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CP 4.18: Immunization Administration

Reviewed: January 2026

Purpose

The Community Paramedic (CP) works together with primary care providers, public health and community health teams to support patients in the community wherever possible. In some cases, the public health team, Nurse Practitioners, Physicians or Pharmacists may request assistance from the CP through the normal request for service process to help administer immunizations to patients.

This CPG will guide Community Paramedics in the safe administration of immunizations while detailing procedures for managing potential anaphylactic reactions in accordance with BCEHS Clinical Practice Guidelines.

This CPG applies only to active Community Paramedics on the BCEHS CP Registry who have successfully completed the BCCDC Immunization Competency course and exam and be signed off on the Immunization Skills Checklist. Additionally, CPs must complete all BCCDC annual immunization education updates required by BCEHS and submit confirmation of successful completion to CP program administrators.

Policy Statements

This guideline applies to Community Paramedics who administer immunizations in community settings, specifying mandatory equipment and guideline for anaphylactic management.

Community Paramedics can provide the full scope of functions related to the immunizations following a request for service from a local public health team in a designated immunization site once “signed off” on having demonstrated adequate knowledge, skills and abilities to deliver safe & effective immunization delivery as outlined on the BCCDC Immunization skill checklist.

Immunization services may only be provided when a public health RN, Primary Care Provider, or Pharmacist agrees to provide in-person or virtual clinical support if required.In the absence of one of these clinicians being available to provide clinical support, Community Paramedics are not authorized to administer immunizations.

All immunizations must be documented in the appropriate provincial immunization registry. For homebound immunizations, documentation must also be completed in SIREN.

Immunizations Overview

Community Paramedics may be requested to administer the following immunizations to patients age 5 and older:

COVID-19: Reduces the severity of illness in vulnerable populations.
Influenza: Annual immunization for preventing respiratory illness, particularly among high-risk groups

Community Paramedics must adhere to all current BCCDC immunization manual dosing guidelines, age-specific considerations, contraindications, and documentation requirements for each immunization. Accurately document in SIREN and in ImmsBC each immunization, including:

Name of the biological product
Date
Dose Administered (e.g. mL)
Route of administration
Anatomical site of administration
Name of the biological product manufacturer
Lot number
Name and professional designation of the person administering the biological product
Any reactions following the immunization
Any recommended biological products that were not given (ie., declined, deferred, or contraindicated)
Informed consent for immunization obtained (see BCCDC Immunization Manual Appendix A- Informed Consent for Immunization

Immunization Administration Guidelines for Community Paramedic

Obtain a Service Request for homebound or clinic-based immunization.

Clinic orientations by site staff are required prior to providing in clinic immunization services

Ensure familiarity with equipment and documentation protocols

Patient Assessment and Preparation

Explain the immunization’s purpose, assess patient’s general health and understanding of the purpose of the vaccine, and discuss concerns. Verify immunization suitability with a supervising public health RN, Primary Care Provider, or Pharmacist if contraindications or precautions exist (e.g., pregnancy, immunocompromised status, allergies). Confirm the patient is due to receive the planned immunization in ImmsBC or review “Immunization” tab in CareConnect

Informed Consent and Identity Verification

Community Paramedics should review Appendix A (seven steps for obtaining informed consent) in the BCCDC Immunization Manual.

Ensure government issued identification is presented, to confirm identity – ideally using 3 identifiers (name, date of birth, PHN).

Confirm patient identity and obtain verbal consent from patient or guardian prior to delivering immunization.

Immunization Preparation

Review precautions, health, and immunization history per the BC Immunization Manual. Check immunization vial expiry, reconstitution stability, and perform three administration checks: on removal from storage, during preparation, and before administration. Confirm the 7-medication rights. Review the BCCDC Immunization Manual- Appendix B for review of Administration of Biological Products.

Immunization Administration - Intramuscular

Use the correct IM injection technique: Deltoid or vastus lateralis (deltoid preferred for most immunizations). Follow best practice for site preparation and injection technique, per the BCCDC Immunization Manual.

Always read the product-specific page in the BC Immunization Manual, Part 4: Biological Products.

Prior to administration, Community Paramedics are also recommended to review Appendix B of the BCCDC Immunization Manual

Recommended needle size and volume for patients > 19 years:

Deltoid: 1-1.5", maximum volume 2 mL
Vastus lateralis: 1-1.5", maximum volume 5 mL

May use smaller sizes (5/8" to 1") for those who appear to have smaller frames or muscle size.

Palpate the site; the immunization should not be administered where there is poor muscle mass, existing inflammation, itching, scars, nodules, sensitivity, induration, or pain.

Deltoid: (Preferred site for adult.) Define the site by drawing a triangle with its base at the lower edge of the acromion and its peak above the insertion of the deltoid muscle. The injection site is in the centre of this triangle. The upper border of the deltoid muscle is located one to two finger widths below the acromion process. The bottom point of the deltoid muscle can be located by drawing an imaginary line across the arm from the crease of the axilla at the front to the crease of the axilla in the back. The target zone for injection is 4 cm below the acromion for adults.

Vastus Lateralis: (NOT recommended for COVID.) When immunizing an adult, position the client in a seated, supine, or side-lying position. Define the site by dividing the space between the trochanter major of the femur and the top of the knee into three parts; draw a horizontal median line along the outer surface of the thigh. The injection site is in the middle third, just above the horizontal line.

Cleanse the injection site with a new alcohol swab by circling from the centre of the site outward for 2.5-5-centimetre circumference. Let dry.

Place your thumb and forefinger of non-dominant hand on either side of the injection site and press the area flat. Insert the needle at a 90-degree angle. Aspiration is not necessary, however if blood is noticed in the needle hub, immediately withdraw and discard. A new syringe and needle with immunization should be prepared.

Safely discard of sharps in approved container & provide wound care.

Immunization Administration - Intranasal

There may be events where an immunization is administered via the intranasal route.

Check expiration date of medication. Product must be used before the date on the sprayer label.
Remove rubber tip protector from medication – do not remove dose-divider clip at the other end of the sprayer.
With patient in an upright position, place tip just inside nostril to ensure medication is delivered into the nose.
With a single motion, depress the plunger as rapidly as possible until the dose-divider clip prevents you from going further.
Pinch and remove the dose-divider clip from plunger.
Place the tip just inside the other nostril and repeat delivering remaining vaccine

Post-Administration Observation

Document all relevant details and monitor patients for 15 minutes post-vaccination for potential adverse reactions.

For home-bound patients, a set of vitals signs must be taken prior to the administration, and at the end of the monitoring period.

For patients of concern, or history of immunization reaction, this is extended to 30 minutes.

In the event of any allergic or anaphylactic reaction – treats as per BCEHS Clinical Practice Guidelines.

Adverse Event Management and Reporting (Review, refer & report):

REVIEW BCCDC Immunization Manual: Part 5: Adverse Events Following Immunization.

REFER to the BCEHS Anaphylaxis CPG in the event of a severe adverse reaction.

REPORT any adverse events following immunization immediately to the primary health care provider.

STEP ONE: Adverse events will be reported to the public health unit by the primary health care provider running the immunization clinic.
STEP TWO: Adverse events will be reported to the public health unit by the community paramedic and/or BCEHS.

In addition to the above, the Community Paramedic will report the event via the PSLS portal.

Conveyance to an Emergency Department

Any patient who receives epinephrine or experiences an adverse reaction should be conveyed to the nearest Emergency Department via BCEHS for ongoing monitoring and specific tests.

All anaphylactic events must have serum tryptase testing done between 30 min – 3 hours of the vaccine, as per Part 3 of the Communicable Disease Control Manual. BCEHS Paramedics must present a “Request for Serum Tryptase Test” letter to the triage nurse upon handover.

Adverse Event Reporting

All incidents of an adverse event must have the appropriate documentation submitted within 24hrs using this form: BCCDC Report An Adverse Event. Submit the completed form to your local public health unit using these contact details: Reporting Map

Cold Chain Breach

Any breach in the cold chain must be reported using this form, within 24 hours: BCCDC Cold Chain Breech. This should also be reported to the site unit where the vaccine was obtained, e.g., public health unit or pharmacy.

Needle Stick Injury

ALL needle-stick injuries are to be reported using the normal internal reporting procedures per the BCEHS Sharps Handling Policy

For any blood & bodily fluid exposure or injury, staff will need to follow the Blood and Body Fluids (BBF) protocol immediately. All workplace incidents including near misses are to be reported to your Supervisor and the Provincial Workplace Health Contact Centre (1-866-922-9464) without delay.

Critical Incident Stress Management (CISM) and Employee Family Assistance Program (EFAP) will also be offered in the event of an exposure or injury.

All staff are required to complete all mandatory needle stick injury reporting paperwork that the host clinic requires.

Quality Assurance and Continuous Improvement

All incidents of CP administered immunization anaphylaxis must to be reported via a PSLS.

All anaphylaxis cases will be reviewed under a quality assurance program to ensure alignment with BCEHS CPG standards, facilitate process improvements, and maintainoptimal readiness across Community Paramedic teams. In addition, they will be reviewed by the MHO.