Overview

The Ministry of Health, Emergency Health Services Division, is responsible under the Ambulance Act for publishing standards for patient care, documentation, safety, equipment requirements and transportation. These requirements are outlined in various paramedic practice documents such as standards, training bulletins, manuals and guides.

Standards set the requisites for paramedic practice; many are incorporated by reference in O. Reg 257/00 as made under the Ambulance Act. Training bulletins provide clarification regarding current issues or make amendments to existing standards and manuals and guides further direct practice.

Click on the document titles in the tables below to access a copy of the document. If the document is in a non-accessible format, clicking on the link will automatically initiate an email to EHS to allow you to request a copy of the document.

As per Ontario government services standards, all emails will be acknowledged within two business days and answered within 15 business days.

Living standards

Living standards were established to update, maintain, and disseminate paramedic practice documents. This process recognizes that development and maintenance is a cyclical process in which publication of a revised version is both the end of one process and the start of another. Documents are reviewed on set maintenance cycles, but requests for change can also be made on an ad hoc basis.

To request a Change Request Form, please email ParamedicStandards@ontario.ca.
Version numbers may have up to three numeric digits and one alpha value (for example, 0.0.1.a) depending on the document’s state (but always a minimum of two). Please note:

  • the first numeric digit will indicate the full update version number
  • the second numeric digit will indicate the partial update version number
  • the third numeric digit will indicate the update due to a reissue after a publication error (if applicable)
  • the alpha value (listed after the numeric digits) will indicate the draft version number (if applicable)

Documents which stakeholders and the public can comment on are posted on the Proposed changes to documents page.

Patient care documents by reference

The standards listed in this table are incorporated by reference into O. Reg 257/00 as made under the Ambulance Act. Once a new version of a standard comes into force, it replaces the existing, in force version.

StandardsVersionIn force as of
Advanced Life Support Patient Care Standardsversion 5.3February 9, 2024
Ambulance Service Communicable Disease Standardsversion 2.1March 2, 2022
Basic Life Support Patient Care Standardsversion 3.4March 10, 2023
Patient Care Model Standardsversion 1.1January 27, 2023
Ontario Ambulance Documentation Standardsversion 3.0April 1, 2017
Patient Care and Transportation Standardsversion 2.7August 19, 2022
Provincial Equipment Standards for Ontario Ambulance ServicesVersion 3.7.1February 9, 2024
Ontario Provincial Land Ambulance and Emergency Response Vehicle Standardversion 6.1November 1, 2023
List of Certified Vehicle ManufacturersVersion - December 1, 2023October 31, 2023
Land Ambulance Certification StandardsVersion 1.4August 2, 2022

Other patient care documents, manuals and guides

The documents in the table below provide clarification regarding current issues and address such things as safety, equipment requirements and additional direction for practice.

Training bulletinsIssue dateIn force as of
Training Bulletin No. 101
Influenza Educational Review 2021-2022, version 20.0
October 27, 2021N/A
Training Bulletin No. 120
Novel Coronavirus (COVID-19), version 1.6
October 1, 2020N/A
Manuals and guidesVersionIn force as of
COVID-19 Screening Tool for Paramedicsversion 2.0August 26, 2021
Ambulance Call Report (ACR) Codesversion 3.0N/A
Ambulance Call Report (ACR) Completion Manualversion 3.0April 1, 2017
Infection Prevention and Control Best Practices Manual for Land Ambulance Paramedicsversion 1.0March 30, 2007
Prehospital CTAS Paramedic Guideversion 2.0December 31, 2016

Paramedic practice documents archive

Once a new version of a paramedic practice document comes into force, the previous version will be archived here.

To request a copy of any of the archived paramedic practice documents (documents incorporated by reference), click on the document title. If the document is in a non-accessible format, clicking on the link will automatically initiate an email to EHS to allow you to request a copy of the document.

StandardsVersionIn force as of
Advanced Life Support Patient Care Standardsversion 3.3February 1, 2016
Amendment to version 3.3 (Opioid Toxicity Medical Directives)December 23, 2016
version 3.4February 1, 2017
Amendment to version 3.4 (Opioid Toxicity Medical Directives)February 1, 2017
version 4.3July 17, 2017
version 4.5May 1, 2018
version 4.6.1October 23, 2019
version 4.7April 8, 2020
version 4.8November 23, 2020
version 4.9February 1, 2022
version 5.1February 1, 2023
version 5.2July 10, 2023
version 5.2.1January 10, 2024
Ambulance Service Communicable Disease Standardsversion 2.0August 1, 2015
Basic Life Support Patient Care Standardsversion 2.0January 1, 2007
version 3.0.1December 11, 2017
version 3.1March 1, 2018
version 3.2September 3, 2019
version 3.3January 11, 2021
Ontario Ambulance Documentation Standardsversion 2.0April 1, 2000
version 2.1July 1, 2016
Patient Care and Transportation Standardsversion 2.0October 1, 2007
version 2.1July 18, 2016
version 2.2July 22, 2016
version 2.3April 8, 2020
version 2.4October 22, 2020
version 2.5March 3, 2021
version 2.6December 31, 2021
Provincial Equipment Standards for Ontario Ambulance Servicesversion 2.3February 1, 2016
version 3.2July 17, 2017
version 3.3December 11, 2017
version 3.4May 1, 2018
version 3.5April 8, 2020
version 3.6December 20, 2021
version 3.7February 1, 2023
Training bulletinsVersionIn force as of
Training Bulletin No. 101
Influenza Educational Review 2020-2021, version 19.0
October 7, 2020N/A
Training Bulletin No. 105
Personal medical information programs, version 1.0
July 26, 2005N/A
Training Bulletin No. 106
Summary of Major Revisions BLS PCS (version 2.0), version 1.0
October 20, 2006N/A
Training Bulletin No. 108
DNR Standard
version 1.0February 1, 2008
Training Bulletin No. 109
Penetrating Chest Injuries, version 1.0
March 26, 2010N/A
Training Bulletin No.110
Revised Paramedic Prompt Card for Acute Stroke Protocol
version 1.0September 1, 2011
Training Bulletin No.111
Deceased Patient Standard
version 1.0March 1, 2011
Training Bulletin No. 112
Excited Delirium, version 1.0
February 28, 2012N/A
Training Bulletin No. 113
Field Trauma Triage and Air Ambulance Utilization Standards
version 1.0June 1, 2015
Training Bulletin No. 114
Ebola Virus Disease, version 4.0
September 20, 2015N/A
Training Bulletin No. 115
Ambulance Service Communicable Disease Standards (version 2.0), version 1.0
November 21, 2014N/A
Training Bulletin No. 116
Child in Need of Protection Standard
version 1.0June 1, 2015
Training Bulletin No. 117
Infectious Disease Physicians Consultation Process Training Bulletin
version 1.0August 25, 2015
Training Bulletin No. 118
STEMI Hospital Bypass Protocol
version 1.0February 1, 2017
Training Bulletin No. 119
Basic Life Support Patient Care Standards, version 3.0, version 1.0
July 20, 2016N/A
Manuals and guidesVersionIn force as of
Ambulance Call Report (ACR) Completion Manualversion 2.2June 1, 2003