On behalf of the Base Hospital program, Ben De Mendonça, Program Director and Dr. Michael Austin, Regional Medical Director would like to provide a reminder to all RPPEO-certified paramedics of the annual requirements under ALS PCS Section 5.4 - Certification Standard (see the supplemental document RPPEO oversight and enforcement of the Certification Standards for further details). As part of our mandate, RPPEO is responsible for monitoring and enforcing these standards. We hope this communication assists you in planning for adjustments that RPPEO will implement in the 2026/27 certification year to better align our practices to these Standards regarding the 90-day Patient Care Standard.

We would like to extend our sincere appreciation to you for the effort you put in to maintaining your annual certification in line with the Maintenance of Certification Standards. Your commitment to high-quality patient care and ongoing learning is foundational to providing excellent patient care across our region.

New 90-day Patient Care Process

Starting with the 2026/27 certification year, paramedics and their services will be notified directly via email when 90 days have passed and the paramedic has no documented 911 patient care. Each paramedic will be given an additional 90-day grace period to comply with this aspect of the Maintenance of Certification Standard. Failure to meet the existing standard will result in administrative deactivation.

This change comes as RPPEO is revising our Certification Policy and procedures. RPPEO has noted inconsistent application of the 90-day Patient Care Standard across paramedics in the region, creating misalignment with the intent of the Standard and divergence from other Ontario base hospital regions.

Maintenance of Certification Standards: 90-day Patient Care 

See section 3 of the Appendix for more information on annual Maintenance of Certification.

• A paramedic must not go more than 90 consecutive days without providing patient care under regulation O. Reg. 257/00.
• If a paramedic goes more than 90 days in a row without documented patient care, the Medical Director must address the lapse.
• The Standard provides no direction on alternative methods for maintaining clinical recency.

To address this gap, RPPEO is moving toward consistent oversight and enforcement of the 90-day Standard in a step-wise approach in 2026/27. Here are key details of this approach:

As of February 1, 2026 (the start of the new certification year), RPPEO considered every certified paramedic to be at 0 days without patient contact. From that date forward, any paramedic who exceeds 180 days without an ACR record of patient care (90 days with no documented 911 patient care plus an additional 90-day grace period) will be administratively deactivated.

Should a paramedic who has been administratively deactivated wish to return to clinical activities under RPPEO oversight, RPPEO will continue to provide opportunities to complete the Return to Clinical Practice (RTCP) Process Return to Clinical Practice (RTCP) Process as well as to complete any remediation that the Medical Director deems appropriate.

Procedure for 90-day Patient Care Requirement

• Beginning on February 1, 2026, RPPEO will monitor each paramedic’s patient care episodes every 30 days.

• Ambulance Call Reports (ACR) provide the key evidence of documented patient care and will be used to monitor this requirement.
• At the beginning of April 2026, and in subsequent months, RPPEO will provide an email notification to any paramedic who has gone 60 days or more (since February 1, 2026) without documented patient care, with a copy to the paramedic’s service. The notification will remind them that the Standards require 911 patient care documented at least every 90 days.
• At the beginning of May 2026, and for subsequent months, RPPEO will provide an email notification to any paramedic who has gone 90 days or more without documented patient care, with a copy to the paramedic’s service. This notification will remind paramedics that the Standards require 911 patient care at least every 90 days and that they have an additional (temporary) 90-day grace period, for a total of up to 180 days, to meet the requirement. Failure to meet the requirement by the end of the grace period will result in administrative deactivation.
• At the beginning of July 2026, and for subsequent months, RPPEO will provide a final notice to any paramedic who has gone 150 days or more without documented patient care, with a copy to the paramedic’s service. The final notice will remind them that the Standards require 911 patient care at least every 90 days, that they are in a grace period that is set to expire, and that failure to meet the requirement by the end of the grace period will result in administrative deactivation.
• At the beginning of August 2026, and for subsequent months, any paramedic who has reached 181 days without documented patient care will be administratively deactivated.
• RPPEO will notify via email on their day of deactivation any paramedic who is administratively deactivated. The paramedic will not be eligible to receive medical delegation and will not be able to perform any controlled clinical activities.

• The grace period is a temporary measure while we adapt to full alignment with the Standards and with Ontario base hospital practice.
• Paramedics who wish to reactivate will be able to request RTCP via their paramedic service.

Communication to Stakeholders

RPPEO communicated these expectations to Paramedic Services in February 2026.

RPPEO is committed to reviewing and revising our oversight and enforcement of the 90-day Standard to strengthen the quality of care patients receive. For this and any other modification required to oversight of the Certification Standards (see Appendix), RPPEO will keep open and ongoing communication.

For questions or concerns, please contactquality@RPPEO.ca.