CSA Z1650:21

National Standard of Canada

Paramedic response to the opioid crisis: Education and training across the treatment and care continuum in

out-of-hospital and community settings

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  CSA Z1650:21

  January 2021

  
  

  Title: Paramedic response to the opioid crisis: Education and training across the treatment and care continuum in out-of-hospital and community settings

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National Standard of Canada

CSA Z1650:21

Paramedic response to the opioid crisis: Education and training across the treatment and care continuum in

out-of-hospital and community settings

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CSA Z1650:21

Paramedic response to the opioid crisis: Education and training across the treatment and care continuum in out-of-hospital and community settings

Contents

Technical Committee on Paramedic Response to Opioids 3

Preface 6

0 Introduction 7

1. General 7

2. Overview 7

3. Copyright permissions 7

1. Scope 8

   
   

2. Reference publications 8

   
   

3. Definitions and abbreviations 9

   1. Definitions 9

   2. Abbreviations 11

      
      

4. Framework 11

   1. General 11

   2. Roles and responsibilities 12

   3. Framework planning 13

   4. Community and stakeholder engagement 14

      
      

5. Education and training 15

   1. General 15

   2. Paramedic training and education programs 15

   3. Continuing education 16

1. Opioid use, poisoning, and overdose — Caring for the patient and public responder 21

   1. Assessing the scene 21

   2. Supporting public responders and bystanders 21

January 2021 © 2021 Canadian Standards Association 1

CSA Z1650:21

Paramedic response to the opioid crisis: Education and training across the treatment and care continuum in out-of-hospital and community settings

1. Communication and tracking 23

   1. Opioid surveillance system 23

   2. Public reporting and alerting 23

      
      

2. Review and evaluation 24

Annex A (informative) — Guidelines for support of supervised consumption sites 26 Annex B (informative) — Guidelines for support of overdose prevention sites 27 Annex C (informative) — Opioid response clinical pathway 28

Annex D (informative) — Example naloxone education pamphlet 29

Annex E (informative) — PPE recommendations 30

January 2021 © 2021 Canadian Standards Association 2

CSA Z1650:21

Paramedic response to the opioid crisis: Education and training across the treatment and care continuum in out-of-hospital and community settings

Preface

This is the first edition of CSA Z1650, Paramedic response to the opioid crisis: Education and training across the treatment and care continuum in out-of-hospital and community settings.

This Standard was developed with funding support by Health Canada under the Substance Use and Addictions Program (SUAP). The views expressed herein do not necessarily represent the views of Health Canada.

This Standard was prepared by the Technical Committee on Paramedic Response to Opioids under the jurisdiction of the Strategic Steering Committee on Health and Well-being, and has been formally approved by the Technical Committee.

This Standard has been developed in compliance with Standards Council of Canada requirements for National Standards of Canada. It has been published as a National Standard of Canada by CSA Group. Notes:

1. Use of the singular does not exclude the plural (and vice versa) when the sense allows.

2. Although the intended primary application of this Standard is stated in its Scope, it is important to note that it remains the responsibility of the users of the Standard to judge its suitability for their particular purpose.

3. This Standard was developed by consensus, which is defined by CSA Policy governing standardization — Code of good practice for standardization as “substantial agreement. Consensus implies much more than a simple majority, but not necessarily unanimity”. It is consistent with this definition that a member may be included in the Technical Committee list and yet not be in full agreement with all clauses of this Standard.

4. To submit a request for interpretation of this Standard, please send the following information to inquiries@csagroup.org and include “Request for interpretation” in the subject line:

   1. define the problem, making reference to the specific clause, and, where appropriate, include an illustrative sketch;

   2. provide an explanation of circumstances surrounding the actual field condition; and

   3. where possible, phrase the request in such a way that a specific “yes” or “no” answer will address the issue.

      Committee interpretations are processed in accordance with the CSA Directives and guidelines governing standardization and are available on the Current Standards Activities page at standardsactivities.csa.ca.

5. This Standard is subject to review within five years from the date of publication. Suggestions for its improvement will be referred to the appropriate committee. To submit a proposal for change, please send the following information to inquiries@csagroup.org and include “Proposal for change” in the subject line:

   1. Standard designation (number);

   2. relevant clause, table, and/or figure number;

   3. wording of the proposed change; and

   4. rationale for the change.

January 2021 © 2021 Canadian Standards Association 6

CSA Z1650:21

Paramedic response to the opioid crisis: Education and training across the treatment and care continuum in out-of-hospital and community settings

CSA Z1650:21

Paramedic response to the opioid crisis: Education and training across the treatment and care continuum in

out-of-hospital and community settings

0 Introduction

1. General

   This Standard provides a framework to guide paramedic service organizations in addressing health promotion, prevention, harm reduction, and treatment of opioid addiction, poisoning, and overdose in out-of-hospital and community settings. This Standard is intended for use by paramedic services organizations and community partners.

   
   

2. Overview

   Canada continues to face a serious and growing trend with escalating numbers of opioid-related poisonings, overdoses, and deaths. The opioid crisis places strain on society, healthcare, and responders working to provide critical community and medical services. While many paramedic service organizations and jurisdictions are developing programs to address and respond to this crisis, there are no nationally or internationally accepted guidelines for the development of a paramedic response to address opioid use disorder, poisoning, overdose, addiction prevention, and treatment.

   
   

   This Standard provides a comprehensive framework for paramedic response to the opioid crisis in out- of-hospital and community settings, which can be implemented by paramedic service organizations and other responders across Canada. The Standard fills a critical need for out-of-hospital care to help reduce emergency department visits and hospitalizations related to opioid poisoning and overdose. The uptake and dissemination of this Standard will facilitate the delivery of evidence-informed quality care, including poisoning and overdose prevention, and harm reduction treatment services dealing with substance use and addiction.

   
   

3. Copyright permissions

In Clause 3, Definitions and abbreviations, the definitions for harm reduction and problematic substance use are adapted and reproduced with permission from the Minister of Health. © All rights reserved. The Chief Public Health Officer’s Report on the State of Public Health in Canada 2018: Preventing Problematic Substance Use in Youth. Public Health Agency of Canada, 2017. Adapted and reproduced with permission from the Minister of Health, 2019.

In Clause 3, Definitions and abbreviations, the definition for knowledge translation is reproduced with the permission of the Canadian Institutes of Health Research. Canadian Institutes of Health Research, Definition of Knowledge Translation, Canadian Institutes of Health Research Web site, Canada, 2016, https://www.cihr-irsc.gc.ca/e/29418.html#2. All rights reserved. Reproduced with the permission of the Canadian Institutes of Health Research, 2019.

January 2021 © 2021 Canadian Standards Association 7

CSA Z1650:21

Paramedic response to the opioid crisis: Education and training across the treatment and care continuum in out-of-hospital and community settings

1. Scope

   
   

   1.1

   This Standard provides a framework for the paramedic service organization’s (PSO) response to the opioid crisis. The framework provides practical guidance on how to address opioid use in the out-of- hospital setting, including caring for patients during a poisoning or overdose, as well as tracking the crisis across paramedic service organizations. The Standard provides guidance regarding the full continuum of care including the prevention, treatment, and referral of patients experiencing problematic opioid use. To support paramedics in their out-of-hospital and community setting roles, the Standard addresses clinical practice, training and education, community engagement, and physical and psychosocial supports.

   
   

   1.2

   This Standard does not cover clinical opioid response and treatment procedures in an emergency room or hospital, nor does it cover emergency procedures for non-opioid poisoning and overdose.

   
   

   1.3

   In this Standard, “shall” is used to express a requirement, i.e., a provision that the user is obliged to satisfy in order to comply with the Standard; “should” is used to express a recommendation or that which is advised but not required; and “may” is used to express an option or that which is permissible within the limits of the Standard.

   Notes accompanying clauses do not include requirements or alternative requirements; the purpose of a note accompanying a clause is to separate from the text explanatory or informative material.

   
   

   Notes to tables and figures are considered part of the table or figure and may be written as requirements.

   
   

   Annexes are designated normative (mandatory) or informative (non-mandatory) to define their application.

   
   

2. Reference publications

This Standard refers to the following publications, and where such reference is made, it shall be to the edition listed below.

Note: In cases where the editions listed below are amended, replaced by new editions, or superseded by another standard during the life of this referencing Standard, it is the responsibility of the users of this Standard to investigate the possibility of applying those amendments, new editions, or superseding standards.

CSA Group

CAN/CSA-Z94.4-18

Respiratory Protective Devices

Z1003.1-18

Psychological health and safety in the paramedic service organization

CAN/CSA-Z1630-17

Community paramedicine: Framework for program development

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