Paramedic assessment and referral of patients with suspected or confirmed COVID-19 in the out-of-hospital environment: a scoping review.

OBJECTIVE

To collate assessment tools, diagnostic/screening methods, referral pathways, and clinical practice guidelines (CPGs) available to paramedics managing suspected or confirmed COVID-19 patients in the out-of-hospital (OOH) setting, and to examine the evidence cited in these resources.

INTRODUCTION

COVID-19 presents with varied severity and has caused over seven million deaths since 2020. Ambulance Health Services (AHSs) have faced sustained demand and implemented new measures for patient care, often without evidence-based guidance. This review explores how paramedics assess, diagnose, and refer these patients, and what evidence supports these practices.

INCLUSION CRITERIA: Sources from January 2020 to October 2024 were included, with grey literature from six countries eligible until April 2025. Participants were patients of any age assessed or referred by paramedics in OOH settings.

METHODS

Following JBI methodology and PRISMA-ScR, literature was sourced from databases and ambulance organisations. Data were extracted using Covidence and customised tools, then synthesised narratively and in tables.

RESULTS

Sixty-seven sources from 20 countries were included. Six screening tools, 29 assessment tools, and 13 referral pathways were identified. Few AHS resources cited evidence.

CONCLUSIONS

Paramedic practice is significantly heterogenous and most CPGs lack supporting evidence. This review can aide further evidence-mapping and validation of clinical tools and patient pathways.