Chiropractors: Considerations in Providing “Emergency Care”

Effective 11:59 p.m. on March 24, 2020, the Ontario government ordered the closure of “non-essential” workplaces.  The list of “essential” workplaces included “health care professionals providing emergency care including dentists, optometrists and physiotherapists”.

The College of Chiropractors of Ontario (“CCO”) interprets this list as including chiropractors, and we agree.

So the question becomes – what is “emergency care”?

The CCO’s website has helpful information and ongoing updates as to the CCO’s interpretation of what constitutes “emergency care”.  We expect that, within reason, the province would defer to the CCO in interpreting “emergency care” as it relates to chiropractic practice. 

Currently, the CCO has defined “emergency care” as including the following:

• “Care for patients experiencing a sudden and debilitating change in functional abilities (understood as walking, standing, sitting, lifting floor-to-waist or waist-to-shoulder, stair climbing, ladder climbing) or significant restrictions (experienced during bending/twisting, repetitive movement, pushing/pulling with right/left arm) as well as injury to head/neck/back and extremities”; and/or

• Treatment aimed at alleviating significant pain, understood as pain that is incapacitating for the patient and interferes with their ability to carry out normal functioning”.

The CCO also notes generally that the member needs to weigh the value of treatment against the risk when deciding to treat a patient.

In terms of risk assessment, you need to consider the risks of treatment not only to the patient and yourself, but also to other patients, staff and - at this time of collective physical distancing - the public at large.

Before deciding to treat, in addition to determining whether the proposed treatment constitutes “emergency care”, perform active screening of the patient for COVID-19 risk factors in advance and over the phone before scheduling the in-person treatment sessions.  Do not treat if you yourself have travelled in the previous 14 days, have symptoms of COVID-19, or have come into contact with individuals who have been diagnosed with or deemed to be a presumptive case of COVID-19.

If you do decide to treat, manage your risk by doing the following:

• Take precautions including physical distancing as much as possible and observe the highest levels of hygiene protocols;
• Stay within your scope of practice even if the patient is pressing for more due to the scarcity of other healthcare services;
• Document not only your treatment, but also why you deemed this to be “emergency” treatment;
• Don’t take shortcuts – even though this is a pandemic, unless expressly stated otherwise, the usual CCO standards of practice, policies and guidelines apply.

NOTE:  This blog was written on March 25, 2020, and was current as of that date.  A blog post is never a substitute for legal advice specific to your situation, and that is particularly so when circumstances are changing so rapidly. 

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