crews are NOT to leave the remainder of the medication with the patient. This is a violation of the St John WA poisons licence and the Medicines and Poisons Act 2014.

The dosage/administration guidelines are as per medication protocol.

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