RPPEO has issued a new Medical Advisory (MA-2025-02) providing clinical guidance on STEMI Hospital Bypass by Primary Care Paramedics (PCPs) with Autonomous IV (AIV) certification. The Medical Advisory comes into effect on July 22, 2025. 

This advisory recognizes that PCPs with AIV certification are equipped to effectively manage hypotension, enabling them to safely apply STEMI bypass criteria under circumstances previously limited to Advanced Care Paramedics. Specifically, it outlines when bypass to the University of Ottawa Heart Institute (UOHI) is appropriate for stable STEMI patients treated by PCP-AIVs.

This clarification does not change existing BLS PCS guidance for standard PCPs, for whom hypotension remains a contraindication to STEMI bypass.

We are seeking exceptional Primary and Advanced Care Paramedics to join our team as Education Facilitators.

Help Shape the Future of Paramedicine

As an Education Facilitator, you’ll take a lead role in strengthening paramedic practice across Eastern Ontario. Whether it’s through delivering Continuing Medical Education (CME) sessions or assessing paramedics during Entry to Practice Certification, this role offers a meaningful way to contribute to clinical excellence.

Position Summary

• Facilitate engaging educational sessions for paramedics.

• Conduct assessments of paramedic performance and certification readiness.

• Support curriculum development and educational quality improvement.

Required Qualifications

• Certified by RPPEO as a paramedic (ACP or PCP) with 3–5 years of experience.

• Skilled in interpersonal communication, critical thinking, and conflict resolution.

• Comfortable working independently and collaboratively.

• Willing to travel within Eastern Ontario.

• Experience in adult education is an asset.

📅 New Deadline to Apply: Monday, June 23, 2025, at 23:59
📧 Submit your resume and cover letter to: info@rppeo.ca

🔗 Learn more and view the full job posting: Work With Us!

A new RPPEO Medical Advisory is in effect.

Medical Advisory on Bougie Use Through Suction Catheter 2025-01 provides clinical practice guidance for RPPEO-certified paramedics.

In accordance with our preoccupation for patient safety, the Medical Advisory on Bougie Use Through Suction Catheter 2025-01 presents guidance prioritizing patient safety in the use of equipment for clinical intervention.

To develop this guidance, the RPPEO reviewed the scientific literature on catheter use as an adjunct in intubation. 

You can find all Medical Advisories in effect here on the RPPEO website.

Should you have any questions, please contact quality@RPPEO.ca or MedicLINE at 1 877 587 7736.

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.

As paramedics, staying informed means staying ready. In this edition of MedicNEWS, we spotlight several developments shaping your practice this spring.

In this issue:

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

One of the most significant updates in recent years, ALS PCS v5.4 introduces new directives, revised protocols, and clarifies standards around interventions such as analgesia, nausea/vomiting, cardiac arrest, and traumatic hemorrhage. We walk you through what’s new, what it means for your scope of practice, and what to expect next.

🦠 Measles Management: Clinical Bulletin Released

With a measles outbreak in Ontario, our updated bulletin helps paramedics focus on the clinical signs, documentation, and hospital notification procedures that matter most. Learn how to assess risk, identify mimics, and document effectively.

📚 Case Studies from the Front Lines

Medical Director Dr. Mike Austin shares two insightful case studies with real-world implications for paramedic assessment and documentation. His reflections in this month’s BHP Corner explore how even routine-seeming calls carry critical clinical weight.

🎓 CME Update: Final Trauma Day of 2025 Coming Soon

Don’t miss your last chance this year to join the hands-on Level 2 Trauma Day. Build your trauma care confidence with dynamic, scenario-driven learning.

As always, we want to hear from you! If you come across news items relevant to paramedic clinical care, send them to info@RPPEO.ca with "MedicNEWS" in the subject line.

Enjoy the issue!

Erratum - In an earlier version of the May 2025 issue of MedicNEWS, we incorrectly stated that there were changes to the Hypoglycemia Medical Directive anticipated in the June 2, 2025 ALS PCS v5.4. This was an error.

There are no changes to the Hypoglycemia Medical Directive.

The digital and PDF versions have been updated to reflect this correction. We regret the oversight and appreciate your understanding. – Editor

Read online or download the PDF version.

We are pleased to announce that Dr. Sara-Pier Piscopo has joined the Regional Paramedic Program for Eastern Ontario as a new Associate Medical Director.

Dr. Piscopo is a pediatric emergency physician with a strong background in prehospital and transport medicine. She completed her fellowship in Prehospital and Transport Medicine (PTM) at the University of Ottawa, where she developed a keen understanding of EMS systems and care delivery beyond the hospital setting.

Her clinical work has focused on pediatric emergency medicine, and she brings a depth of knowledge and experience in the acute care of children and youth.

Please join us in welcoming Dr. Piscopo to the RPPEO team!

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:

• Early recognition and patient masking
• Use of appropriate airborne precautions PPE, as outlined by your paramedic service
• Timely and effective hospital notification to minimize system disruption
• Operational reminders about running the ambulance’s internal exhaust system during and after transport, in outdoor areas only

These elements are recommended for any scenario where airborne transmission of infectious disease, such as measles, is suspected. 

Reminder on Infection control

Paramedics should be familiar with your paramedic service's policies and procedures on infection control. These are developed in consultation with provincial guidance including:

• Public Health Ontario – Routine Practices and Additional Precautions

• Ontario Ministry of Health – Patient Care and Transportation Standards (PDF)

Routine Practices

Routine Practices are the standard infection prevention and control measures applied to all patient care, regardless of suspected or confirmed infection status. They include:

• Hand Hygiene: Perform before and after patient contact, after contact with potentially contaminated surfaces, and after removing gloves.

• Personal Protective Equipment (PPE): Based on a point-of-care risk assessment, select appropriate PPE to prevent exposure to blood, body fluids, secretions, excretions, mucous membranes, non-intact skin, or contaminated equipment. This may include gloves, gowns, masks, and eye protection.

• Environmental Controls: Implement measures such as proper cleaning and disinfection of equipment and surfaces, safe handling of sharps and waste, and appropriate patient placement.

• Administrative Controls: Ensure policies and procedures are in place for infection prevention and control, staff education, and monitoring compliance.

Airborne Precautions

Airborne Precautions are additional measures used for patients known or suspected to be infected with pathogens transmitted by the airborne route (e.g., measles, tuberculosis). They include:

• N95 Respirator: Wear a fit-tested, seal-checked N95 respirator when entering the patient care area.

• Patient Placement: Place the patient in an enclosed room with the door closed. Hospitals may place patients in an airborne infection isolation room (AIIR), if available.

• Patient Transport: Limit patient movement outside a defined space. If transport is necessary, have the patient wear a surgical mask to minimize dispersal of infectious droplets. Inform the receiving hospital of the incoming patient suspected to have infectious disease (i.e., measles)

• Additional PPE: Depending on the situation and risk assessment, additional PPE such as gloves, gowns, and eye protection may be required.

It is important to note that PPE requirements may vary based on the specific clinical situation and the results of a point-of-care risk assessment. Healthcare providers should always assess the risk of exposure and select appropriate PPE accordingly.

The Clinical Bulletin on Measles Management is now posted in the RPPEO Clinical Bulletin Library and can also be accessed directly here: RPPEO Clinical Bulletin on Measles Management.

The Regional Paramedic Program for Eastern Ontario (RPPEO) is excited to announce the return of Trauma Days for 2025! Following another year of success, Eric Gagnon is back to deliver his popular and informative Trauma Day Continuing Medical Education (CME) sessions.

The online module for RPPEO's Spring 2025 Continuing Medical Education (CME) program is now available on MedicLEARN!

All Advanced Care Paramedics and those Primary Care Paramedics participating in Spring CME are encouraged to complete the online portion as soon as you can. The module available on MedicLEARN must be complete before paramedics undertake the classroom portion. 

This year’s CME, "The Competency Challenge: Mastering Rare but Essential Skills," takes a hybrid approach, blending online learning with hands-on, in-class training. The focus is on building confidence and mastery in high-acuity skills that paramedics must be ready to perform, even if they are used infrequently in the field.

What You’ll Learn

📌 Skill Mastery & Critical Interventions – Practical training in essential paramedic skills.
📌 Cognitive Practice & Visualization – Enhancing performance through mental rehearsal techniques.

Key Skill Areas:
✔ Advanced Airway Management
✔ CVAD Access
✔ Cardioversion
✔ Pacing
✔ Magill Forceps Use

Spring CME launched online on March 31, 2025. The classroom component is scheduled in collaboration with paramedic services and paramedics will receive information on their schedule from their service.

Welcome to the March 2025 issue of MedicNEWS! This edition brings you clinical updates, continuing education opportunities, and system-level developments that impact paramedic practice in our region and beyond.

News Nuggets – Quick, relevant updates from the world of paramedicine, including a critical look at a recent study on physician-paramedic teams and what it really tells us about interdisciplinary care in the field.

Continuing Education – Everything you need to know about Spring 2025 CME, where the focus is on mastering rare but essential skills through hands-on learning and cognitive rehearsal techniques. Plus, we’re excited to announce the return of Trauma Days, now with Level 1 and Level 2 sessions tailored to different experience levels.

Medical Direction: BHP Corner – A deep dive into the complex process of pronouncing death and what paramedics must consider when making this critical determination in the field.

Get Involved – The Ontario Base Hospital Group (OBHG) is seeking Paramedic Advisors to join key committees shaping education, medical direction, and data quality standards. Find out how you can contribute to provincial decision-making.

As always, we want to hear from you! If you come across news items relevant to paramedic clinical care, send them to info@RPPEO.ca with "MedicNEWS" in the subject line.

Enjoy the issue!

Read online or download the PDF version.