EXCLUSIVE: 'Patients will die - and it won't be from coronavirus': How paramedics are being forced to treat severe asthma attacks with hand-held puffers after bans on life-saving treatments due to COVID-19 fears
- Paramedics are banned from using nebulisers in ambulances due to COVID-19
- They have also been prohibited from administering any treatment by intubation
- Restrictions affect those suffering from asthma, cardiac arrest and other illness
- Paramedics fear patients will die if not treated properly on their way to hospital
- Here’s how to help people impacted by Covid-19
Paramedics are being hampered treating patients suffering life-threatening conditions such as severe asthma attacks and cardiac arrest due to fears they could contract COVID-19.
Some ambulance officers fear a prohibition on using nebulisers and intubation to treat patients on the way to hospital could in some instances be more dangerous than coronavirus itself.
The restrictions cover any patient being transported by ambulance in New South Wales regardless of whether or not they have symptoms of COVID-19.
One experienced NSW ambulance officer told Daily Mail Australia he and his colleagues believed measures meant to stop the spread of coronavirus would likely cost lives.
'Patients will die - and it won't be from coronavirus,' he said. 'There'll be COVID deaths of people that don't have COVID-19.
'Our policy now is that you protect yourself and you get them to hospital as quickly as you can, otherwise "too bad, too sad".'
Paramedics are being stopped from treating patients suffering life-threatening conditions such as severe asthma and cardiac arrest due to fears they could contract COVID-19. An international traveller is pictured arriving in Australia last month
Some ambulance officers fear a new prohibition on using nebulisers and intubation to administer patients with medicine on the way to hospital will potentially cost lives. Stock image of intubated patient
Nebulisers deliver medication via a mist inhaled into the lungs to treat conditions including asthma, chronic obstructive pulmonary disease and other respiratory illnesses.
NSW Ambulance has banned their use during the coronavirus pandemic in all but the most exceptional circumstances to prevent paramedics being exposed to infected droplets in the air.
Officers have instead been instructed to tell patients to use a hand-held puffer fitted with a spacer to administer metered doses of medicines such as salbutamol, sold as Ventolin.
The same rules apply to administering ipratropium bromide, known commercially as Atrovent, which is used to treat the symptoms of asthma and chronic obstructive pulmonary disease.
About 2.7million Australians - one in nine of the population - has asthma and it kills more than 400 sufferers a year nationwide. COVID-19 has claimed 101 Australian lives.
In NSW there has been just one coronavirus infection detected since May 22, with only 384 active cases.
Endotracheal administration, or intubation, which involves inserting a flexible plastic tube down the windpipe, has also been banned during the pandemic.
Intubation is used whenever patients are unconscious and have a compromised airway after medical episodes such as cardiac arrest or serious head injury.
NSW Ambulance officers have been instructed to tell patients to use a hand-held puffer fitted with a spacer to administer medications such as Ventolin (pictured) and Atrovent themselves.
New protocols for NSW paramedics, introduced this month and detailed in a document obtained by Daily Mail Australia, are designed to reduce the aerosol transmission of COVID-19
Nebulisers can no longer be used inside an ambulance during the critical period transporting a patient to hospital, when every minute counts.
They can only be used outdoors or in a 'large, well-ventilated area', which paramedics warn is impractical if a patient needs urgent treatment.
Adrenaline may be nebulised to treat children with severe croup or patients in anaphylaxis if intramuscular medication has not worked against a severe allergic reaction.
The new protocols, introduced this month and detailed in a document obtained by Daily Mail Australia, are designed to reduce the aerosol transmission of COVID-19.
'Nebulisers generate a high level of aerosolised particles that spread widely and can infect staff and other patients,' the protocols state.
'The use of nebulisers for medication delivery is only recommended when there is no alternative to delivering medication via other routes.
'Do not nebulise medications in the ambulance or any other confined space.
'If loaded, move the patient out of the vehicle if nebulised medications are required. Only nebulise outdoors or in a large well-ventilated area.'
Australian Department of Health guidelines state nebulisers should be avoided. For other aerosol-generating procedures including intubation and CPR it recommends 'care should be taken'. A patient returning from overseas during the COVID-19 pandemic is pictured
But some paramedics warn not being able to nebulise or intubate patients during transport is putting lives at risk.
One officer who spoke on the condition of anonymity said the restrictions left paramedics few options when treating serious respiratory illness.
'What it boils down to is that if we turn up to someone with asthma, we normally use a nebuliser, so basically we've got no treatment now,' he said.
'For the majority of patients it's just hands off - it's basically load and go.'
Taking a patient outside to be put on a nebuliser caused its own dilemmas.
'You can stay on the scene and get them in the open with a nebuliser,' the paramedic said. 'But if they're well enough to do that then they're not that sick.
'And if they're sick enough that they really need it, well then you should probably just get going.
Nebulisers deliver medication via a mist inhaled into the lungs to treat conditions including asthma, chronic obstructive pulmonary disease and other respiratory illnesses. Stock image of a woman using a nebuliser
There have been 3,084 coronavirus cases in New South Wales during the pandemic, with 46 deaths
'But you cannot provide that treatment en route in the back of an ambulance. We've got the little Ventolin puffers but that's not really the same.'
A spokeswoman for NSW Ambulance told Daily Mail Australia there had been no deaths attributed to banning nebulisation in favour of Ventolin puffers.
'As always, and particularly during the pandemic, NSW Ambulance continues to modify and review the clinical advice in order to provide the best care and safety for patient and paramedics,' she said.
'NSW Ambulance reviews any patient deaths and to date there have been no identified deaths attributable to the use of metered dose salbutamol as an alternative to nebulised salbutamol.'
The paramedic said some officers would probably ignore the protocols in emergencies, particularly if a child's life was in danger.
'Some people would be going, "That's well and good, but I'm doing it the old way anyway",' he said. 'You've got to do something. I dare say a lot would.
'I think it's left to what you're prepared to do and what you feel comfortable with.'
Australian Department of Health guidelines updated last month also state nebulisers should be avoided. For other aerosol-generating procedures including intubation and CPR it recommends 'care should be taken'.
A spokeswoman for NSW Ambulance told Daily Mail Australia there had been no deaths attributed to banning nebulisation in favour of Ventolin puffers
