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.