As you may know, the Standards of Practice set out the minimum standards in paramedic services. Each regulated member is required to understand and comply with these Standards, but how does this translate in the day-to-day work of EMRs, PCPs and ACPs?
In an effort to help regulated members understand and apply the Standards to real life situations, we will be sharing scenarios that give context to the Standards and ideas on how to implement this into practice.
The following scenario will attempt to address infection prevention and control.
4.1 Infection Prevention and Control
A regulated member will demonstrate adherence to all appropriate infection prevention and control measures by:
- Utilizing best practices in infection prevention and control, in compliance with all relevant legislation, regulations, College documents and employer policies/guidelines.
- Utilize routine practices (including universal precautions, hand hygiene, use of personal protective equipment) to reduce occurrence of infection.
Scenario:
Amina and Jorge are midway through their shift in the rural community of Smoky Lake when they receive a call for a 67-year-old male who is experiencing shortness of breath, cough and fever. The dispatcher notes that the patient has recently returned from international travel, and the call is flagged as a potential respiratory infection.
As the crew approaches the address, they immediately begin thinking about infection prevention measures. Even before exiting the ambulance, both paramedics don initial PPE—gloves and surgical masks—as a precautionary step in accordance with routine practices. This baseline PPE ensures protection during first contact while preserving limited supplies of more advanced equipment until the patient’s condition is better understood.
At the front door, they’re met by the patient’s wife, who appears concerned but calm. She explains that her husband, John, has had a high fever for the past two days and is coughing frequently. He’s feeling weaker and more short of breath today than usual. She also mentions that he returned from overseas travel last week.
Hearing this, Amina quickly recognizes a need to escalate their protective measures. The fever, cough and recent travel suggest a risk of an airborne or droplet-spread illness such as COVID-19, influenza or tuberculosis. She steps back, signals Jorge to remain outside for now, and begins donning full airborne and droplet PPE.
Following proper procedure and employer protocols, Amina:
- Performs hand hygiene with alcohol-based hand rub.
- Dons a gown, ensuring full coverage and secure ties.
- Applies an N95 respirator, completing a seal check.
- Adds eye protection in the form of a face shield.
- Puts on gloves, overlapping the gown cuffs to create a secure barrier.
Jorge remains at a safe distance, using this time to stage and prepare necessary equipment outside the home. He ensures that only essential gear will enter the patient environment, reducing contamination risk and simplifying decontamination later.
Once fully protected, Amina enters the home and finds John seated on the couch, visibly flushed and breathing with some difficulty. A productive cough accompanies his labored respirations. Amina immediately offers John a surgical mask to place over his mouth and nose—an important step in reducing droplet spread at the source—while explaining what she’s doing and why.
She applies a nasal cannula for oxygen support beneath the patient’s mask, bringing Mr. Jensen’s oxygen saturation from 89% up to 94%, which helps ease his discomfort. While speaking with the patient and gathering his history, Amina avoids touching surfaces unnecessarily and maintains awareness of her PPE to avoid cross-contamination.
After the initial assessment, Jorge performs hand hygiene and dons full PPE in the same order before entering to assist with packaging the patient for transport. Together, they safely move John to the stretcher, ensuring he remains masked throughout the process.
Once at the hospital and after patient transfer, Amina and Jorge move to a designated doffing area and carefully remove their PPE, following the proper sequence to avoid contamination:
- Gloves come off first using the glove-in-glove technique, ensuring no contact with contaminated outer surfaces.
- Hand hygiene is performed immediately.
- Gown is removed by untying and rolling it inward, away from the body.
- Another round of hand hygiene follows.
- Eye protection is removed carefully by the straps.
- Finally, the N95 respirator is removed using only the straps, followed by a last round of hand hygiene.
Used PPE is disposed of according to infection control policy, and all reusable equipment is cleaned and disinfected, including the stretcher and ambulance interior surfaces. The team ensures that everything is safe and ready for the next call without risking pathogen transmission.
In this example, Amina and Jorge demonstrate their knowledge and adherence to the Standard 4.1 Infection Prevention and Control in which a regulated member will demonstrate adherence to all appropriate infection prevention and control measures. They also ensure compliance with all relevant legislation, regulations, College documents and employer policies/guidelines while utilizing routine practices to reduce occurrence of infection. Their decisions regarding PPE were rooted in both risk assessment and the need to protect themselves, the patient and future contacts from infectious exposure.