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.


Nebulised bronchodilators for adult respiratory symptoms.


  • Younger child: Aged between 0 and 8 years inclusive
  • Older child: Aged between 9 and 14 years inclusive
  • Adult: Older than 15 years


Nebulisation is an aerosol-generating procedure (AGP). See PPE requirements.

In an environment where there are extremely low levels of both COVID and Influenza in our community, risks associated with the use of nebulisers are no longer at an associated high risk.

The use of nebulisers in adult respiratory illness is acceptable in situations where the probable benefits to the patient outweigh the risks to our crews.

Nebulised bronchodilators should not be used in patients known to be COVID or Influenza positive unless unavoidable.

Caution should be applied to the use of nebulised bronchodilators in children with infective symptoms. Metered-dose inhalers (MDI’s; ‘puffers’) via a spacer are the preferred method of delivering bronchodilators to this patient group. Again, should the use of nebulisers be unavoidable, the risks to our crew are very low.

Nebulised adrenaline should continue to be used for severe croup in younger children as per the current CPG. Croup does not seem to be caused by or linked to COVID in other locations.

Some additional guidance:

  • Ideally apply maximal distancing between patient and staff when nebuliser is running.
  • Don full AGP PPE on exposed clinical crew – ideally single crew member with partner standing off.
  • Avoid using nebulisers inside the ambulance where possible. If unavoidable, discontinue the nebuliser prior to entering the hospital or transferring a patient out of the ambulance.

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