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.

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.

We're thrilled to share an exciting update that will improve patient care: the expansion of Online Medical Consultation (OMC) services to two more base hospitals - the Centre for Paramedic Education and Research (CPER) in Hamilton, and Health Sciences North (HSN) in Sudbury.

Palliative Care Treat & Refer Directives are now available.

The Palliative Care Medical Directives provide the standards of paramedic care for patients receiving palliative care who are attended by emergency paramedics participating in the Ministry of Health's special project, Paramedics Providing Palliative Care.

Read more

Enhance Your Pediatric Care Skills with this Expert Seminar on Trauma and Resuscitation in Ottawa on November 29

Join us on Wednesday, November 29 from 09h until 11h30 for a compelling seminar led by Jonathan Lee, an acclaimed Critical Care Paramedic and the founder of KinderMedic. Geared towards a diverse audience of healthcare professionals – paramedics, nurses, physicians, and more – this free seminar promises to elevate your knowledge and skills for managing critical pediatric trauma and resuscitation effectively.

During the session, Mr. Lee will delve into evidence-based concepts and key assessment findings crucial in pediatric resuscitation. Drawing from over 25 years of extensive experience in 911 response, critical care, aeromedical services, and pediatric critical care transport, Jonathan will also share insights on trauma for pediatric patients. These young patients often pose unique challenges, making this seminar a valuable learning opportunity for healthcare providers.

RPPEO paramedics are invited to attend a live online discussion about the landmark "DOSE VF" study on October 6, 2023 at 10am. Register now for this event!

The RPPEO has rescinded Medical Advisory 2012-006 "Drug Shortage: Atropine preload."

With the coming into effect of the Advanced Life Support Patient Care Standards version 4.9 on February 1, 2022, the Symptomatic Bradycardia Medical Directive now indicates an IV atropine dose of 1mg. This dose may be repeated twice.

Paramedics should provide treatment consistent with this directive.

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:

Fall 2023 CME for Advanced Care Paramedics launches online October 11, 2023.

The Regional Paramedic Program for Eastern Ontario (RPPEO) has revised several of our policies.

Paramedics and others for whom RPPEO policies provide guidance should note that there are two important updates to policies CLI 180 and CLI 230. Most of the other policies reviewed received minor revisions that do not substantively impact the guidance.

The revised policies and all RPPEO Policies are available in the online Policy Manual. Read on for more detail on the policy updates.

RPPEO is pleased to present an important online seminar addressing Undifferentiated Loss of Consciousness on Wednesday, February 18, 2026, from 2-3pm ET. The webinar is presented as part of RPPEO Spring 2026 CME programming. All are welcome to attend!

Pre-eminent clinical educator and STARS Air Ambulance critical care physician Dr. Katie Lin presents a lecture packed with pearls for those encountering loss of consciousness in prehospital care. Register now!