Proposed changes to the paramedic practice standards
Learn about the latest, currently proposed changes to the Ministry of Health’s paramedic practice standards.
Advanced Life Support Patient Care Standard v5.4
| Document Name/Version: | Advanced Life Support Patient Care Standards (BLS PCS) v5.4.a |
|---|---|
| Posting Date: | November 27, 2024 |
| Comments Due Date: | December 27, 2024 |
| Proposed in force date: | February 1, 2025 |
| Summary of Proposal: | Since the publication/in force date of the ALS PCS v5.4, the ministry has received recommendations from the Ontario Base Hospital Group who have commenced training on some of the proposed changes. To comment please email paramedicstandards@ontario.ca |
Standard/subsection: transport and storage of controlled substances (new section)
Proposed text
Controlled substances.
Please refer to the government of Canada’s specific permissions granted for paramedics in Ontario under the Controlled Drugs and Substances Act.
Counts
An inventory or ‘count’ shall be performed:
- When removing controlled substances from storage
- When returning controlled substances to storage
- When exchanging controlled between one paramedic to another
A record of counts shall be maintained.
Storage/Transport
With the exception of performing counts, restocking or providing patient care, controlled substances shall be stored at all times either:
- On the person of a paramedic approved to administer or transport the controlled substances or
- Secured by double locking (i.e. the controlled substances are contained in a locked pouch, bag, container, safe [or equivalent] which is locked inside a vehicle, room, mounted safe, mounted cupboard or equivalent)
Rationale
Ensures provincial compliance pursuant to subsection 56(1) of the Controlled Drugs and Substances Act (CDSA), paramedics with the title of Primary Care Paramedics, Advanced Care Paramedics or Critical Care Paramedics in the province of Ontario employed by certified ambulance service operators under the Ambulance Act (Ontario) are exempted for medical purposes from the application of the following provisions of the CDSA and its regulations.
Standard/subsection: PCP/ACP/medical cardiac arrest–primary clinical consideration(s)
Current text
In the following settings, consider very early transport after a minimum of one analysis (and defibrillation if indicated) once an egress plan is organized:
- pregnancy presumed to be ≥ 20 weeks gestation (fundus above umbilicus, ensure manual displacement of uterus to left)
- hypothermia
- airway obstruction
- non-opioid drug overdose/toxicology, or
- other known reversible cause of arrest not addressed
For patients in refractory VF or pulseless VT, transport following 3 rounds of epinephrine (or after 3rd consecutive defibrillation if no IV/IO/CVAD/ETT access). Refractory VF or pulseless VT is defined for the purpose of this directive, as persistent VF or pulseless VT after 3 consecutive shocks.
Proposed text
In the following settings, consider very early transport after a minimum of one analysis (and defibrillation if indicated) once an egress plan is organized:
- pregnancy presumed to be ≥ 20 weeks gestation (fundus above umbilicus, ensure manual displacement of uterus to left)
- known reversible cause of the arrest unable to be addressed.
For patients in refractory VF or pulseless VT, consider:
- Double sequential external defibrillation (DSED) if authorized, OR
- Vector change defibrillation (VCD) if DSED is unavailable or not authorized, AND
- Transport following three (3) doses of DSED or VCD <and three (3) rounds of epinephrine if they remain in VF or pulseless VT (or after 3rd consecutive defibrillation if no IV/IO/CVAD/ETT access).> ACP Only
Refractory VF or pulseless VT is defined for the purpose of this directive, as persistent VF or pulseless VT after 3 consecutive shocks.
Rationale
Restructured to remove redundant items that are addressed under ‘reversible causes’. Additional considerations added to address DSED and VCD for refractory VF/pulseless VT.
Standard/subsection: PCP/ACP medical cardiac arrest–CORE/CPR
Current text
CPR treatment.
Proposed text
(Removed from Medical Directive).
Rationale
CPR is covered in the BLS PCS as per the Canadian Heart and Stroke.
Standard/subsection: PCP/ACP medical cardiac arrest CORE/conditions/AED or SAED defibrillation
Current text
| AED or SAED Defibrillation | |
|---|---|
| Age | ≥ 24 hours |
| LOA | Altered |
| HR | N/A |
| RR | N/A |
| SBP | N/A |
| Other | Defibrillation indicated If not using manual defibrillation |
Proposed text
| AED or SAED Defibrillation | |
|---|---|
| Age | ≥ 24 hours |
| LOA | Altered |
| HR | N/A |
| RR | N/A |
| SBP | N/A |
| Other | Defibrillation indicated If not using manual defibrillation |
Rationale
Not a required statement.
Standard/subsection: PCP/ACP medical cardiac arrest/conditions/DSED or VCD (auxiliary) (new treatment)
Proposed text
| DSED or VCD | |
|---|---|
| Age | ≥ 18 years |
| LOA | Altered |
| HR | N/A |
| RR | N/A |
| SBP | N/A |
| Other | Non-traumatic VF/pulseless VT of presumed cardiac origin Presenting rhythm of VF/pulseless VT. Three consecutive standard shocks by Paramedics or Fire Services |
Rationale
ILCOR recommended treatment for refractory VF/Pulseless VT.
Standard/subsection: PCP/ACP medical cardiac arrest–CORE/contraindications/ medical TOR
Current text
Known reversible cause of the arrest unable to be addressed.
Pregnancy presumed to be ≥ 20 weeks gestation.
Suspected hypothermia.
Airway obstruction.
Non-opioid drug overdose/toxicology.
Proposed text
Pregnancy presumed to be ≥ 20 weeks gestation.
Suspected hypothermia.
Airway obstruction.
Non-opioid drug overdose/toxicology.
Rationale
Removed as it is addressed in conditions.
Standard/subsection: PCP/ACP medical cardiac arrest-treatment/DSED
(if trained and authorized) or VCD (if DSED is not available) (new component of the medical directive)
Proposed text
Consider DSED (if trained and authorized) or VCD (if DSED is not available)
| Age | ≥18 years |
|---|---|
| Dose | 1 DSED or vector change defibrillation |
| Max. single dose | as per RBHP / manufacturer |
| Dosing interval | 2 min |
| Max. # of doses | 3 |
Rationale
ILCOR recommended treatment for refractory VF/Pulseless VT.
Standard/subsection: PCP/ACP medical cardiac arrest–CORE/mandatory provincial patch point
Current text
Patch to consider Medical TOR (if applicable).
If the patch fails or if Medical TOR does not apply, transport to the closest appropriate hospital following ROSC or 20 minutes of resuscitation without ROSC.
Patch early (e.g. following the 4th analysis) to consider TOR if there are extenuating circumstances; surrounding egress, prolonged transport or significant clinical limitations where the paramedic considers ongoing resuscitation to be futile.
Proposed text
Patch to consider Medical TOR (if applicable).
Patch early to consider TOR if there are extenuating circumstances or where the paramedic considers ongoing resuscitation to be futile.
If the patch fails, and/or, no ROSC after 20 minutes of resuscitation, initiate transport.
Rationale
Restructured for clarification.
Standard/subsection: ACP medical cardiac arrest–CORE/treatment/amiodarone
Current text
Consider amiodarone.
Proposed text
Consider amiodarone (if not using lidocaine).
Rationale
To address if not using lidocaine.
Standard/subsection: ACP medical cardiac arrest–CORE/conditions/amiodarone
Current text
| amiodarone | |
|---|---|
| Age | ≥ 24 hours |
| LOA | Altered |
| HR | N/A |
| RR | N/A |
| SBP | N/A |
| Other | VF OR pulseless VT as an equivalent to lidocaine |
Proposed text
| amiodarone | |
|---|---|
| Age | ≥ 24 hours |
| LOA | Altered |
| HR | N/A |
| RR | N/A |
| SBP | N/A |
| Other | VF OR pulseless VT |
Rationale
Removed as this is addressed under Treatment.
Standard/subsection: ACP medical cardiac arrest–CORE/conditions/lidocaine
Current text
| lidocaine | |
|---|---|
| Age | ≥ 24 hours |
| LOA | Altered |
| HR | N/A |
| RR | N/A |
| SBP | N/A |
| Other | VF OR pulseless VT as an equivalent to amiodarone |
Proposed text
| lidocaine | |
|---|---|
| Age | ≥ 24 hours |
| LOA | Altered |
| HR | N/A |
| RR | N/A |
| SBP | N/A |
| Other | VF OR pulseless VT |
Rationale
Removed as this is addressed under Treatment.
Standard/subsection: PCP medical cardiac arrest–CORE/clinical considerations
Current text
Consider regional base hospital advanced airway strategy (e.g. SGA medical directive) where more than OPA/NPA and BVM is required.
Proposed text
The BHP might not authorize TOR even though the patient meets TOR rule. Factors may include: location of the patients, EtCO2, age, bystander witnessed, bystander CPR, transportation time, and unusual cause of cardiac arrest such as electrocution, hanging, and toxicology.
DSED/VCD:
The second defibrillator for Dual Sequential Defibrillation will be a paramedic service defibrillator or a fire service defibrillator (in order of preference and if agreed to by the fire service). If a second defibrillator is not available, Vector Change Defibrillation should be provided.
Rationale
Removal of educational points to be addressed in the Companion Document. Additional clinical considerations to address the addition of DSED and VCD.
Standard/subsection: ACP medical cardiac arrest–CORE/clinical considerations
Current text
Consider regional base hospital program advanced airway strategy where more than OPA/NPA and BVM is required.
There is no clear role for routine administration of naloxone in confirmed cardiac arrest.
The IV/IO/CVAD routes of medication administration are preferred over the ETT route. However, ETT administration may be used if the IV/IO/CVAD routes are delayed (e.g. ≥ 5 min).
The BHP might not authorize TOR even though the patient meets TOR rule. Factors may include: location of the patients, EtCO2, age, bystander witnessed, bystander CPR, transportation time, and unusual cause of cardiac arrest such as electrocution, hanging, and toxicology.
The BHP may authorize TOR even though the patient does not meet the TOR rule. Factors that may be taken into account include extenuating egress limitations, prolonged transport, caregiver wishes, existence of DNR confirmation form, and underlying end stage progressive illness.
Proposed text
The IV/IO/CVAD routes of medication administration are preferred over the ETT route. However, ETT administration may be used if the IV/IO/CVAD routes are delayed (e.g. ≥ 5 min).
The BHP might not authorize TOR even though the patient meets TOR rule. Factors may include: location of the patients, EtCO2, age, bystander witnessed, bystander CPR, transportation time, and unusual cause of cardiac arrest such as electrocution, hanging, and toxicology.
DSED/VCD:
The second defibrillator for Dual Sequential Defibrillation will be a paramedic service defibrillator or a fire service defibrillator (in order of preference and if agreed to by the fire service). If a second defibrillator is not available, Vector Change Defibrillation should be provided.
Rationale
Removal of educational points to be addressed in the Companion Document. Additional clinical considerations to address the addition of DSED and VCD.
Standard/subsection: PCP/ACP advanced airway and tracheostomy suctioning & reinsertion–previously (PCP/ACP endotracheal and tracheostomy suctioning & reinsertion) (auxiliary)
Current text
Endotracheal Tracheostomy Suctioning & Reinsertion Medical Directive.
Proposed text
advanced airway and tracheostomy suctioning & reinsertion Medical Directive.
Rationale
Medical Directive name change to include all advanced airways.
Standard/subsection: PCP/ACP advanced airway and tracheostomy suctioning & reinsertion–indications (auxiliary)
Current text
Patient with endotracheal or tracheostomy tube.
AND
Airway obstruction or increased secretions.
Proposed text
Patient with endotracheal, SGA (with gastric suction port) or tracheostomy tube.
AND
Airway obstruction or increased secretions.
Rationale
Includes suctioning of SGA gastric port.
Standard/subsection: PCP/ACP advanced airway and tracheostomy suctioning & reinsertion–conditions/suctioning through the SGA gastric port (auxiliary) (new component of the medical directive)
Proposed text
| Suctioning through SGA Gastric Port (if available) | |
|---|---|
| Age | N/A |
| LOA | N/A |
| HR | N/A |
| RR | N/A |
| SBP | N/A |
| Other | Known or suspected gastric secretions or emesis following placement of SGA Persistent difficult ventilation despite other efforts to improve ventilation |
Standard/subsection: PCP/ACP advanced airway and tracheostomy suctioning & reinsertion – Contraindications/(auxiliary) (new component of the medical directive)
Proposed text
Suctioning through SGA Gastric Port (if available)
N/A
Standard/subsection: PCP/ACP advanced airway and tracheostomy suctioning & reinsertion – treatment/suctioning through SGA gastric port (if available) (auxiliary)
Proposed text
| Consider Suctioning through SGA Gastric Port (if available) | |
|---|---|
| Age | < 1 year |
| Dose | Suction at 60-100 mmHg |
| Max. single dose | Until fluid disappears or after 15 seconds of no fluid return |
| Dosing interval | N/A |
| Max. # of doses | N/A |
| Age | ≥ 1 to < 12 years |
| Dose | Suction at 100-120 mmHg |
| Max. single dose | Until fluid disappears or after 15 seconds of no fluid return |
| Dosing interval | N/A |
| Max. # of doses | N/A |
| Age | ≥ 12 years |
| Dose | Suction at 100-150 mmHg |
| Max. single dose | Until fluid disappears or after 15 seconds of no fluid return |
| Dosing interval | N/A |
| Max. # of doses | N/A |
Standard/subsection: PCP/ACP advanced airway and tracheostomy suctioning & reinsertion–clinical considerations (auxiliary) (new component of the medical directive)
Proposed text
Suctioning of SGA with gastric suction port:
When gastric secretions are not evident, consider other causes of difficult ventilation (e.g., improper device size, incorrect depth, lack of posterior/inferior pressure, or airway obstruction) prior to attempting SGA suctioning.
Once fluid clears or if no fluid appears after 15 seconds, turn off suction.
Standard/subsection: PCP tachydysrhythmia/indications (auxiliary) (new medical directive)
Proposed text
Symptomatic Tachydysrhythmia.
Standard/subsection: PCP tachydysrhythmia/conditions (auxiliary)
Proposed text
| Valsalva Maneuver | |
|---|---|
| Age | ≥18 years |
| LOA | Unaltered |
| HR | ≥150 bpm |
| RR | N/A |
| SBP | Normotension |
| Other | Narrow complex and regular rhythm |
Standard/subsection: PCP tachydysrhythmia/contraindications (auxiliary)
Proposed text
Valsalva Maneuver Sinus tachycardia or atrial fibrillation or atrial flutter.
Standard/subsection: PCP tachydysrhythmia/treatment (auxiliary)
Proposed text
Consider Rhythm determination (confirm regularity).
Consider 12-lead ECG acquisition and interpretation to confirm QRS width (if this won’t delay therapy).
Standard/subsection: PCP tachydysrhythmia/treatment/valsalva/modified valsalva (auxiliary)
Proposed text
N/A
Standard/subsection: PCP tachydysrhythmia/considerations for treat and discharge (if authorized) (auxiliary)
Proposed text
- the patient must meet all of the following criteria
- the patient is ≥ 18 AND < 65 years old
- patient must have a prior history of SVT
- the patient presented with narrow complex and regular rhythm Supraventricular Tachycardia (SVT)
- the patient must have only had a single SVT episode in the past 24 hours
- the patient has returned to normal sinus rhythm (NSR) either spontaneously or with a valsalva maneuver and is now asymptomatic
- the patient has returned to their normal level of consciousness
- a complete set of vital signs are within expected normal ranges with a HR <100bpm and the patient remains in NSR for at least 15 minutes post conversion
AND
- the patient is not pregnant
- the SVT must not be related to alcohol or substance abuse or withdrawal, and
- the patient has no fever or preceding illness
In addition to the above criteria, if all of the following requirements have been met, the patient can be discharged by paramedics
- a responsible adult agrees to remain with the patient for the next 4 hours
- all of the patient or substitute decision makers questions were answered and a care plan was developed
- the patient or substitute decision maker has been advised to follow up with their primary health care team or provider
- clear instructions to call 911 were provided should symptoms redevelop
- patient or substitute decision maker has the ability to access 911 should symptoms redevelop, and
- patient or substitute decision maker consents to the discharge
Standard/subsection: PCP tachydysrhythmia–CORE/clinical considerations (treat and discharge) (auxiliary)
Proposed text
Patch to BHP for consultation if you are unclear if the patient meets all of the discharge criteria.
Standard/subsection: PCP & ACP Analgesia–CORE Conditions/ketorolac
Current text
SBP - Normotension.
Proposed text
SBP – N/A
Standard/subsection: ACP analgesia-CORE/conditions /fentaNYL
Current text
SBP - Normotension.
Proposed text
SBP – N/A.
Rationale
Supported by medical evidence.
Standard/subsection: ACP Analgesia CORE/conditions/ketamine (new component of the medical directive)
Proposed text
| Age | ≥1 year |
|---|---|
| LOA | Unaltered |
| HR | N/A |
| RR | N/A |
| SBP | N/A |
| Other | N/A |
Standard/subsection: ACP Analgesia CORE/contraindications /ketamine
Current text
New treatment option.
Proposed text
Allergy or sensitivity to ketamine.
Treatment of headache.
Treatment of chronic pain.
Suspected ischemic chest pain.
Active labour.
Standard/subsection: ACP analgesia CORE/treatment/ketamine (new component of the medical directive)
Proposed text
| Age | ≥ 1 year to < 18 years |
|---|---|
| Route | IV, IN |
| Dose | 0.25 mg/kg (IV) 1mg/kg (IN) |
| Max. single dose | 10 mg(IV) 30 mg (IN) |
| Dosing interval | 15 min |
| Max. # of doses | 2 |
| Age | ≥ 18 years |
| Route | IV, IN |
| Dose | 0.25 mg/kg (IV) 1mg/kg (IN) |
| Max. single dose | 20 mg (IV) 75 mg (IN) |
| Dosing interval | 15 min |
| Max. # of doses | 2 |
Standard/subsection: ACP Analgesia CORE/clinical considerations
Current text
Whenever possible, consider co-administration of acetaminophen and ibuprofen.
Suspected renal colic patients should routinely be considered for NSAIDs, either ibuprofen or ketorolac, and morphine or fentaNYL.
Exercise caution when using narcotics in opioid naïve patients and patients ≥ 65 years old as they may be more sensitive to dosages.
When higher doses of morphine (5-10 mg) or fentaNYL (50-75 mcg) are given intravenously, consider administering medication in small aliquots q 3 minutes until desired effect or max. single dose is reached to avoid nausea and vomiting.
FentaNYL should not be used in combination with morphine unless authorized by BHP.
The maximum volume of fentaNYL that may be administered IN is 1 mL per nare.
Proposed text
Administration of morphine or fentaNYL and ketamine must be sequential, not co-administered. The dosing interval must be no earlier than the most recently administered medication dosing interval.
When higher doses of morphine (5-10 mg) or fentaNYL (50-75 mcg) are given intravenously, consider administering medication in small aliquots q 3 minutes until desired effect or max. single dose is reached to avoid nausea and vomiting.
FentaNYL should not be used in combination with morphine unless authorized by BHP.
Rationale
Removed educational points from the medical directive to be placed in the Companion Document. Clarified sequential administration of narcotics and ketamine.
Standard/subsection: PCP/ACP traumatic hemorrhage/indications (auxiliary) (new medical directive)
Proposed text
Suspected hemorrhage due to trauma.
AND/OR
Hemodynamic instability.
Standard/subsection: PCP/ACP traumatic hemorrhage–CORE/ conditions/tranexamic acid (TXA) (auxiliary)
Proposed text
| Age | ≥ 16 years |
|---|---|
| LOA | N/A |
| HR | N/A |
| RR | N/A |
| SBP | N/A |
| Other | HR ≥ 110 BPM or hypotension |
Standard/subsection: PCP/ACP traumatic hemorrhage–CORE/contraindications/tranexamic acid (TXA) (auxiliary)
Proposed text
tranexamic acid (TXA).
Known hypersensitivity to TXA.
Greater than 3 hours from the time of injury to drug administration OR unknown time of injury.
Isolated head injury.
Standard/subsection: PCP/ACP traumatic hemorrhage–CORE/ treatment/tranexamic acid (TXA) (auxiliary)
Proposed text
| Consider tranexamic acid (TXA) | |
|---|---|
| Route | IV, IO (ACP only) IM |
| Initial dose | 1000 mg |
| Max. single dose | 1000mg |
| Dosing interval | N/A |
| Max. # of doses | 1 |
Standard/subsection: PCP/ACP traumatic hemorrhage–CORE/clinical considerations (auxiliary)
Proposed text
TXA should not delay transport and should not be prioritized over the management of other reversible causes.
IV administration of TXA applies only to PCPs authorized for PCP Autonomous IV.
tranexamic acid solution for injection should be administered intravenously by slow injection over a period of at least 5 minutes, as rapid administration can cause hypotension.
Standard/subsection: PCP/ACP nausea/vomiting–CORE/treatment/ ondansetron
Current text
| Weight | ≥ 25 kg |
|---|---|
| Route | PO |
| Dose | 4 mg |
| Max. single dose | 4 mg |
| Dosing interval | N/A |
| Max. # of doses | 1 |
Proposed text
| Weight | ≥ 25 kg |
|---|---|
| Route | PO,IV*/IM* |
| Dose | 4 mg |
| Max. single dose | 4 mg |
| Dosing interval | N/A |
| Max. # of doses | 1 |
*IV/IM (if formulation is available and authorized).
Rationale
Additional routes for ondansetron administration if available and authorized.
Standard/subsection: PCP/ACP nausea/vomiting–CORE/treatment/dimenhydrinate
Current text
| Weight | ≥ 25 kg to <50 kg |
|---|---|
| Route | IV/IM |
| Dose | 25mg |
| Max. single dose | 25 mg |
| Dosing interval | N/A |
| Max. # of doses | 1 |
| Max. Cumulative dose | N/A |
Proposed text
| Weight | ≥ 25 kg to <50 kg |
|---|---|
| Route | IV/IM |
| Dose | 25mg |
| Max. single dose | 25 mg |
| Dosing interval | N/A |
| Max. # of doses | 1 |
| Max. Cumulative dose | N/A |
| Weight | ≥ 50 kg |
| Route | IV/IM |
| Dose | *25 or 50 mg |
| Max. single dose | 50 mg |
| Dosing interval | 30 min |
| Max. # of doses | 2 |
| Max. Cumulative dose | 50 mg |
*If ondansetron is unavailable, assess the risks and benefits to patients ≥ 65 years old for dimenhyDRINATE administration. This may include an initial reduced dose of 25 mg.
Rationale
Changes to allow clinical consideration when administering dimenhyDRINATE to a patient equal to or greater than 65 years.
Standard/subsection: PCP/ACP nausea/vomiting–CORE/clinical considerations
Current text
IV administration of dimenhyDRINATE applies only to PCPs authorized for PCP Autonomous IV.
Prior to IV administration, dilute dimenhyDRINATE (concentration of 50 mg/1 ml) 1:9 with Normal Saline or D5W. If administered IM do not dilute.
If a patient has received Ondansetron and has no relief of their nausea & vomiting symptoms after 30 minutes, dimenhyDRINATE may be considered (or vise versa).
dimenhyDRINATE can be used in patients ≥ 65 if ondansetron is not unavailable.
Proposed text
IV administration of dimenhyDRINATE and ondansetron applies only to PCPs authorized for PCP Autonomous IV.
Prior to IV administration, dilute dimenhyDRINATE (concentration of 50 mg/1 ml) 1:9 with Normal Saline or D5W. If administered IM do not dilute.
If a patient has received an antiemetic and has no relief of their nausea & vomiting symptoms after 30 minutes, the alternative antiemetic may be considered. For patients ≥ 65 years who received a 25 mg dose of dimenhyDRINATE and continue to experience nausea or vomiting, ondansetron should be considered after a single dose of dimenhyDRINATE.
Rationale
Simplified to address patients equal to or greater than 65.
Standard/subsection: PCP/ACP lateral patellar Dislocation Reduction–CORE/indications (auxiliary) (new medical directive)
Proposed text
Patient with suspected lateral patellar dislocation.
Standard/subsection: PCP/ACP lateral patellar Dislocation reduction–CORE/conditions (auxiliary)
Proposed text
| Patellar Reduction | |
|---|---|
| Age | ≥10 to ≤50 |
| LOA | Unaltered |
| HR | N/A |
| RR | N/A |
| SBP | N/A |
| Other | N/A |
Standard/subsection: PCP/ACP lateral patellar dislocation reduction–CORE/contraindications (auxiliary)
Proposed text
Patellar Reduction
High velocity trauma.
Direct knee trauma.
Standard/subsection: PCP/ACP lateral patellar Dislocation reduction–CORE/treatment (auxiliary)
Proposed text
Consider patellar reduction
With the patient in a seated or lying position, gently extend the knee while lifting up on the patella and placing medial pressure to the edge of the patella.
The maximum number of attempts for Patellar Reduction per patient is 2.
Past proposed changes
| Document name/version | Posting date | Comments due date | Summary of proposal |
|---|---|---|---|
| Ontario Ambulance Documentation Standards 4.0.v | June 20, 2024 | August 3, 2024 | Under 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 6.1 | September 27, 2023 | October 17, 2023 | Changes 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. |
| Advance Life Support Patient Care Standards v5.2.g (Draft) | May 17, 2023 | June 16, 2023 | Since 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.a | January 24, 2023 | February 7, 2023 | Since 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 v1.1 | December 21, 2022 | January 13, 2023 | The 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) v5.1 | December 21, 2022 | January 13, 2023 | To 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.a | November 2, 2022 | November 30, 2022 | Since 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) v5.0 | August 11, 2022 | October 3, 2022 | Since 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. |
| Advance Life Support Patient Care Standards v4.9.a (Draft) | October 21, 2021 | November 21, 2021 | Since 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, 2021 | October 21, 2021 | Since 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, 2020 | October 17, 2020 | Since 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, 2020 | October 17, 2020 | Since 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 v1.0a | January 7, 2020 | January 21, 2020 | The 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, 2019 | January 24, 2020 | Since 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, 2019 | January 24, 2020 | Since 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, 2019 | March 14, 2019 | Since 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, 2019 | August 30, 2019 | Since 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. |