You'll find a major focus on palliative care with this year's online Fall CME. Giving you a better knowledge about this patient population will help in care whether or not your paramedic service goes on to implement the new care pathways that the Ottawa Health Research Institute plans to introduce through the Paramedics Providing Palliative Care Project. We've included a discussion forum in MedicLEARN to help support the lessons' content.

The Regional Paramedic Program for Eastern Ontario is pleased to announce that every paramedic in the RPPEO region is now using the RPPEO’s Online Medical Consultation (OMC) service for all patch consultations with our dedicated group of base hospital physicians (BHP).

The Ministry of Health has published a partial revision to the Advanced Life Support Patient Care Standards (ALS PCS) that will come into force on Monday, November 23, 2020.

Version 4.9 of the Advanced Life Support Patient Care Standards (ALS PCS) is now in effect.

The revisions to these Standards include changes to paramedic clinical practice. The Ontario Base Hospital Group (OBHG) Education Subcommittee has prepared a support document that discusses these practice changes.

The RPPEO has made the necessary revisions to paramedics' MedicNET profiles to provide the certifications paramedics require for these practice changes. Paramedics may notice these changes in the letter they received when their RPPEO certification renewed on February 1, 2022.

The Ontario Paramedic Clinical Guide mobile application has been updated with the ALS PCS v.4.9.

The ALS PCS version 4.9 and the support materials available in this article are available in the usual Medical Directives section of the site from February 1 forward.

Version 5.1 of the Advanced Life Support Patient Care Standards (ALS PCS) is now in effect. 

The Ministry of Health has amended version 5.0 of the ALS PCS to include 3 new treat and discharge auxiliary medical directives as well as to integrate minor edits. ALS PCS version 5.1 is in force, replacing the previously circulated version 5.0 of the ALS PCS. Support materials related to ALS PCS 5.0 are applicable to 5.1. 

The revisions to these Standards include changes to paramedic clinical practice. The Ontario Base Hospital Group (OBHG) Education Subcommittee has prepared a support document that discusses these practice changes. 

The Ontario Ministry of Health has not yet announced the release of ALS PCS v.5.4.

While the update was originally expected to take effect in February 2025, the release timeline remains uncertain. Until ALS PCS v.5.4 is formally published, paramedics should continue to follow the current ALS PCS v.5.3 directives.

For updates, please monitor the Ministry of Health’s Paramedic Practice Documents.

The Ministry of Health has issued a revised version of the Advanced Life Support Patient Care Standards (ALS PCS). Version 5.2.1 came into force on January 10, 2024.

ALS PCS v5.2.1 corrected the adult doses for atropine and the pediatric doses for pralidoxime in both the PCP and ACP Nerve Agent Exposure Medical Directives.

The Ministry of Health has released ALS PCS version 5.4, which will come into force on Monday, June 2, 2025. This update includes meaningful changes to both core and auxiliary medical directives that impact clinical practice across the region.

What’s New

ALS PCS v5.4 includes:

• Revised core directives such as analgesia, nausea/vomiting, and cardiac arrest

• New core directives for advanced airway and tracheostomy suctioning

• Optional auxiliary directives, including:

  • Tranexamic Acid (TXA)

  • Lateral patellar dislocation reduction

  • Valsalva manoeuvre

  • Ondansetron IV/IM

  • Double Sequential External Defibrillation (DSED)*
    (*Paramedics who participated in the Research Study are the only ones currently trained and authorized for DSED. Service implementation may vary.)

The Companion Document provides helpful clinical context and should be reviewed alongside the directives themselves. The Ontario Base Hospital Group Education Subcommittee has also provided this useful Implementation Memo detailing important changes.

The Education Subcommittee in collaboration with Regional Medical Directors has also produced a Video Intro to ALS PCS v5.4 that provides rationale and details on the updates. 

What You Should Do

Paramedics

Paramedics are encouraged to review ALS PCS v5.4 carefully and become familiar with the updates before the in-force date. Training has been provided on the revised core directives, and implementation of auxiliary directives may differ between services. Please speak with your service leadership about which optional directives will apply to your practice.

Paramedic Services

RPPEO has prepared Frequently Asked Questions about the implementation of ALS PCS v.5.4. The guidance helps paramedic services identify impacts of this new standard. 

📥 Download ALS PCS v5.4 Implementation FAQ version 2 (May 27, 2025).

📥 Download ALS PCS v5.4 and the Companion Document.

📧 If you have any questions, reach out to: education@rppeo.ca

Let’s continue to deliver safe, evidence-based care — together.

The Ministry of Health has released the newest iteration of the Advanced Life Support Patient Care Standards (ALS PCS), version 5.2. This updated version of the Standards comes into force on Monday, July 10, 2023.

Immediate practice-related changes are limited and include updates to 2 core medical directives (Opioid Toxicity and Withdrawal Medical Directive and Nausea/Vomiting Medical Directive). Paramedics will find changes to auxiliary medical directives within the Chemical Exposure directives and the Special Event directives.

A new clinical app is on its way! Here are the details:

The Ontario Base Hospital Group is pleased to inform you that a new clinical app for Ontario paramedics is coming!

All new app, all new name

In anticipation of creating a new app, we distributed a survey this spring about the naming of a new app. Thank you for completing our survey. We received lots of great suggestions for the new clinical app!

Spring 2022 CME features live events and online content

Spring 2022 CME is a two-part offering again this year, with both virtual workshops for live participation or recorded viewing and online learning modules. 

Two optional live virtual workshops are coming to Spring 2022 CME's core learning for RPPEO-certified ACPs! PCPs are also invited to participate in the live or recorded CME events.

The Regional Paramedic Program for Eastern Ontario is pleased to launch Spring 2023 CME's online learning component on Monday, March 27, 2023.

In Spring 2023 CME, RPPEO presents "Discharge from Care," provincially developed training about out of hospital treat and discharge. This is the training that paramedics require to receive authorization to apply the new auxiliary medical directive options in the Advanced Life Support Patient Care Standards (ALS PCS) version 5.1 for patient discharge planning.

A new RPPEO Clinical Bulletin on Opioid Use Disorder, Buprenorphine/naloxone, and Naloxone is now available.

This Clinical Bulletin provides paramedic practice guidance from the Regional Medical Director on the appropriate administration of naloxone in the context of opioid toxicity, and differentiates naloxone from the new combined medication for opioid withdrawal in the prehospital context, buprenorphine/naloxone.

Paramedics are invited to consult Health Canada's posted version of the Canadian monograph for buprenorphine/naloxone (trade name "Suboxone") for more detailed information of this new drug's pharmacology, indications, contraindications, and risk management.

We invite paramedics who have questions or concerns about this Clinical Bulletin, naloxone, buprenorphine/naloxone, Opioid Use Disorder, or opioids more generally to contact quality@RPPEO.ca.

Note that RPPEO has not yet authorized any paramedic use of the auxiliary aspects of the Opioid Toxicity and Withdrawal Medical Directive in the ALS PCS. While buprenorphine/naloxone is not yet available for paramedic administration within the RPPEO jurisdiction, we are planning the infrastructure and training needed to support implementation of this important treatment.

Each paramedic may find their current practice authorizations in the most recent RPPEO Certification Letter available within the 'My Profile' section on MedicNET. When RPPEO issues a new Certification Letter, it is also provided to the paramedic via email.

This is the first RPPEO Clinical Bulletin. The format is intended to provide clinical discussion about issues affecting paramedic practice. RPPEO Clinical Bulletins communicate the best front-line strategies for emerging clinical issues in the region using rich formats with text, images, charts or other visual supports. In contrast to Medical Advisories, Clinical Bulletins do not provide new direction; rather, they clarify concepts and inform paramedics and other partners about clinical practice.

RPPEO Clinical Bulletins are available at RPPEO.ca in the RPPEO Policies section. 

RPPEO paramedics are invited to attend an online discussion about the landmark "DOSE VF" study on October 6, 2023 at 10am. Dr. Sheldon Cheskes, principal investigator and lead author of the paper, Defibrillation Strategies for Refractory Ventricular Fibrillation published last year in the New England Journal of Medicine, will present and host a discussion. 

This live webinar is presented as part of RPPEO Fall 2023 CME. Paramedics who attend the live event will receive credit toward Fall CME requirements. This year, ACPS are required to complete Fall CME. PCPs are welcome to attend this event and any who are planning to complete Fall CME will receive credit. 

Registration details are forthcoming.

The Regional Paramedic Program for Eastern Ontario is pleased to announce the Ottawa Hospital’s appointment of Dr. Michael Austin, MD, FRCPC, DRCPSC (PTM) to the position of Regional Base Hospital Medical Director effective July 1, 2023.

You'll find the complete learning package for Fall 2021 CME in MedicLEARN.

This entirely online CME launched on October 13, 2021 for all paramedics certified at the RPPEO. Certified paramedics have until the end of the current certification period - January 31, 2022 - to complete Fall 2021 CME as well as any other requirements for maintenance of certification.

Get Started

The Regional Paramedic Program for Eastern Ontario is pleased to announce the full lineup for your 8-hour Fall 2022 CME!

Paramedics participating in Fall 2023 CME are invited to complete the online module now available on MedicLEARN.

Under the theme "Matters of the Heart," paramedics will learn and practice skills related to cardiac care during Fall CME. The online didactic portion accounts for 4 hours of content and includes:

• medical cardiac arrest management
• tachycardia with a focus on synchronized cardioversion
• bradycardia with a focus on transcutaneous pacing
• STEMI and sex bias
• Left Ventricular Assist Device (LVAD)

The RPPEO is pleased to announce the full lineup for Fall 2023 CME under the theme At the Heart of the Matter: Emergency Cardiac Care. Advanced Care Paramedics (ACP) certified by the RPPEO and Primary Care Paramedics (PCP) from participating paramedic services are invited to learn the latest evidence-based approaches and practise intervention skills for cardiac emergencies.

A new RPPEO Medical Advisory is in effect.

Medical Advisory on Cardiac Arrest On-scene Resuscitation Time (2024-01) provides clinical practice guidance for RPPEO-certified paramedics.

You may find this Medical Advisory and other written RPPEO guidance in the Policies and Practices section of RPPEO.ca.

Ondansetron (Zofran) is the preferred medication over dimenHYDRINATE (Gravol) to treat nausea / vomiting in patients 65 and older. Paramedics can consult (patch) a Base Hospital Physician (BHP) if they believe an antiemetic is indicated for patients 65 and older and ondansetron is not available.

Paramedics should read Medical Advisory DimenHYDRINATE (Gravol) for Patients 65 and Older. If you have any questions, please contact quality@RPPEO.ca.

A new RPPEO Medical Advisory is in effect.

Medical Advisory on Discontinuation of Cardiac Monitoring in the ED 2023-01 provides clinical practice guidance for RPPEO-certified paramedics.

In accordance with our preoccupation for patient safety, the Medical Advisory on Discontinuation of Cardiac Monitoring in the ED 2023-01 presents guidance prioritizing patient safety in the face of scarce resources.

Following the identification of patient safety incidents regarding use of IV EPINEPHrine for anaphylaxis across the region, Dr. Richard Dionne, Regional Medical Director, has issued an important Medical Advisory for paramedics. This Medical Advisory identifies the patient safety risks associated with using the IV route in administration of EPINEPHrine for anyone who is profusing.

Paramedics should read Medical Advisory 2022-02. If you have any questions, please contact quality@RPPEO.ca.

The Ministry of Health's Emergency Health Regulatory and Accountability Branch has published a partial revision to the Provincial Equipment Standards for Ontario Ambulances version 3.6. The revised Equipment Standards come into force on Monday, December 20, 2021.

The Ministry has also provided a Summary of Changes to version 3.6 of the Equipment Standards.

For a complete list of all the up-to-date standards for Ontario paramedicine, please visit the Paramedic Practice Documents page on the Ministry of Health website.

If you have any questions about this update, contact ParamedicStandards@Ontario.ca.

The Ontario Base Hospital Group Education Subcommittee (OBHG ESC) has released its Companion Document for the Advanced Life Support Patient Care Standards version 5.1. 

The Companion Document is an educational tool that helps to provide clarification on changes and updates to the Advanced Life Support Patient Care Standards.

Medical Directives Page

• Paramedics with disabilities can request accommodations for barriers they encounter in certification, education, or other RPPEO services.
• Each request will be evaluated individually, and appropriate accommodations will be determined collaboratively.
• The policy is available on RPPEO.ca in the Policy section.

The Ontario Base Hospital Group (OBHG) is seeking applications for new representation from front line paramedics for all provincial committees:

• Ontario Base Hospital Group Medical Advisory Committee (OBHG MAC) -2
• Data Quality Management Subcommittee (DQM) -1
• Education Subcommittee (ESC) -1

 Term: April 1, 2024 – March 31, 2027

For more information about this opportunity and how to apply, please see the invitation on the OBHG website. Note that the application deadline is March 1, 2024.

More information about OHBG and its committees is available by visiting the Paramedics section of the OBHG website. 

Remember when you could bring a page of notes into your math exam? Having all the formulas written out in your teeny-tiny scribble really helped not to forget that r was squared and c was a constant equal to the speed of light.

Now you've got a similar tool integrated into the Ontario Paramedic Clinical Guide.

The new tool isn't for math, though. The Ontario Base Hospital Group put the key highlights for applying the prehospital Canadian Triage and Acuity Score (CTAS) to your adult patients into graphic form.