The Advanced Life Support Patient Care Standards (ALS PCS) outline the specific patient care procedures authorized for Ontario paramedics, aligned with their scope of practice at the Primary Care (PCP) and  Advanced Care (ACP) levels.

ALS PCS Version 5.4

The full standards document as released by the Ministry of Health.

ALS_PCS_5.4_Final.pdf

Ministry of Health Memo on ALS PCS v5.4

This official memo from the Ministry of Health confirms the implementation of ALS PCS v5.4 and outlines the effective date.

Download MOH Implementation Memo

OBHG Companion Document for ALS PCS v5.4

Prepared by the Ontario Base Hospital Group Education Subcommittee, this educational supplement provides context, rationale, and clinical considerations to support the implementation of ALS PCS v5.4.

Download OBHG Companion Document

OBHG Memo on ALS PCS v5.4 Practice Changes

This memo from the OBHG Education Subcommittee highlights the most relevant updates in ALS PCS v5.4 that impact paramedic clinical practice and patient care.

Download OBHG Practice Changes Memo

The BLS Patient Care Standards are the Ministry of Health and Long-Term Care expectations with respect to how paramedics will interact with their patients.

The Ministry of Health (ministry) has proceeded with the implementation of patient care models for eligible 9-1-1 patients, as enabled since the regulatory and legislative changes proclaimed on November 1, 2019. These patient care models will provide eligible patients with appropriate community-based care options to improve patients’ timely access to care needed, and to reduce pressures on hospital emergency departments and ambulance services.

Dr. Michael Austin, RPPEO Medical Director, has released a new Clinical Bulletin providing guidance on the use of anti‑emetic medications in adults aged 65 years and older. This bulletin supports day‑to‑day clinical decision‑making for an ageing patient population with differing risk profiles.

The guidance clarifies how ondansetron and dimenhydrinate may be selected and dosed in older adults, with emphasis on:

• using the lowest effective dose
• weighing sedation, anticholinergic burden, and cardiac risk
• reassessment and clear documentation
• applying clinical judgment rather than age‑based rules alone

Key messages include that ondansetron is generally preferred in older adults due to lower sedation and anticholinergic effects, while dimenhydrinate may still be appropriate in selected cases. Online Medical Consultation remains available at any point when risks and benefits are unclear.

All paramedics are encouraged to review RPPEO Clinical Bulletin 3.1: Guidance on Anti‑Emetic Use in People 65 Years and Older before applying this guidance in the field.

Questions, feedback, or quality‑related concerns can be directed to Quality@RPPEO.ca.

The Regional Paramedic Program for Eastern Ontario (RPPEO) has released a Clinical Bulletin on Measles Management, developed in response to the 2025 Ontario measles outbreak.

This Clinical Bulletin reflects collaboration with paramedic services across Eastern Ontario, with particular thanks to the Ottawa Paramedic Service for providing valuable feedback on infection control and transport practices.

Measles is a highly infectious disease transmitted in the air. 

The bulletin focuses on core best practices in suspected measles, including:

The Regional Paramedic Program for Eastern Ontario (RPPEO) is supporting paramedic services as they implement the ALS PCS Auxiliary Directive for buprenorphine/naloxone (Suboxone®). This directive is an important step in improving care for patients with opioid use disorder.

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Central Resources

To help paramedics and services navigate this change, RPPEO has created a repository of guidance and tools:

• Clinical Bulletin (Revised)
  Updated RPPEO Clinical Bulletin outlining eligibility, dosing, documentation, and harm reduction principles. >>>Read Clinical Bulletin on OUD, Buprenorphine/Naloxone, and Naloxone

• MedicNEWS Articles

  In-depth coverage of Opioid Use Disorder, Suboxone® implementation, and clinical considerations.

  1. “Suboxone Authorization for Paramedics: What You Need to Know” https://sway.cloud.microsoft/YbadDTosQYN8kL9f?ref=Link

  2. “Paramedics on the Front Line of the Opioid Crisis” https://sway.cloud.microsoft/Mb1LtcDiC36dDdnx?ref=Link

• Frequently Asked Questions (FAQ)
  Answers to common questions about training, certification, and operational requirements.
  >>> View and download FAQ

• Suboxone Administration - Paramedic Poster
  Quick reference for paramedics on patching, documentation, and patient safety.
  >>>View and download poster

• OMC Video
  “Suboxone: Clinical Overview and Patch Guidance”
• RPPEO Training Module
  RPPEO Substance Use Health - Suboxone Training Module (first delivered during Fall 2024 CME): See MedicLEARN

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Consultation and Support

• Patching to OMC remains mandatory before administration. This ensures real-time clinical oversight and patient safety.
  >>>Read Medical Advisory on BHP Consultation for Consideration of Suboxone
• For questions or clarification, use MedicASK to connect with RPPEO educators and medical direction.

Your Feedback Matters

We encourage paramedics and services to share feedback on these resources and the implementation process. Your input helps us refine guidance and support tools.