2025 Resuscitation Council UK (RCUK) Guidelines — What They Mean for Paramedics

As a paramedic or pre-hospital clinician, staying ahead of changes [...]

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As a paramedic or pre-hospital clinician, staying ahead of changes in resuscitation practice is essential not just for compliance but for delivering the best possible outcomes for patients. The 2025 guideline update from RCUK (aligned with the European Resuscitation Council (ERC) Guidelines 2025) brings a suite of key changes that directly affect how we operate on scene, during transport, and as part of the wider system of care. This post aims to walk through the major changes, highlight what they mean specifically for paramedics, and suggest how you and your service might prepare.

1. A Shift from Action-Only to System-Driven Resuscitation

One of the biggest themes of the new guidance is that resuscitation is no longer purely about “you vs the patient” in isolation — it’s about the system, the chain of survival, and the interface between bystanders, dispatch, EMS crews, hospital care and post-resuscitation follow-up. Eden Custom Training+3emsuklearning.co.uk+3Resuscitation Council UK+3

What this means for paramedics

  • You should expect more performance metrics around system times: call-to-scene, bystander CPR rate, AED use, and hand-over quality. emsuklearning.co.uk+1

  • Your service’s protocols may shift to embed lay-responder activation, AED registries (e.g., via The Circuit) and stronger links between EMS dispatch and community response. Resuscitation Council UK+1

  • On scene you’ll increasingly be part of a continuum: taking over from bystander/first responder, managing post-ROSC hand-over to hospital and ensuring your documentation supports system-level outcomes.

Action items

  • Review and update your ambulance service’s key performance indicators (KPIs) and link them to the updated guidelines.

  • Engage in debrief and audit of each resuscitation event not just for the clinical aspects, but how the system performed (e.g., bystander CPR, AED retrieval, scene-to-hospital hand-over).

  • Strengthen working relationships/interfacing with dispatch, community first-response schemes and local hospital post-cardiac arrest pathways.

2. Adult Basic Life Support (BLS) – On-Scene Implications

While many of the core principles remain unchanged (early recognition, chest compressions, defibrillation), the 2025 update includes several refinements that impact pre-hospital care. Resuscitation Council UK+1

Key changes

  • Call 999 first: For any unresponsive person, call the ambulance service before assessing breathing. Earlier guidelines put breathing assessment first; now, the call goes first. Resuscitation Council UK+1

  • Ambulance call-handler role: The dispatch/999-call handler is officially tasked with guiding bystanders through recognition of cardiac arrest and initiating CPR instructions. Resuscitation Council UK+1

  • Compression rate and depth reaffirmed: 100–120 per minute, depth 5–6 cm (but no deeper than 6 cm). Resuscitation Council UK

  • Start CPR on soft surface: If the patient is on a bed/soft surface, you should not delay to move them to the floor. Remove pillows, begin compressions on the bed if necessary. First Aid for Life+1

  • Simplification for bystanders: Compression-only CPR remains appropriate for untrained rescuers; rescue breaths are optional for bystanders unless they are trained. However, as paramedics you’ll still deliver full airway/ventilation care. Resuscitation Council UK+1

Paramedic-specific implications

  • When you arrive, be prepared that bystanders/volunteers may already be performing compressions (or receiving instructions from dispatch). Rapidly assess the quality of this CPR and optimise transition.

  • Ensure AED pad placement is correct (as per updated guidance below).

  • Document whether bystander CPR was initiated, whether an AED was applied pre-arrival — this will feed into system audit.

  • Understand that the on-scene timeline may accelerate: earlier call, earlier bystander CPR → you need to integrate quickly.

  • Your training should emphasise smooth transition from lay person/first responder to full ALS team, recognising system-level flow.

3. Advanced Life Support (ALS) & ‘Special Circumstances’

The 2025 guidelines provide updated guidance for ALS, including airway management, defibrillation strategy, and special situations (pregnancy, obesity, thrombosis, toxins, etc). Resuscitation Council UK+1

Highlights

  • There is less prescriptive guidance about devices (for example, exactly which supraglottic airway), and more emphasis on what works in the local context and skill mix. emsuklearning.co.uk

  • Defibrillator pad placement: for shockable rhythms after three failed shocks, repositioning pads may be advised (e.g., move the pad closer to the centre of the chest). First Aid for Life+1

  • Growing emphasis on ventilation quality and avoiding excessive ventilation. Resuscitation Council UK+1

  • Special circumstances chapter emphasises rapid recognition and management of reversible causes beyond myocardial infarction: hypoxia, toxins, thrombosis, pregnancy. Resuscitation Council UK

Paramedic-specific implications

  • Update your protocols and checklists to align with new ALS recommendations (e.g., pad repositioning, team briefings around reversible causes).

  • Training should emphasise scenario-based practice around “special circumstances” rather than just standard cardiac arrest in adult. For example: pregnancy arrest, massive pulmonary embolism, post-operative arrest, drowning/hypothermia.

  • Ensure airway and ventilation training incorporates the refined focus on quality of ventilation and recognising when devices/techniques may need to be adapted for the context.

  • Given the greater emphasis on system performance, ALS teams should document not just what they did, but why (for example: identified reversible cause X → took action Y). This supports audit and continuous improvement.

4. Post-Resuscitation Care & Handover

A significant expansion in the 2025 guidelines is the post-resuscitation care section — recognising that the job isn’t done when ROSC (return of spontaneous circulation) is achieved. Resuscitation Council UK+1

Key updates

  • Structured management post-ROSC: using an ABC approach (Airway, Breathing, Circulation), with focus on airway protection, controlled oxygenation, normocapnia, targeted blood pressure (systolic >100 mmHg or MAP 60–65 mmHg). Resuscitation Council UK

  • Early coronary angiography for patients with ST-elevation or strong suspicion of coronary occlusion. Whole‐body CT scan may be recommended to identify non-coronary causes. Resuscitation Council UK

  • Temperature control: Prevent fever (≤ 37.5 °C) in comatose survivors; temperature control for 36–72 h. Resuscitation Council UK

  • Prognostication: Multimodal at ≥72 h using exam, EEG, biomarkers, imaging. Withdrawal of therapy must be separated from prognostication and include patient values/survivor input. Resuscitation Council UK

  • Survivorship and co-survivor care: Structured follow-up within three months, support networks. Resuscitation Council UK

Implications for paramedics and EMS

  • The hand-over to the receiving hospital is more critical than ever. You must ensure full documentation of the arrest rhythm, times (collapse, 999 call, CPR start, defibrillation, ROSC), airway/ventilation details, medications given, pad placement and repositioning if done.

  • On-scene decisions may increasingly factor in post-resuscitation trajectories: for example, choosing transport to a cardiac arrest centre, early notification to hospital of a post-ROSC patient with high chance of angiography.

  • As part of care continuity, ensure you flag survivors and their families for the community follow-up pathway; in many services this may be a formal hand-off rather than “we drop at ED and leave it”.

  • Debriefing your team (and documenting system performance) on post-ROSC care preparation is now part of quality improvement.

5. Ethics, Documentation & Person-Centred Care

The 2025 guidelines give much stronger attention to ethics, advance care planning, involvement of families and documentation (such as ReSPECT form). Resuscitation Council UK+1

Key elements

  • Early, person-centred conversations (where appropriate) about emergency and future care decisions. Resuscitation Council UK

  • Families should be supported and given the option to be present during resuscitation when possible. Resuscitation Council UK

  • Termination of resuscitation (TOR) decisions must consider patient values, reversibility, and be embedded in organisational policy/training. Resuscitation Council UK

Paramedic-specific implications

  • When arriving on scene, check for existing advance care plans, ReSPECT forms, DNACPR status and ensure these are considered within your decision-making.

  • Your service may need to revise TOR protocols in line with the new guidance (especially in out-of-hospital arrest) and ensure paramedics receive training in ethical decision-making and documentation.

  • Post-event documentation should reflect not just the clinical actions, but also notes on family involvement, decision-making processes and ethical considerations as required by service governance.

6. Paediatric & Newborn Resuscitation Updates

The 2025 update also includes important changes for paediatric life support and newborn/transition at birth care. Whilst paramedics often focus on adult arrests, many services still attend paediatric cases and must be aware. Resuscitation Council UK+1

Highlights

  • Structured tools for early recognition of critical illness in children (ABCDE assessment) and detailed paediatric BLS/ALS guidance for children, infants and adolescents. Resuscitation Council UK

  • Newborn guidance: less emphasis on skin-colour (recognising variable tone among different skin types); early use of two-person jaw thrust, supraglottic airways, video laryngoscopy where available; standardised intervals for adrenaline every 4 minutes. Resuscitation Council UK

  • In drowning or hypoxia-related paediatric arrest: emphasises that five initial rescue breaths should be delivered before compressions. Eden Custom Training+1

What you need to do

  • Review your paediatric arrest protocols (BLS/ALS) and ensure training reflects the updated guidance.

  • Ensure the equipment mix (airway devices, big/ small pads, supraglottic options) reflects the guidance and local skill-mix.

  • On scene, ensure your crew is prepared to recognise high-risk paediatric deterioration and arrest early, implement ABCDE, and use the correct algorithms (including rescue breaths first when appropriate).

7. Training, Simulation & Quality Improvement

The guidelines place importance on high-fidelity training, simulation, whole-team performance and system audit. emsuklearning.co.uk+1

Key take-aways

  • Moving away from purely didactic courses: simulation, team debriefs, non-technical skills (communication, leadership) are increasingly emphasised. emsuklearning.co.uk

  • EMS services should adopt data-driven debriefing: CPR quality metrics, timeline performance, system hand-over, pad placement etc. Resuscitation Council UK

  • Training needs to reflect real-world settings (pre-hospital environment, soft surfaces, challenging access, bystander transitions) not just classroom.

Recommendations

  • Invest in high-fidelity simulation for your team, including scenarios that mirror the updated guidance (e.g., special circumstances, post-ROSC hand-over, ethical decision-making).

  • Develop local audit tools aligned with guideline key performance indicators (KPIs) and feed findings into continuous improvement.

  • Ensure paramedic documentation/training emphasises team dynamics, system integration, and upstream/downstream interfaces (dispatch ↔ on-scene ↔ hospital hand-over).

8. What Services & Paramedics Should Start Doing Now

Given that the guidelines were published 27 October 2025 (RCUK) and training materials are expected from January 2026. Resuscitation Council UK Here are some immediate action-points:

  • Protocol review: Ambulance services should begin updating their cardiac arrest, post-ROSC, paediatric arrest and termination–of–resuscitation protocols to align with 2025 guidance.

  • Training & education: Update your training syllabus and schedule refresher sessions. Ensure paramedics and non-ALS crew are aware of the changes.

  • Equipment check: Review defibrillator pad-placement guides, AED accessibility/registration (e.g., The Circuit), airway devices and mechanical CPR devices if used.

  • Debrief and audit: Set up or adjust your audit cycle to capture new KPIs: bystander CPR/defib, dispatch-to-scene, CPR quality metrics, ROSC hand-over completeness, documentation of ethical/advance-care decisions.

  • Team awareness: Foster awareness among all pre-hospital staff (paramedics, technicians, call-handlers) that the process is system-wide. Encourage integrated team culture: dispatch-crew-hospital working.

  • Patient & family focus: Emphasise documentation of family presence, advance care planning (ReSPECT), psychosocial follow-up of survivors and bystanders.

9. Summary – What Should You Remember?

  • The 2025 guidelines build on existing evidence, reaffirming core resuscitation principles but emphasising system performance, team coordination, post-resuscitation care and ethical/person-centred decision-making.

  • As paramedics you are not only the clinical responders, you are system integrators: linking bystander/first-responder → EMS crew → hospital → post-discharge pathway.

  • On scene, expect changes in how bystander CPR and dispatch work, ensure high-quality compression/ventilation, optimize ALS interventions, and refine post-ROSC hand-over.

  • Training and protocols need to evolve: more simulation, stronger non-technical skills, audit and continuous improvement.

  • Documentation and audit will matter more than ever: system metrics, team dynamics, ethical decisions, hand-over quality are all part of the new landscape.

10. Why This Matters

Survival following out-of-hospital cardiac arrest remains disappointingly low. The 2025 guidance reflects decades of research and aims to accelerate improvement by shifting emphasis from isolated actions to the entire chain of survival. For paramedics, this means that every link you touch—from arrival on scene to hospital hand-over — can influence outcomes. By embracing the updated guidance proactively, you help push the survival needle, improve functional recovery for patients, and embed stronger systems of care in your organisation.