European Resuscitation Council (ERC) 2025 Guidelines

What’s New, What’s Changed, and What It Means for Ambulance

and Pre-Hospital Staff

Background

The European Resuscitation Council (ERC) has commenced its resuscitation guideline

update for 2025. They have published a “Process Document” outlining chapters, topics

and methodology. Draft chapters such as Systems Saving Lives have been released for

public comment, with the official launch of the Guidelines scheduled for 22 October 2025

in Rotterdam.

In short, this is an update cycle, not a completely new paradigm, but for the pre-hospital

arena there are important nuances.

Stronger Focus on the Chain of Survival as a System

The focus is shifting from individual rescuer actions to system performance, including

dispatch, bystander CPR, EMS response, defibrillation, post-resuscitation care and

integration of care across settings.

What this means for you:

1 Expect more emphasis on performance metrics such as scene times, bystander

CPR rates, early defibrillation and post-arrest handover quality.

2 Training will focus on system interfaces such as dispatch coordination, lay

responder activation and hospital integration rather than isolated clinical skills.

3 Services may see increased audit and benchmarking of system performance

indicators.

Clarified Advanced Life Support (ALS) Recommendations

Expect revised ALS guidance, especially around supraglottic airway use, tracheal

intubation and intraosseous access. Guidance will be less prescriptive about devices and

more focused on what works within the local context and skill mix.

1 Review equipment, training on mechanical CPR devices and standardisation of

defibrillator pad placement.

Training Shifts from Technique to Teamwork

Future resuscitation training will demand scenario-based simulation with feedback devices

rather than static classroom sessions. Pre-hospital staff will be evaluated not only on

whether the algorithm was followed but on teamwork, communication and scene

leadership.

Adapting to Resource and Setting Variability

Guideline recommendations may be tiered, recognising differences in resources and

capabilities. Training and policy should help staff understand how to apply the same

clinical principles flexibly in both high-resource and low-resource environments.Basic Life Support (BLS) Developments

BLS integration with early bystander and first responder programs will likely expand. There

will be an increased push for CPR quality monitoring, simplified bystander algorithms and

feedback systems even before advanced crews arrive.

Operational Implications

1 Protocol reviews: Local ambulance protocols will be updated to reflect changes in

airway management, defibrillation, vascular access and post-ROSC care.

2 Training demands: Services will need to prioritise high-fidelity simulation,

structured debriefing and assessment of non-technical skills.

3 Equipment and monitoring: Wider use of CPR quality feedback devices, improved

defibrillator pads and potential evaluation of mechanical CPR devices.Professional Opinion

The ERC 2025 guidelines represent an essential evolution in European resuscitation

practice. They maintain the core science while demanding higher system performance and

accountability.

For pre-hospital staff, this means doing the basics better, working as integrated teams,

embracing structured training and demonstrating performance with data.

In short, the crews who communicate clearly, debrief honestly and train realistically will

deliver better outcomes, and that’s exactly what ERC 2025 is built to measure.References

1. European Resuscitation Council. (2025). Guidelines 2025 Process Document.

https://cprguidelines.eu/assets/posters/ERC-Guidelines-2025-process-document.pdf

2. European Resuscitation Council. (2025). Systems Saving Lives – Draft for Public

Comment. https://cprguidelines.eu/assets/other-documents/ERC-Guidelines-2025-System

s-Saving-Lives_final-for-public-comments.pdf

3. International Liaison Committee on Resuscitation (ILCOR). (2025). Advanced Life

Support CoSTR Full Chapter. https://ilcor.org/uploads/ALS-2025-COSTR-Full-Chapter.pdf

4. International Liaison Committee on Resuscitation (ILCOR). (2025). Basic Life Support

CoSTR Full Chapter. https://ilcor.org/uploads/BLS-2025-COSTR-Full-Chapter.pdf

5. EMSy.io. (2025). ERC 2025 – Analysis: What’s New in ALS. https://www.emsy.io/en/po

st/erc-2025-we-continue-the-analysis-what-s-new-in-the-als-field

6. PMC. (2025). ALS Practices Across European Resuscitation Councils.

https://pmc.ncbi.nlm.nih.gov/articles/PMC12329084/