Thank you for the question. We hear you that there is so much up in the air and the one constant in this pandemic is change. This is a novel virus and the world is learning as we go. The best and safest management for the patient, the care providers and the community as a whole is a moving target.
We also understand that it can be overwhelming and will try to simply things as much as we can. The next iteration of the OBHG treatment recommendations that will be released has a new format which hopefully allows for clarification and ease of use.
Here and short answer followed by a more detailed one.
To make it as black and white as possible: “CONSIDER withholding” means “do not perform/administer (unless there is strong clinical reason to withhold it)”. Unfortunately, medical care is never black and white and sometimes there can be exceptions.
To help clarify, regarding wording differences between “Consider” and “Should not”, this comes down to the current wording in the ALS-PCS and the need for a statement NOT to provide treatment as you normally would in pre-pandemic times. This conventional wording is required as the ALS PCS is a legislated document and the terminology needs to be consistent.
Within the Preamble section of the ALS, under “Conventions” there is a clarifying statement that, “The word ‘consider’ is used repeatedly throughout the Medical Directives. Where this word appears, it indicates that a paramedic should initiate the treatment unless there is strong clinical rationale to withhold it. A paramedic must document his or her justification for withholding treatment on the ACR.’ To simplify this, “Consider means ‘proceed with the following’ (unless there is strong clinical reason to withhold it)”.
Within the latest OBHG Considerations for Paramedics Managing Patients during the COVID-19 Pandemic recommendations (here) the Revision Points section state “IN ALL CASES WITHHOLD” treatments that we know put you and the community at risk (i.e. nebulized medications) that were previously outlined in older versions of the recommendations (Feb 5 and Mar 20th, 2020) using the convention of “CONSIDER withholding”. The wording was changed in this most recent OBHG recommendation to be clear, as there was ongoing confusion from the paramedics.
The new treatments in this recommendations that were not included in previous OBHG recommendations say “CONSIDER withholding” in keeping with the ALS-PCS conventional wording.
To keep it simple: They mean the same thing.