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RPPEO General Info

Advanced Life Support

Patient Care Standards

Version 4.5

Comes into force May 1, 2018

Download v.4.5

For a summary of changes click here

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ALS PCS v.4.9 Now in Effect

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.

Read more …ALS PCS v.4.9 Now in Effect

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ALS PCS v.5.1 Now in Effect

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. 

Read more …ALS PCS v.5.1 Now in Effect

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ALS PCS v.5.4 – Implementation Delay

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.

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ALS PCS v5.2.1 in Force January 10, 2024

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.

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ALS PCS v5.3 in Force February 9, 2024

The Ministry of Health has issued a revised version of the Advanced Life Support Patient Care Standards (ALS PCS). Version 5.3 came into force on February 9, 2024.

ALS PCS v5.3 added intranasal glucagon to the Hypoglycemia Medical Directives for trained and authorized paramedics.

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ALS PCS v5.4 Comes Into Force June 2, 2025

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.

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ALS PCS version 5.2 in Force July 10

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.

Read more …ALS PCS version 5.2 in Force July 10

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Announcing A New Clinical App for Ontario Paramedics

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!

Read more …Announcing A New Clinical App for Ontario Paramedics

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