As part of our ongoing work to strengthen medication stewardship and controlled substances oversight, RPPEO has completed a review and revision of several internal policies. While most changes were administrative or formatting in nature, we made one substantive revision that may affect clinical work:

CLI 120 – Ordering and Managing Controlled Substances

The updated policy now includes the following clarifications:

• Expanded Scope: The policy explicitly applies to RPPEO staff, paramedic services, and certified paramedics.
• Authorized Use: Medications prescribed by the RPPEO Medical Director may only be used for their intended clinical purpose and patient, as aligned with Ministry of Health standards for emergency ambulance services, as defined in the Ambulance Act, R.S.O. 1990, c. A.19, such as the Advanced Life Support Patient Care Standards and approved Patient Care Model Standards. Any other use must be authorized through direct consultation with a Base Hospital Physician.

These changes are part of a broader RPPEO Action Plan on Controlled Substances Oversight. The plan reflects our commitment to support safe, appropriate, and transparent medication practices, and will include further improvements to processes, education, and documentation over the coming months.

We encourage all RPPEO-certified paramedics to review the revised CLI 120 policy, which is available on the RPPEO website.

If you have any questions or feedback, please contact us at quality@RPPEO.ca.

Click to download a copy of the RPPEO Memo on CLI 120 Revision. 

The Regional Paramedic Program for Eastern Ontario (RPPEO) is pleased to introduce the Fall 2025 Continuing Medical Education (CME) course Critical Interventions, Critical Thinking: From Emergency Childbirth to Medication Safety.

Starting on Tuesday, September 2, 2025, paramedics will have access to the Fall 2025 CME online module via MedicLEARN. This hybrid CME session is designed to enhance your critical thinking and skill mastery in essential areas of paramedic practice.

The Fall CME session is for both Advanced Care Paramedics (ACPs) and Primary Care Paramedics (PCPs).

What You'll Learn

This Fall, we begin an educational series on patient history-taking as part of a broader focus on advancing paramedic assessment skills. In Fall 2025 CME, you will be digging into two of the twelve different themes: medication history and past medical history. These are essential components of both advanced patient assessment and our ongoing commitment to medication safety.

Paramedics will gain a deeper understanding of how accurate and comprehensive history-taking contributes to clinical decision-making, patient safety, and effective care in the field.

Main Topics

• Emergency Childbirth: Gain comprehensive knowledge and practical skills in managing emergency childbirth, including handling complications such as nuchal cord, cord prolapse, shoulder dystocia, and more.

• Newborn Resuscitation: Learn and practice life-saving techniques for newborn resuscitation, including CPR, airway management, and positive pressure ventilation.

• Medication Safety: Focus on safe medication administration, correct dosing practices, and minimizing errors to ensure patient safety.

• Advanced Patient Assessment: Develop advanced skills in taking the best possible past medical history, which improves clinical decision-making and patient safety in both complex and critical situations.

Evaluation

This Fall, you will once again complete evaluation components during both online and in-class CME. This evaluation is formative and supportive, designed to reinforce skill retention and offer constructive feedback.

Why?

• Ongoing Competency: RPPEO provides training, feedback, and medical advisories to help paramedics maintain competency across the full scope of clinical practice. We want to create an opportunity for paramedics to refresh their skills, receive feedback, and continue to grow in a structured, supportive environment.
• Professional Accountability: While RPPEO facilitates training, paramedics must take an active role in maintaining proficiency in all areas of practice as a healthcare professional.
• Medical Oversight: Medical Directors delegate controlled medical acts only to paramedics they believe to be competent. This underscores the importance of maintaining proficiency in all areas.

How?

• Pharmacology and Medical Safety Assessment: As part of the Fall 2025 CME, you will complete a Pharmacology/Medical Safety Knowledge Assessment. This assessment is not designed to be pass/fail but to highlight the level of pharmacological understanding that RPPEO, our Medical Director, and our patients expect from paramedics. It is an opportunity for self-reflection, helping you identify areas of strength and areas for further development in pharmacology knowledge.The questions will cover critical topics, including pharmacokinetics, autonomic and CNS pharmacology, cardiovascular and respiratory medications, and much more. Our goal is to build confidence and competence in paramedic decision-making, providing safe, informed, and patient-centered medication practices. By understanding the “poisons” we use - their mechanisms, benefits, and risks - paramedics will be better equipped to provide exceptional care. This tool will reinforce your professional responsibilities in understanding the pharmacology of medications you carry, challenge your clinical thinking, and promote continuous self-directed learning expected of a health professional.  
• Formative Evaluation: The CME evaluation is not punitive but a helpful tool for skill development, reinforcing learning and giving you a clearer sense of areas for improvement no matter what your scope of practice.

Completion and Certification

Participation in both the online and in-class components of Fall 2025 CME is mandatory for both ACPs and PCPs and contributes to your annual Maintenance of Certification requirements.

Online Module Launch: Tuesday, September 2, 2025
In-Class Sessions Begin: Monday, September 15, 2025 – your service will provide your CME schedule

IMPORTANT NOTICE: All participants must complete the online module before attending the in-person practical component to fully prepare for hands-on practice and discussion.

For certification and continuing education requirements, please visit RPPEO.ca for more information. You are encouraged to check your status in MedicNET from time to time so that you may verify your progress toward annual Maintenance of Certification requirements. MedicNET now automatically emails you when you complete a milestone (such as Fall CME) to help remind you of your progress toward maintenance of certification

We look forward to your participation in this engaging CME experience, which is designed to build critical skills and help paramedics continue to provide safe and effective care for your patients.

Are you passionate about evidence-based practice? Do you want to collaborate directly with physicians and clinical leaders to guide the next evolution of paramedic care? Here's your chance.

The Regional Paramedic Program for Eastern Ontario (RPPEO) is excited to announce recruitment for the Clinical Practice Evidence Panel (CPEP) — a select group of paramedics who will help lead the Comprehensive Medical Directive Review (CMDR).

What Is CPEP?

CPEP is a voluntary, multidisciplinary team formed to evaluate clinical evidence and make recommendations on updating two critical medical directives: the Combative Patient Directive and Analgesia Directive (adult and pediatric). These recommendations will be submitted to the Medical Advisory Committee (MAC) by December 2025.

This initiative represents more than just a review — it’s the foundation of a long-term evidence review mechanism that could influence provincial standards.

Learn more about being a CPEP member here. 

What Will You Do?

As a member of CPEP, you’ll:

• Collaborate in bi-weekly virtual meetings (approx. 3 hours)

• Review and interpret clinical evidence with fellow paramedics, physicians, and research staff

• Apply your frontline insights to ensure recommendations are grounded in operational realities

• Receive CME credit for your contributions

Who Should Apply?

We’re looking for:

• Primary Care Paramedics (PCP), PCP-AIV, and Advanced Care Paramedics (ACP)

• Paramedics from urban, suburban, and rural environments

• Individuals with a strong interest in evidence-informed care

• Clinicians who are collaborative, curious, and eager to help shape practice standards

Your leadership reference is required as part of your application.

How to Apply

1. Download the Application Form here (fillable Word document).

2. Submit your completed form, leadership reference, and resume to: info@RPPEO.ca

3. Use subject line: “Clinical Practice Evidence Panel Application”

📌 Deadline: August 18, 2025

Have Questions?

Reach out to:
Charlene Vacon, EMS Specialist
Lvacon@RPPEO.ca

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.