Emergency medical services in Canada
Encyclopedia
Emergency medical services
in Canada
are the responsibility of each Canadian province
or territory. As such, the services, including both ambulance
and paramedic
services, may be provided directly by the province, may be contracted to a private provider, or may be delegated to the local government level, which may in turn create its own service delivery arrangements with municipal departments, hospitals, or private providers. The approach, and the standards, vary considerably between provinces and territories.
In Canada
, responsibility for Emergency Medical Services
, as a part of health care in general, has been allocated to the provincial
/territorial level of government. With the exceptions of British Columbia
and Alberta
, which operates its EMS services directly, the method used for service delivery will vary to some degree between jurisdictions. Typically, the provincial/territorial government will provide enabling legislation
, technical standard, accreditation
or licensing, and oversight to a variety of potential system operators, including municipalities, hospitals, or private companies. Municipalities or hospitals may also, in turn, elect to provide EMS service directly, as a branch of another municipal department, such as the fire department
or health department
, or may contract out this responsibility to a private company. The approaches used for service delivery are governed by what is permitted under the legislation of the individual province or territory, or under the by-laws of a local municipality, when that municipality accepts responsibility for EMS service. Provincial governments may also, as in the case of the provinces of New Brunswick
, Nova Scotia
, and Prince Edward Island
, contract directly with a single private company, Medavie EMS (the same one in these three cases) to provide seamless, province-wide services.
Canadian provinces are also served by air ambulance
services. These arrangements may come in a variety of forms, including direct service provision, contracts between private companies and the provincial government, or they may be 'brokerage' arrangements, in which one private company takes the lead on service provision, perhaps even operating some of their own aircraft and providing dispatch services, but subcontracting many of the operations to smaller air charter services. In some cases, the inter-facility transport of high-acuity patients may be a mix or air-based and ground-based resources. Canada is a vast country, and the sheer size dictates that in many cases, the traditional helicopter
-based air ambulance service found in the U.S., the U.K., or Europe
is impractical as the distances required exceed the flight range of the aircraft. For this reason, the use of fixed wing aircraft is commonplace. As another feature which is somewhat unique to Canada, in some jurisdictions not all air ambulance calls are emergencies; distances to tertiary care centres mean that patients with lower-acuity medical conditions will also be flown on occasion.
As examples of standards, individual provinces and territories will typically specify, generally through legislation and regulations, the specifications and types of vehicles which may be used in EMS. These vehicles will include ambulances but may also include rapid response vehicles (sometimes called 'fly-cars'), and specialized Emergency Support Units, such as equipment vehicles and mass-casualty transport vehicles. To illustrate, each province or territory, and also the Canadian military, have their own unique ambulance specifications. Individual provinces or territories may also specify types of mandatory equipment in those vehicles, including medical equipment.
Ambulances type in Canada
are based on United States
federal KKK-1822 Standards requirements:
Bus based and air ambulances are not based on these standards. Buses are mostly for ambulatory transfer only and offer less advance care services.
, Alberta
, Saskatchewan
, Nova Scotia
, Ontario
, Prince Edward Island
and the Yukon Territory are served by highly educated paramedics with advanced skill sets. Other jurisdictions have not yet reached these levels, and some jurisdictions have or are considering the introduction of critical care paramedics and/or paramedic practitioners. On a province by province basis, the progress varies, driven primarily by public demand, acceptance by the medical community, and funding resources. A great deal of the recent advancement in standards of care and procedures have been driven by formal outcome-based research and clinical trials. An excellent example of this was the groundbreaking research work on the management of S-T segment elevation myocardial infarctions (STEMI), undertaken in cooperation with the Ottawa Paramedic Service
. Indeed, particularly in larger services, some paramedics undertake their own formal research
projects or collaborate with other researchers in the medical community, leading to publication, as with the preceding two references; both of which had paramedics in lead investigator
roles.
, and setting standards. In addition, initiatives by the EMS Chiefs of Canada organization are working towards improved interoperability and a 'best practices' approach to the overall management of EMS systems.
The big problem is the tendency of demedicalization in the sense of non participation of Care Professionals and Paraprofessionals in this Canadian Ambulance First aid Ambulance like in USA. In many Jurisdictions prehospital-care providers are evolving toward independent practice. They may have limited contact with other health care providers and can develop more allegiance to public service agencies, such as the police and fire services. The AAEMSP believes that collaboration between emergency medical technicians and knowledgeable, committed physicians providing medical control is essential for the provision of high-quality care based on sound, current scientific knowledge. Our belief, and that of others, is that abdication of or exclusion from this role increases the risk of inappropriate, cost-ineffective and potentially dangerous prehospital medical care.
or territory in which they operate, through the Ministry of Health or Health Department
of that level of government. However, paramedics and ambulance services are not mentioned in the Canada Health Act and are therefore not an insured service. Provinces may choose to subsidize some of the cost, usually just for patients with a valid provincial health card. Health insurance
in Canada is universal and publicly funded, therefore the cost of emergency ambulance services is covered to some degree. The degree to which individual use of EMS is subsidized by provincial health insurance varies by province, and may be supplemented by either partial fees for service, or from the property tax
revenues of local municipalities operating such services. The approach to such systems varies, as well. In some jurisdictions, funding is at the 100 percent level, and occurs without the patient being aware of its existence. Other jurisdictions fund at varying levels, but may require 'up front' payment for service, which is subsequently reimbursed. This may be particularly true of out of jurisdiction services, with an individual from one province, who requires EMS service in another province, being required to pay for that service and then submit the receipt to their own provincial health insurance scheme for reimbursement. In some jurisdictions, such as Ontario, a 'deterrent fee' scheme is used to discourage the medically unnecessary use of EMS by the public. In such cases, the provincial health insurance scheme will pay the majority of the cost of EMS service (around 80%) for medically necessary EMS service (when a physician decides that the service was not medically necessary, they can cause the patient to pay the full, uninsured amount of the charge), with the patient receiving a bill for the additional 'deterrent fee' at some point after the emergency is over. Within Ontario, for example, such deterrent billing occurs through the receiving hospital, despite the fact that the hospital neither provides nor oversees EMS in most cases.
Emergency medical services
Emergency medical services are a type of emergency service dedicated to providing out-of-hospital acute medical care and/or transport to definitive care, to patients with illnesses and injuries which the patient, or the medical practitioner, believes constitutes a medical emergency...
in Canada
Canada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...
are the responsibility of each Canadian province
Province
A province is a territorial unit, almost always an administrative division, within a country or state.-Etymology:The English word "province" is attested since about 1330 and derives from the 13th-century Old French "province," which itself comes from the Latin word "provincia," which referred to...
or territory. As such, the services, including both ambulance
Ambulance
An ambulance is a vehicle for transportation of sick or injured people to, from or between places of treatment for an illness or injury, and in some instances will also provide out of hospital medical care to the patient...
and paramedic
Paramedic
A paramedic is a healthcare professional that works in emergency medical situations. Paramedics provide advanced levels of care for medical emergencies and trauma. The majority of paramedics are based in the field in ambulances, emergency response vehicles, or in specialist mobile units such as...
services, may be provided directly by the province, may be contracted to a private provider, or may be delegated to the local government level, which may in turn create its own service delivery arrangements with municipal departments, hospitals, or private providers. The approach, and the standards, vary considerably between provinces and territories.
Land Ambulance
Canada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...
, responsibility for Emergency Medical Services
Emergency medical services
Emergency medical services are a type of emergency service dedicated to providing out-of-hospital acute medical care and/or transport to definitive care, to patients with illnesses and injuries which the patient, or the medical practitioner, believes constitutes a medical emergency...
, as a part of health care in general, has been allocated to the provincial
Province
A province is a territorial unit, almost always an administrative division, within a country or state.-Etymology:The English word "province" is attested since about 1330 and derives from the 13th-century Old French "province," which itself comes from the Latin word "provincia," which referred to...
/territorial level of government. With the exceptions of British Columbia
British Columbia
British Columbia is the westernmost of Canada's provinces and is known for its natural beauty, as reflected in its Latin motto, Splendor sine occasu . Its name was chosen by Queen Victoria in 1858...
and Alberta
Alberta
Alberta is a province of Canada. It had an estimated population of 3.7 million in 2010 making it the most populous of Canada's three prairie provinces...
, which operates its EMS services directly, the method used for service delivery will vary to some degree between jurisdictions. Typically, the provincial/territorial government will provide enabling legislation
Legislation
Legislation is law which has been promulgated by a legislature or other governing body, or the process of making it...
, technical standard, accreditation
Accreditation
Accreditation is a process in which certification of competency, authority, or credibility is presented.Organizations that issue credentials or certify third parties against official standards are themselves formally accredited by accreditation bodies ; hence they are sometimes known as "accredited...
or licensing, and oversight to a variety of potential system operators, including municipalities, hospitals, or private companies. Municipalities or hospitals may also, in turn, elect to provide EMS service directly, as a branch of another municipal department, such as the fire department
Fire department
A fire department or fire brigade is a public or private organization that provides fire protection for a certain jurisdiction, which typically is a municipality, county, or fire protection district...
or health department
Health department
A health department or health ministry is a part of government which focuses on issues related to the general health of the citizenry. Subnational entities, such as states, counties and cities, often also operate a health department of their own...
, or may contract out this responsibility to a private company. The approaches used for service delivery are governed by what is permitted under the legislation of the individual province or territory, or under the by-laws of a local municipality, when that municipality accepts responsibility for EMS service. Provincial governments may also, as in the case of the provinces of New Brunswick
New Brunswick
New Brunswick is one of Canada's three Maritime provinces and is the only province in the federation that is constitutionally bilingual . The provincial capital is Fredericton and Saint John is the most populous city. Greater Moncton is the largest Census Metropolitan Area...
, Nova Scotia
Nova Scotia
Nova Scotia is one of Canada's three Maritime provinces and is the most populous province in Atlantic Canada. The name of the province is Latin for "New Scotland," but "Nova Scotia" is the recognized, English-language name of the province. The provincial capital is Halifax. Nova Scotia is the...
, and Prince Edward Island
Prince Edward Island
Prince Edward Island is a Canadian province consisting of an island of the same name, as well as other islands. The maritime province is the smallest in the nation in both land area and population...
, contract directly with a single private company, Medavie EMS (the same one in these three cases) to provide seamless, province-wide services.
Air Ambulance
Air ambulance
An air ambulance is an aircraft used for emergency medical assistance in situations where either a traditional ambulance cannot reach the scene easily or quickly enough, or the patient needs to be transported over a distance or terrain that makes air transportation the most practical transport....
services. These arrangements may come in a variety of forms, including direct service provision, contracts between private companies and the provincial government, or they may be 'brokerage' arrangements, in which one private company takes the lead on service provision, perhaps even operating some of their own aircraft and providing dispatch services, but subcontracting many of the operations to smaller air charter services. In some cases, the inter-facility transport of high-acuity patients may be a mix or air-based and ground-based resources. Canada is a vast country, and the sheer size dictates that in many cases, the traditional helicopter
Helicopter
A helicopter is a type of rotorcraft in which lift and thrust are supplied by one or more engine-driven rotors. This allows the helicopter to take off and land vertically, to hover, and to fly forwards, backwards, and laterally...
-based air ambulance service found in the U.S., the U.K., or Europe
Europe
Europe is, by convention, one of the world's seven continents. Comprising the westernmost peninsula of Eurasia, Europe is generally 'divided' from Asia to its east by the watershed divides of the Ural and Caucasus Mountains, the Ural River, the Caspian and Black Seas, and the waterways connecting...
is impractical as the distances required exceed the flight range of the aircraft. For this reason, the use of fixed wing aircraft is commonplace. As another feature which is somewhat unique to Canada, in some jurisdictions not all air ambulance calls are emergencies; distances to tertiary care centres mean that patients with lower-acuity medical conditions will also be flown on occasion.
Vehicles
Ambulances type in Canada
Canada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...
are based on United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
federal KKK-1822 Standards requirements:
- Type I Ambulances are based on the chassis-cabs of light duty pickup-trucks,
- Type II Ambulances are based on modern passenger/cargo vans.
- Type III Ambulances are based on chassis-cabs of light duty vans,
Bus based and air ambulances are not based on these standards. Buses are mostly for ambulatory transfer only and offer less advance care services.
Staffing and training
Individual provinces and territories will also typically specify required levels of mandatory staff training for that particular province. At the moment British ColumbiaBritish Columbia
British Columbia is the westernmost of Canada's provinces and is known for its natural beauty, as reflected in its Latin motto, Splendor sine occasu . Its name was chosen by Queen Victoria in 1858...
, Alberta
Alberta
Alberta is a province of Canada. It had an estimated population of 3.7 million in 2010 making it the most populous of Canada's three prairie provinces...
, Saskatchewan
Saskatchewan
Saskatchewan is a prairie province in Canada, which has an area of . Saskatchewan is bordered on the west by Alberta, on the north by the Northwest Territories, on the east by Manitoba, and on the south by the U.S. states of Montana and North Dakota....
, Nova Scotia
Nova Scotia
Nova Scotia is one of Canada's three Maritime provinces and is the most populous province in Atlantic Canada. The name of the province is Latin for "New Scotland," but "Nova Scotia" is the recognized, English-language name of the province. The provincial capital is Halifax. Nova Scotia is the...
, Ontario
Ontario
Ontario is a province of Canada, located in east-central Canada. It is Canada's most populous province and second largest in total area. It is home to the nation's most populous city, Toronto, and the nation's capital, Ottawa....
, Prince Edward Island
Prince Edward Island
Prince Edward Island is a Canadian province consisting of an island of the same name, as well as other islands. The maritime province is the smallest in the nation in both land area and population...
and the Yukon Territory are served by highly educated paramedics with advanced skill sets. Other jurisdictions have not yet reached these levels, and some jurisdictions have or are considering the introduction of critical care paramedics and/or paramedic practitioners. On a province by province basis, the progress varies, driven primarily by public demand, acceptance by the medical community, and funding resources. A great deal of the recent advancement in standards of care and procedures have been driven by formal outcome-based research and clinical trials. An excellent example of this was the groundbreaking research work on the management of S-T segment elevation myocardial infarctions (STEMI), undertaken in cooperation with the Ottawa Paramedic Service
Ottawa Paramedic Service
Ottawa Paramedic Service is a uniformed municipal public safety agency providing emergency and non emergency paramedic care to residents and visitors of city of Ottawa, Ontario. It is the sole, licenced, statutory provider and is operated directly by the city. The Service is an independent third...
. Indeed, particularly in larger services, some paramedics undertake their own formal research
Research
Research can be defined as the scientific search for knowledge, or as any systematic investigation, to establish novel facts, solve new or existing problems, prove new ideas, or develop new theories, usually using a scientific method...
projects or collaborate with other researchers in the medical community, leading to publication, as with the preceding two references; both of which had paramedics in lead investigator
Detective
A detective is an investigator, either a member of a police agency or a private person. The latter may be known as private investigators or "private eyes"...
roles.
Response times
Canada is such a diverse country, with 13 separate jurisdictions governing EMS operations, that no single standard for response time measurement currently exists. Urban areas, such as Toronto, will set standards according to percentiles, in this case the standard is 8 minutes and 59 seconds or less, 90 percent of the time on AMPDS triaged Delta and Echo calls. There is no jurisdiction in Canada that is currently reporting successful achievement of this response time standard, and services cite a variety of reasons for this failure, but continue to aspire to the standard. This approach to response time monitoring is accepted in most urban areas of the country, however, there are some jurisdictions which reasonably set a second standard for rural (the majority of the country) response. Such standards can vary from one jurisdiction to the next. Additionally, there are jurisdictions that do not set specific response time objectives, instead simply reporting average response times for emergency calls.Towards national standards
There are currently major initiatives for improved standardization of staff training underway in Canadian EMS. The Paramedic Association of Canada has produced the National Occupational Competency Profile, and many provinces are working toward meeting these standards. Provinces and territories are also responsible for standards with respect to the dispatching of EMS resources, and some jurisdictions are measuring performance, benchmarkingBenchmarking
Benchmarking is the process of comparing one's business processes and performance metrics to industry bests and/or best practices from other industries. Dimensions typically measured are quality, time and cost...
, and setting standards. In addition, initiatives by the EMS Chiefs of Canada organization are working towards improved interoperability and a 'best practices' approach to the overall management of EMS systems.
The big problem is the tendency of demedicalization in the sense of non participation of Care Professionals and Paraprofessionals in this Canadian Ambulance First aid Ambulance like in USA. In many Jurisdictions prehospital-care providers are evolving toward independent practice. They may have limited contact with other health care providers and can develop more allegiance to public service agencies, such as the police and fire services. The AAEMSP believes that collaboration between emergency medical technicians and knowledgeable, committed physicians providing medical control is essential for the provision of high-quality care based on sound, current scientific knowledge. Our belief, and that of others, is that abdication of or exclusion from this role increases the risk of inappropriate, cost-ineffective and potentially dangerous prehospital medical care.
Funding and costs
EMS services in Canada are generally funded, at least in part, and to varying degrees, by the government of the provinceProvince
A province is a territorial unit, almost always an administrative division, within a country or state.-Etymology:The English word "province" is attested since about 1330 and derives from the 13th-century Old French "province," which itself comes from the Latin word "provincia," which referred to...
or territory in which they operate, through the Ministry of Health or Health Department
Health department
A health department or health ministry is a part of government which focuses on issues related to the general health of the citizenry. Subnational entities, such as states, counties and cities, often also operate a health department of their own...
of that level of government. However, paramedics and ambulance services are not mentioned in the Canada Health Act and are therefore not an insured service. Provinces may choose to subsidize some of the cost, usually just for patients with a valid provincial health card. Health insurance
Health insurance
Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is...
in Canada is universal and publicly funded, therefore the cost of emergency ambulance services is covered to some degree. The degree to which individual use of EMS is subsidized by provincial health insurance varies by province, and may be supplemented by either partial fees for service, or from the property tax
Property tax
A property tax is an ad valorem levy on the value of property that the owner is required to pay. The tax is levied by the governing authority of the jurisdiction in which the property is located; it may be paid to a national government, a federated state or a municipality...
revenues of local municipalities operating such services. The approach to such systems varies, as well. In some jurisdictions, funding is at the 100 percent level, and occurs without the patient being aware of its existence. Other jurisdictions fund at varying levels, but may require 'up front' payment for service, which is subsequently reimbursed. This may be particularly true of out of jurisdiction services, with an individual from one province, who requires EMS service in another province, being required to pay for that service and then submit the receipt to their own provincial health insurance scheme for reimbursement. In some jurisdictions, such as Ontario, a 'deterrent fee' scheme is used to discourage the medically unnecessary use of EMS by the public. In such cases, the provincial health insurance scheme will pay the majority of the cost of EMS service (around 80%) for medically necessary EMS service (when a physician decides that the service was not medically necessary, they can cause the patient to pay the full, uninsured amount of the charge), with the patient receiving a bill for the additional 'deterrent fee' at some point after the emergency is over. Within Ontario, for example, such deterrent billing occurs through the receiving hospital, despite the fact that the hospital neither provides nor oversees EMS in most cases.
Private transport services
In addition to regular EMS, many jurisdictions also have non-emergency patient transport services operating. In many jurisdictions, these are companies who specialize in non-emergency patient transfers. Such companies have their own vehicles, which are similar to ambulances and carry similar patient care equipment. These services, certainly welcome and necessary, relieve the workload on public EMS through the elmination of some, or most, of the non-emergency transfer volume, and some provide service to the public that is of the highest standard. In many cases, such services are small private business operations, using second-hand ambulances which have been retired from public EMS service, while others use vehicles expressly built for their purposes. There has, however, been some controversy, in some jurisdictions, with respect to the operating procedures of some (but not all) of these services. In some cases, the vehicles are often made to look as much like an EMS ambulance as possible, even retaining emergency lights and sirens (which they are forbidden by law to actually use), and incorporating the word 'Paramedic' (this term is not protected in Canada), variations on 'EMS' (in some cases, 'Event Medical Services') or spelling variations of 'ambulance' (e.g. 'ambu-lans'), or using the Star of Life logo on their vehicle markings. While such services may not be breaking any current Canadian law, many Canadian paramedics believe that such services work hard to create an erroneous public impression, and that such practises actually mislead the public into the belief that they are receiving an equivalent service, when in fact they are not. These services are not generally licensed, or required to meet any recognized standard, and despite the impression that they work hard to create, the operators will quickly insist that they are not 'ambulances', because becoming actual ambulance services would subject them to licensing and standards. These services generally attempt to recruit staff who meet provincial EMS qualification standards, but are under no legal obligation to do so. Such services are not covered by provincial health insurance, operating on a fee-for-service basis, and are not considered to be a legitimate part of mainstream EMS.Other EMS Operations In Canada
EMS services are public operated and many by the provincial ministry of health (mostly since the 1970s). In Ontario services were downloaded to local municipalities in the 1990s:- List of EMS Services in Ontario
- Alberta Health ServicesAlberta Health ServicesAlberta Health Services is the province-wide organization responsible for providing hospital and other health care in the Canadian province of Alberta. Known as the "superboard", it was created in May 2008, with the abolition of nine previous regional health authorities, the Alberta Mental Health...
- British Columbia Ambulance ServiceBritish Columbia Ambulance ServiceThe British Columbia Ambulance Service is the sole ambulance service and provider of pre-hospital emergency care in the province of British Columbia, Canada. It operates under the Emergency and Health Services Commission and the Provincial Health Services Authority, and is tasked with the...
- Region of Waterloo EMSRegion of Waterloo EMSRegion of Waterloo EMS is an emergency medical service provider for the Regional Municipality of Waterloo. The service provides EMS to Waterloo, Ontario, Cambridge, Ontario and Kitchener, Ontario.-Staff:...
- Toronto EMSToronto EMSToronto Emergency Medical Services is the statutory Emergency medical services provider for the city of Toronto, Ontario, Canada. The service is operated directly as a branch of the municipal government as an independent, third-service option provider, which means that the service is funded by...
- Urgences-Santé
- York Region EMSYork Region EMSYork Region Emergency Medical Services provides ambulance services and paramedic care for the municipalities within York Region. Before 2000, ambulance services were provided by 2 private operators , York County Hospital, Nobleton Volunteer Ambulance and Ontario's Ministry of Health...
See also
- Air ambulanceAir ambulanceAn air ambulance is an aircraft used for emergency medical assistance in situations where either a traditional ambulance cannot reach the scene easily or quickly enough, or the patient needs to be transported over a distance or terrain that makes air transportation the most practical transport....
- Emergency Medical DispatcherEmergency medical dispatcherAn Emergency medical dispatcher is a professional telecommunicator, tasked with the gathering of information related to medical emergencies, the provision of assistance and instructions by voice, prior to the arrival of Emergency Medical Services, and the dispatching and support of EMS resources...
- Paramedics in CanadaParamedics in CanadaIn Canada the paramedic is a health professional, providing pre-hospital assessment and medical care to the victims of illnesses or injuries. The term is generally limited to include those who work on emergency and non-emergency patient transport service environment ambulances...
- 9-1-19-1-19-1-1 is the emergency telephone number for the North American Numbering Plan .It is one of eight N11 codes.The use of this number is for emergency circumstances only, and to use it for any other purpose can be a crime.-History:In the earliest days of telephone technology, prior to the...
External links
- Paramedic Association of Canada
- Ambulance Paramedics of B.C.
- Ontario Paramedic Association
- Saskatchewan College of Paramedics
- Alberta College of Paramedics
- Manitoba Paramedic Association
- Quebec Paramedic Association (in French)
- Paramedic Association of New Brunswick
- College of Paramedics of Nova Scotia
- Paramedic Association of Newfoundland and Labrador
- Paramedic Association of Prince Edward Island