Influenza-Like Illness/COVID ASTaR Clinical Practice Guideline

CPG R07: Patient Disposition

Created:  April 14^th, 2020

Updated:         

Introduction:

The role of paramedics around the world is shifting away from transporting all patients and moving towards an “Assess, See, Treat and Refer” (ASTAR) model for appropriate 9-1-1 calls. The BCEHS Influenza-Like Illness (ILI) clinical practice guidelines supports paramedics in identifying patients who may be suitable for continued care within their own home using a combination of thorough assessment, shared decision-making and appropriate safeguarding measures.

Essentials:

• Patients with ILI/COVID MAY be eligible for care within their own home if they are between the ages of 17 and 60, have no ‘red flag’ symptoms, no single NEWS2 score of 3 and have a total NEWS2 score of 3 or less.

• The ASTAR approach to care does not replace paramedic clinical judgement and transport should still be provided if there are reasonable concerns or doubts about the nature of the patient’s condition, patient or caregiver ability to seek further assistance and any other factors of concern to the paramedic

• Consultation with CliniCall is an essential component of this Clinical Pathway to ensure appropriate safeguarding and follow-up, as required

Additional Treatment Information:

• Where patients do not have access to simple analgesics such as acetaminophen, it may be appropriate for paramedics to provide a single dose on scene prior to discharge from care

• A NEWS2 score MUST be recorded on the ePCR to support the clinical decision making process employed during patient care

• The patient, or their substitute decision maker, should display competency and capacity to provide informed consent, and to be eligible to be included in the ILI Clinical Pathway

Referral:

• ILI Clinical Pathway is for use by PCP, ACP and CCP.

• Patients who paramedics deem that they may be eligible for inclusion in the ILI Clinical Pathway, MUST be referred through the CliniCall service

General:

• Use BCCDC Screening tool as part of initial screen

• Red-Flag concerns in all ILI patients may include:

  • Severe dyspnea whilst at rest

  • On-going dyspnea

  • Dyspnea on exertion

  • Pain or pressure in the chest

  • Cold, clammy, pale or mottled skin

  • New confusion

  • Altered mental status

  • Cyanosis

  • Hemoptysis

  • Little to no urine output

  • Neck stiffness

  • Non-blanching rash

• A systems-based assessment should be recorded within SIREN, including systems such as the Nervous, Respiratory, Cardiovascular, Gastrointestinal, Urinary, Musculoskeletal, Integumentary and Immune Systems

• Patients and/or caregivers should be provided with sufficient discharge advice to be able to identify potential deterioration in condition and act accordingly. This should be documented in the care planning section of SIREN.

ILI/COVID Clinical Practice – Interventions by License Level

EMR:

• Unable to practice with clinical guideline or Clinical Pathway

PCP:

• Able to practice guideline and use pathway.

ACP:

• All above

CCP:

• All above