Advanced Life Support Patient Care Standards (ALS PCS)

The Ministry of Health's Emergency Health Services Division (EHSD) is seeking feedback on proposed updates to the Advanced Life Support Patient Care Standards (ALS PCS) Version 5.5. The ALS PCS contains the medical directives that guide the delivery of patient care by paramedics across Ontario. Proposed revisions are developed and recommended to EHSD by the Ontario Base Hospital Group Medical Advisory Committee (OBHG MAC), the medical authority for Ontario paramedics.

The proposed changes in Version 5.5 include:

  • Updates to the Preamble, including revisions related to Patching and Pediatrics.
    • Updates to several Primary Care Paramedic (PCP) and Advanced Care Paramedic (ACP) core medical directives to reflect current best medical practice, including:
    • Advanced Airway and Tracheostomy Suctioning & Reinsertion Medical Directive (Treatment)
    • Medical Cardiac Arrest Medical Directive
    • Traumatic Cardiac Arrest Medical Directive
    • Newborn Resuscitation Medical Directive
    • Nausea and Vomiting Medical Directive (PCP only)
    • Analgesia Medical Directive (ACP only)
  • Introduction of three new PCP auxiliary medical directives:
    • Narcotic Analgesia Medical Directive
    • Combative Patient Medical Directive
    • Seizure Medical Directive
  • Updates to the PCP Auxiliary Tachydysrhythmia Medical Directive.
  • Updates to the ACP Procedural Sedation Auxiliary Medical Directive.
  • Comprehensive revisions throughout the ALS PCS to incorporate gender-neutral language, replace the term "pre-hospital care" with "out-of-hospital care", and improve formatting consistency.

The ALS PCS Version 5.5 document is being posted for public consultation for 30 days. To review and download the document, please click the link below.

Feedback may be submitted to ParamedicStandards@Ontario.ca. We welcome comments from paramedics, stakeholders, and members of the public during the consultation period

Advanced Life Support Patient Care Standards - Version 5.5

Document Name/Version:Advanced Life Support Patient Care Standards - Version 5.5
Posting Date:August 28, 2026
Comments Due Date:September 27, 2026
Proposed in force date:TBD
Summary of Proposal:Updates to the Preamble, PCP & ACP Advanced Airway and Tracheostomy Suctioning, PCP & ACP Medical Cardiac Arrest, PCP & ACP Traumatic Cardiac Arrest, PCP & ACP Newborn Resuscitation, PCP Nausea and Vomiting, PCP & ACP Tachydysrhythmia, ACP Analgesia, ACP Procedural Sedation and Certification Standard definitions. Addition of PCP Narcotic Analgesia, Combative Patient and Seizure
Comments can be sent to:ParamedicStandards@Ontario.ca

Past proposed changes

Document name/versionPosting dateComments due dateSummary of proposal
Patient Care and Transportation Standards – V3.0October 20, 2025November 18, 2025New definitions section as well as minor changes to communicable disease management were added to enhance understanding and consistency. Updates to crew configurations and influenza reporting/education requirements.
Ontario Provincial Land Ambulance and Emergency Response Vehicle Standard - Version 7.0July 28, 2025August 28, 2025Changes made to ambulance and ERV certification timelines and various design parameters to encourage innovation.  Includes updated language to clarify the requirement of the Professional Engineer (P.Eng).
Ontario Ambulance Documentation Standards 4.0.vJune 20, 2024August 3, 2024Under the living standards process the ministry has updated several aspects of the Ontario Ambulance Documentation Standards including expanded definitions, updated incident reporting requirements, the addition of minimum electronic documentation requirements and the addition of a minimum data set.
Ontario Provincial Land Ambulance and Emergency Response Vehicle Standard - Version 6.1September 27, 2023October 17, 2023Changes made to the oxygen system performance test. Requirements added to ensure all ambulance are equipped with the necessary devices for safe transport of all patients. Please send comments to ParamedicStandards@ontario.ca.
Advanced Life Support Patient Care Standards v5.2.g
(Draft)		May 17, 2023June 16, 2023Since the publication of the Advanced Life Support Patient Care Standards, version 5.1, under the living standards process, the ministry has received input from the Ontario Base Hospital Group to update medical directives to align with clinical evidence for best practice and high quality patient care.
Basic Life Support Patient Care Standards (BLS PCS) v3.4.aJanuary 24, 2023February 7, 2023Since the publication/in force date of the BLS PCS v3.3, the ministry has received numerous recommendations from various sector stakeholders. These minor changes are being made to align the BLS PCS to other standards published by the ministry.
Patient Care Model Standards v1.1December 21, 2022January 13, 2023The patient care models (PCM) for select 9-1-1 patients aim to provide appropriate health care options in community-based care settings instead of visiting the emergency department. This initiative was initially launched in 2020 with patient eligibility and model types defined in the Patient Care Model Standards version 1.0a. In August 2022, the Government approved the expansion of patient care models with broader patient eligibility and one additional model - Treat & Discharge. The Patient Care Model Standards version 1.1 has incorporated revisions based on input from clinical experts and sector partners on the expansion to ensure patient safety.
Medical directives for Treat & Discharge, as part of the Advanced Life Support Patient Care Standards (ALS PCS) v5.1December 21, 2022January 13, 2023To support the expansion of PCM initiative noted above, the Ontario Base Hospital Group Medical Advisory Committee (OBHG MAC) has developed five (5) medical directives for Treat & Discharge to be included in the ALS PCS v5.1.
Provincial Equipment Standards for Ontario Ambulance Services v3.7.aNovember 2, 2022November 30, 2022Since the publication/in force date of the Provincial Equipment Standards for Ontario Ambulance Services, version 3.6, under the living standards process, the Medical Advisory Committee (MAC) has requested both additions and amendments to ALS PCS affecting this equipment standard. Minor updates were also made to the Standard.
Advanced Life Support Patient Care Standards (ALS PCS) v5.0August 11, 2022October 3, 2022Since the publication/in force date of the ALS PCS, version 4.9, under the living standards process, the Medical Advisory Committee (MAC) has requested both additions and amendments to ALS PCS.
Advanced Life Support Patient Care Standards v4.9.a
(Draft)		October 21, 2021November 21, 2021Since the publication of the Advanced Life Support Patient Care Standards, version 4.8, under the living standards process, the ministry has received input from the Ontario Base Hospital Group to update medical directives to align with clinical evidence for best practice and high-quality patient care. An additional proposed change to address delays in initiating treatment is also included for the “Preamble” section.
Equipment Standards v3.6.a
(Draft)		September 21, 2021October 21, 2021Since the publication/in force date of the Provincial Equipment Standards for Ontario Ambulance Services, version 3.5, under the living standards process, the ministry received change request forms requesting a shift toward reusable personal protective equipment and better alignment of paediatric equipment to follow the 2020 American Heart Association’s (AHA) Pediatric Advanced Life Support (PALS) Guidelines. Additionally, other housekeeping updates have also been made to this draft.
BLS PCS v3.2.a (Draft)September 17, 2020October 17, 2020Since the publication/in force date of the BLS PCS v3.2, the ministry has received numerous recommendations from sector stakeholders and the Ontario Base Hospital Group Medical Advisory Committee.
ALS PCS v4.7.a (Draft)September 17, 2020October 17, 2020Since the publication/in force date of the ALS PCS v4.7, the ministry has received numerous recommendations from sector stakeholders and the Ontario Base Hospital Group Medical Advisory Committee. In addition to the proposed change to the ALS PCS v4.6.1 posted December 16, 2019 – updates to the “Assessment of Patients with Possible COVID–19 Medical Directive – AUXILIARY” are also being considered for publication.
Patient Care Model Standards v1.0aJanuary 7, 2020January 21, 2020The Patient Care Model Standards set out requirements for municipal ambulance services seeking approval from the ministry to implement new models of care that would permit select low-acuity 9-1-1 patients to receive appropriate community-based care, rather than transport to the Emergency Department. This includes requirements of paramedics for providing patient care that extends beyond the “Basic Life Support Standards” and the “Advanced Life Support Standards” for the purposes of implementing new models of care.
ALS PCS v4.6.1.a (Draft)December 16, 2019January 24, 2020Since the publication/in force date of the ALS PCS v4.6, the ministry has received numerous recommendations from the Ontario Base Hospital Group Medical Advisory Committee and Change Requests from various stakeholders. For a detailed description of proposed changes, please email ParamedicStandards@ontario.ca.
Provincial Equipment Standards for Ontario Ambulance Services v3.4.a (Draft)December 16, 2019January 24, 2020Since the publication/in force date of the Provincial Equipment Standards for Ontario Ambulance Services, version 3.4, the ministry has reviewed equipment included in this document that more appropriately falls under the responsibility of the ambulance service operator (for example, the employer) to provide and ensure compliance as per the Occupational Health and Safety Act, R.S.O. 1990, c. O.1. It is proposed that these standards be removed from this document. A new supraglottic airway standard has been added. Additionally, other housekeeping updates have also been made to this draft.
BLS PCS v3.1.a (Draft)January 28, 2019March 14, 2019Since the publication/in force date of the BLS PCS v3.1, the ministry has received numerous recommendations from the Ontario Base Hospital Group Medical Advisory Committee and Change Requests from various stakeholders.
ALS PCS v4.6 (Draft)August 14, 2019August 30, 2019Since the publication/in force date of the ALS PCS v4.5, several medical directives that were introduced as auxiliary are now being used by all services across the province. Therefore, these directives are being moved from the auxiliary appendices into the core appendices. The Research Trial Standard which has been added to BLS PCS v3.2 (previously posted for consultative feedback) has been added to this version of the ALS PCS.