Paramedics in Canada - AbsoluteAstronomy.com

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...

the 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...

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. In Canada, the term 'paramedic' is typically used generically, to refer to anyone who works on a land or 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....

. This may not be unreasonable, since the entry level in some jurisdictions involves substantially more mandatory education and training than paramedics (generally speaking Advanced Care Paramedic equivalent) in other environments, and the skill set is sometimes, but not always, beyond that of an EMT

Emergency medical technician

Emergency Medical Technician or Ambulance Technician are terms used in some countries to denote a healthcare provider of emergency medical services...

(generally speaking Primary Care Paramedic equivalent). Increasingly in Canada, paramedics are becoming self-regulated health professionals, operating and regulated in the same manner as nurses, physiotherapists, etc.

Training

Paramedic training in Canada is intense, as paramedics are seen as health professionals. Nevertheless, the nature of training and how it is regulated, like actual paramedic practice, varies from province to province. Training varies regionally, for example, the primary care paramedic training may be six months (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...

) to three years (Quebec

Quebec

Quebec or is a province in east-central Canada. It is the only Canadian province with a predominantly French-speaking population and the only one whose sole official language is French at the provincial level....

) in length.

Training as an advanced care paramedic (ACP) requires that the student be first qualified as a primary care paramedic. Eligibility for ACP training varies from immediate entry following PCP qualification (typically self-funded) to a mandatory period of experience working as a PCP for usually one to three years (which typically results in employer-sponsored training). The length of time required to complete ACP training also varies between provinces, and it is generally inversely related to the length of time required to have completed the prerequisite PCP training. Shorter (around one year) programs build upon the education already learned in a 2 year PCP training program, while longer (typically up to two years) college programs typically cater to PCP who graduated from shorter PCP programs.

Thus, while there is continual debate on the merits of longer or shorter PCP programs (often centered around teaching philosophy), in common, ACPs across Canada will generally have completed approximately 3 years of formal education, inclusive of didactic study and clinical placements. There is an emerging interest toward further development of applied degrees for paramedics. These programs are often offered through partnerships between Canadian universities and community colleges, blending vocational training with higher education.

The accreditation of paramedic educational programs in Canada also varies from province to province. The Canadian Medical Association's

Canadian Medical Association

The Canadian Medical Association , with more than 70,000 members, is the largest association of doctors in Canada and works to represent their interests nationally. It formed in 1867, three months after Confederation...

Committee on Conjoint Accreditation offers the most comprehensive and best known system of national accreditation.
Their accreditation model is an independent body, and draws from The "National Occupational Competency Profile" as the benchmark document that details the knowledge, skills and abilities outcomes that must be possessed by practitioners of each respective level of paramedic practice.

Scope of practice

In Canada the scope of practice of paramedics is described by the National Occupational Competency Profile (NOCP) for Paramedics document developed by the Paramedic Association of Canada with financial support from the Government of Canada

Government of Canada

The Government of Canada, formally Her Majesty's Government, is the system whereby the federation of Canada is administered by a common authority; in Canadian English, the term can mean either the collective set of institutions or specifically the Queen-in-Council...

. The NOCP outlines four provider levels: Emergency Medical Responder (EMR), Primary Care Paramedic (PCP), Advanced Care Paramedic (ACP), and Critical Care Paramedic (CCP)

Provincial variation on the NOCP

Under the new NOCP most providers that work in ambulances will be identified as 'paramedics'. However, in some cases, the most prevalent level of emergency prehospital care is that which is provided by the emergency medical responder (EMR). This is a level of practice recognized under the National Occupational Competency Profile. As a group, EMRs staff rural ambulance stations, community volunteer ambulance services, and for many small communities, without this level of certification, the operation of a much-needed community ambulance might not be possible. EMRs across Canada should not be ignored, as they contribute a critical role in the chain of survival

Chain of survival

The chain of survival refers to a series of actions that, when put into motion, reduce the mortality associated with cardiac arrest. Like any chain, the chain of survival is only as strong as its weakest link...

. It is a level of practice that is least comprehensive (clinically speaking), and is also generally not consistent with any medical acts beyond advanced first-aid, with the possible exception of automated external defibrillation

Defibrillation

Defibrillation is a common treatment for life-threatening cardiac arrhythmias, ventricular fibrillation and pulseless ventricular tachycardia. Defibrillation consists of delivering a therapeutic dose of electrical energy to the affected heart with a device called a defibrillator...

, which is still a regulated medical act in Canada, although one which is increasingly delegated to the general public.

Of considerable relevance to understanding the nature of Canadian paramedic practice, the reader must appreciate the considerable degree of inter-provincial variation. Although a national consensus (by way of the National Occupational Competency Profile) identifies certain knowledge, skills, and abilities as being most synonymous with a given level of paramedic practice, each province retains ultimate authority in legislating the actual administration and delivery of emergency medical services within its own borders. For this reason, any discussion of paramedic practice in Canada is necessarily broad, and general. Specific regulatory frameworks and questions related to paramedic practice can only definitively be answered by consulting relevant provincial legislation, although provincial paramedic associations may often offer a simpler overview of this topic when it is restricted to a province-by-province basis.

Regulatory frameworks vary from province to province, and include direct government regulation (such as Ontario's method of credentialing its practitioners with the title of A-EMCA, or Advanced Emergency Medical Care Assistant) to professional self-regulating bodies, such as the Alberta College of Paramedics. Though the title of paramedic is a generic description of a category of practitioners, provincial variability in regulatory methods accounts for ongoing differences in actual titles that are ascribed to different levels of practitioners. For example, the province of 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...

uses the title "emergency medical technician", or 'EMT' for the PCPs and 'paramedic' only for those qualified as ACPs, meaning Advanced Life Support

Advanced Life Support

Advanced Life Support is a set of life-saving protocols and skills that extend Basic Life Support to further support the circulation and provide an open airway and adequate ventilation .-Components of ALS:These include:...

(ALS) providers. Almost all provinces, however, are gradually moving to adopting the new titles, or have at least recognized the NOCP document as a benchmarking document to permit inter-provincial labour mobility of practitioners, regardless of how titles are specifically regulated within their own provincial systems. In this manner, the confusing myriad of titles and occupational descriptions can at least be discussed using a common language for the sake of comparison.

Skills

Although there is a great deal of variation in what paramedics in Canada are trained and permitted to do from region to region, some skills performed by paramedics include:


Treatment issue	PCP skills	ACP skills	Critical Care Paramedic skills
Airway management	Manual and repositioning, Oro- and nasopharyngeal airway adjuncts (in some case supraglottic airways like the King LT) manual removal of obstructions, suctioning	endotracheal intubation (in some cases, naso as well), advanced airway management, deep suctioning, use of Magill forceps	Rapid sequence induction Rapid sequence induction Rapid Sequence Induction is a medical procedure involving the expeditious induction of general anesthesia and subsequent intubation of the trachea. RSI is generally used in an emergency setting or for patients who have an increased risk of aspirating stomach contents into the lungs... , surgical airways (including needle cricothyrotomy and others)
Breathing	Initial assessment (rate, effort, symmetry, skin color),pulse oximetry, obstructed airway maneuver, passive oxygen Oxygen Oxygen is the element with atomic number 8 and represented by the symbol O. Its name derives from the Greek roots ὀξύς and -γενής , because at the time of naming, it was mistakenly thought that all acids required oxygen in their composition... administration by nasal canula, rebreathing and non-rebreathing mask, active oxygen administration by Bag Valve Mask Bag valve mask A bag valve mask is a hand-held device used to provide positive pressure ventilation to a patient who is not breathing or who is breathing inadequately. The device is a normal part of a resuscitation kit for trained professionals, such as ambulance crew... (BVM) device.	pulse oximetry Pulse oximetry Pulse oximetry is a non-invasive method allowing the monitoring of the oxygenation of a patient's hemoglobin.A sensor is placed on a thin part of the patient's body, usually a fingertip or earlobe, or in the case of an infant, across a foot.... , active oxygen administration by endotracheal tube or other device using BVM	Use of mechanical transport ventilators, active oxygen administration by surgical airway, decompression of chest cavity using needle/valve device (needle thoracotomy)
Circulation	Assessment of pulse (rate, rhythm, volume), blood pressure Blood pressure Blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the arterial pressure of the systemic circulation. During each heartbeat, BP varies... and capillary refill, patient positioning to enhance circulation, recognition and control of hemorrhage of all types using direct and indirect pressure and tourniquets	Ability to interpret assessment findings in terms of levels of perfusion Perfusion In physiology, perfusion is the process of nutritive delivery of arterial blood to a capillary bed in the biological tissue. The word is derived from the French verb "perfuser" meaning to "pour over or through."... , intravenous fluid replacement, vasoconstricting drugs	intravenous plasma volume expanders, blood transfusion Blood transfusion Blood transfusion is the process of receiving blood products into one's circulation intravenously. Transfusions are used in a variety of medical conditions to replace lost components of the blood... , intraosseous (IO) cannulation (placement of needle into marrow space of a large bone), central venous access (central venous catheter by way of external jugular or subclavian)
Cardiac arrest Cardiac arrest Cardiac arrest, is the cessation of normal circulation of the blood due to failure of the heart to contract effectively...	Cardiopulmonary resuscitation Cardiopulmonary resuscitation Cardiopulmonary resuscitation is an emergency procedure which is performed in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person in cardiac arrest. It is indicated in those who are unresponsive... , airway management, manual ventilation with BVM, semi-automatic external defibrillator	Dynamic resuscitation including intubation, drug administration (includes anti-arrhythmics), ECG interpretation (may be limited to Lead II) Semi-automatic or manual defibrillator	Expanded drug therapy options, ECG interpretation (12 Lead), manual defibrillator, synchronized mechanical or chemical cardioversion Cardioversion Cardioversion is a medical procedure by which an abnormally fast heart rate or cardiac arrhythmia is converted to a normal rhythm, using electricity or drugs. Synchronized electrical cardioversion uses a therapeutic dose of electric current to the heart, at a specific moment in the cardiac cycle... , external pacing of the heart
Cardiac Monitoring	Cardiac monitoring Cardiac monitoring The phrase cardiac monitoring generally refers to continuous monitoring with electrocardiography with assessment of the patients condition relative to their cardiac rhythm. It is different from hemodynamic monitoring, which monitors the pressure and flow of blood within the circulatory system. The... and interpretation of ECGs Electrocardiogram Electrocardiography is a transthoracic interpretation of the electrical activity of the heart over a period of time, as detected by electrodes attached to the outer surface of the skin and recorded by a device external to the body...	12-lead ECG monitoring and interpretation	18-lead ECG monitoring and interpretation
Drug administration	Limited oral, limited aerosol, limited injection (usually IM)	Intramuscular, subcutaneous, intravenous injection (bolus Bolus (medicine) In medicine, a bolus is the administration of a medication, drug or other compound that is given to raise its concentration in blood to an effective level... ), IV drip	per ETT, per rectal tube, per infusion pump Infusion pump An infusion pump infuses fluids, medication or nutrients into a patient's circulatory system. It is generally used intravenously, although subcutaneous, arterial and epidural infusions are occasionally used....
Drug types permitted	Low-risk/immediate requirements (e.g. ASA (chest pain), nitroglycerin (chest pain), oral glucose Glucose Glucose is a simple sugar and an important carbohydrate in biology. Cells use it as the primary source of energy and a metabolic intermediate... (diabetes), glucagon Glucagon Glucagon, a hormone secreted by the pancreas, raises blood glucose levels. Its effect is opposite that of insulin, which lowers blood glucose levels. The pancreas releases glucagon when blood sugar levels fall too low. Glucagon causes the liver to convert stored glycogen into glucose, which is... (diabetes), epinephrine Epinephrine Epinephrine is a hormone and a neurotransmitter. It increases heart rate, constricts blood vessels, dilates air passages and participates in the fight-or-flight response of the sympathetic nervous system. In chemical terms, adrenaline is one of a group of monoamines called the catecholamines... (Allergic Reaction), ventolin Salbutamol Salbutamol or albuterol is a short-acting β2-adrenergic receptor agonist used for the relief of bronchospasm in conditions such as asthma and chronic obstructive pulmonary disease. It is marketed as Ventolin among other brand names.... (Asthma)). Note: Some jurisdictions also permit naloxone Naloxone Naloxone is an opioid antagonist drug developed by Sankyo in the 1960s. Naloxone is a drug used to counter the effects of opiate overdose, for example heroin or morphine overdose. Naloxone is specifically used to counteract life-threatening depression of the central nervous system and respiratory... (Narcotic Overdose), nitrous oxide Nitrous oxide Nitrous oxide, commonly known as laughing gas or sweet air, is a chemical compound with the formula . It is an oxide of nitrogen. At room temperature, it is a colorless non-flammable gas, with a slightly sweet odor and taste. It is used in surgery and dentistry for its anesthetic and analgesic... (for pain); considerable variation by jurisdiction	Considerable expansion of permitted drugs, but still typically limited to about 20, including analgesics (narcotic Narcotic The term narcotic originally referred medically to any psychoactive compound with any sleep-inducing properties. In the United States of America it has since become associated with opioids, commonly morphine and heroin and their derivatives, such as hydrocodone. The term is, today, imprecisely... or otherwise) (for pain), antiarrhythmics (irregularities in heartbeat), major cardiac resuscitation drugs, bronchodilators (for breathing), vasoconstrictors (to improve circulation), sedatives	Dramatically expanded (up to 60) drug list, Note: In some jurisdictions advanced levels of paramedics are permitted to administer any drug, as long as they are familiar with it.
Patient assessment	Basic physical assessment, 'vital' signs, history of general and current condition	More detailed physical assessment and history, auscultation, interpretation of assessment findings, ECG interpretation, glucometry, capnography Capnography Capnography is the monitoring of the concentration or partial pressure of carbon dioxide in the respiratory gases. Its main development has been as a monitoring tool for use during anaesthesia and intensive care. It is usually presented as a graph of expiratory plotted against time, or, less... , pulse oximetry Pulse oximetry Pulse oximetry is a non-invasive method allowing the monitoring of the oxygenation of a patient's hemoglobin.A sensor is placed on a thin part of the patient's body, usually a fingertip or earlobe, or in the case of an infant, across a foot....	Interpretation of lab results, interpretation of chest x-rays, interpretation of cranial CT scan, limited diagnosis Medical diagnosis Medical diagnosis refers both to the process of attempting to determine or identify a possible disease or disorder , and to the opinion reached by this process... (e.g. rule out fracture using Ottawa Ankle Rules)
Wound management	Assessment, control of bleeding Bleeding Bleeding, technically known as hemorrhaging or haemorrhaging is the loss of blood or blood escape from the circulatory system... , application of pressure dressings and other types of dressings		Wound cleansing, wound closure with Steri-strips, suturing

Primary Care Paramedics

Primary Care Paramedics (PCPs) are the entry-level of paramedic practice in Canadian provinces. The scope of practice

Scope of Practice

Scope of Practice is a terminology used by national and state/provincial licensing boards for various professions that defines the procedures, actions, and processes that are permitted for the licensed individual. The scope of practice is limited to that which the law allows for specific education...

includes performing semi-automated external defibrillation

Automated external defibrillator

An automated external defibrillator or AED is a portable electronic device that automatically diagnoses the potentially life threatening cardiac arrhythmias of ventricular fibrillation and ventricular tachycardia in a patient, and is able to treat them through defibrillation, the application of...

, interpretation of 3-lead or 12 lead ECG's depending on the area, administration of Symptom Relief Medications

Symptom Relief Medications

Symptom relief medications are medications that paramedics in Ontario are certified to administer under a base hospital physician's license. The Ministry of Health and Long Term Care has established a minimum standard of care for the province, however, base hospitals can add medications at their...

for a variety of emergency medical conditions (these include oxygen

Oxygen

Oxygen is the element with atomic number 8 and represented by the symbol O. Its name derives from the Greek roots ὀξύς and -γενής , because at the time of naming, it was mistakenly thought that all acids required oxygen in their composition...

, epinephrine

Epinephrine

Epinephrine is a hormone and a neurotransmitter. It increases heart rate, constricts blood vessels, dilates air passages and participates in the fight-or-flight response of the sympathetic nervous system. In chemical terms, adrenaline is one of a group of monoamines called the catecholamines...

, antihistamine

Antihistamine

An H1 antagonist is a histamine antagonist of the H1 receptor that serves to reduce or eliminate effects mediated by histamine, an endogenous chemical mediator released during allergic reactions...

, salbutamol

Salbutamol

Salbutamol or albuterol is a short-acting β2-adrenergic receptor agonist used for the relief of bronchospasm in conditions such as asthma and chronic obstructive pulmonary disease. It is marketed as Ventolin among other brand names....

, aspirin

Aspirin

Aspirin , also known as acetylsalicylic acid , is a salicylate drug, often used as an analgesic to relieve minor aches and pains, as an antipyretic to reduce fever, and as an anti-inflammatory medication. It was discovered by Arthur Eichengrun, a chemist with the German company Bayer...

, nitroglycerine, naloxone

Naloxone

Naloxone is an opioid antagonist drug developed by Sankyo in the 1960s. Naloxone is a drug used to counter the effects of opiate overdose, for example heroin or morphine overdose. Naloxone is specifically used to counteract life-threatening depression of the central nervous system and respiratory...

, dextrose

Diabetic hypoglycemia

Diabetic hypoglycemia is a low blood glucose level occurring in a person with diabetes mellitus. It is one of the most common types of hypoglycemia seen in emergency departments and hospitals...

, thiamine

Thiamine

Thiamine or thiamin or vitamin B1 , named as the "thio-vitamine" is a water-soluble vitamin of the B complex. First named aneurin for the detrimental neurological effects if not present in the diet, it was eventually assigned the generic descriptor name vitamin B1. Its phosphate derivatives are...

, glucagon

Glucagon

Glucagon, a hormone secreted by the pancreas, raises blood glucose levels. Its effect is opposite that of insulin, which lowers blood glucose levels. The pancreas releases glucagon when blood sugar levels fall too low. Glucagon causes the liver to convert stored glycogen into glucose, which is...

and nitrous oxide

Nitrous oxide

Nitrous oxide, commonly known as laughing gas or sweet air, is a chemical compound with the formula . It is an oxide of nitrogen. At room temperature, it is a colorless non-flammable gas, with a slightly sweet odor and taste. It is used in surgery and dentistry for its anesthetic and analgesic...

), performing trauma immobilization, including cervical immobilization, and other basic medical care. PCPs may also receive additional training in order to perform certain skills that are normally in the scope of practice of ACPs. This is regulated both provincially (by statute) and locally (by the medical director), and ordinarily entails an aspect of medical oversight by a specific body or group of physicians. This is often referred to as medical control, and is the role played by a base hospital. For example, in the province of 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....

many paramedic services allow PCPs to perform 12-lead ECG

Electrocardiogram

Electrocardiography is a transthoracic interpretation of the electrical activity of the heart over a period of time, as detected by electrodes attached to the outer surface of the skin and recorded by a device external to the body...

interpretation, or initiate intravenous therapy

Intravenous therapy

Intravenous therapy or IV therapy is the infusion of liquid substances directly into a vein. The word intravenous simply means "within a vein". Therapies administered intravenously are often called specialty pharmaceuticals...

, or to deliver a few additional medications, such as 50% Dextrose, ASA, Nitroglycerin, Epinephrine, Ventolin, and Glucagon.

Advanced Care Paramedics

The ACP is a level of practitioner that is in high demand by many ambulance services across Canada. However, still not all provinces and jurisdictions have ACPs (Quebec, New Brunswick). The ACP typically carries approximately 20 different medications, although the number and type of medications may vary substantially from region to region. ACPs perform advanced airway management including intubation

Intubation

Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic or rubber tube into the trachea to maintain an open airway or to serve as a conduit through which to administer certain drugs...

, surgical airways, intravenous therapy

Intravenous therapy

, place external jugular IV lines, perform needle thoracotomy, perform and interpret 12-lead ECGs, perform synchronized and chemical cardioversion

Cardioversion

Cardioversion is a medical procedure by which an abnormally fast heart rate or cardiac arrhythmia is converted to a normal rhythm, using electricity or drugs. Synchronized electrical cardioversion uses a therapeutic dose of electric current to the heart, at a specific moment in the cardiac cycle...

, transcutaneous pacing

Transcutaneous pacing

Transcutaneous pacing is a temporary means of pacing a patient's heart during a medical emergency. It is accomplished by delivering pulses of electric current through the patient's chest, which stimulates the heart to contract....

, perform obstetrical assessments, provide pharmacological chemical pain relief for various conditions, and reverse hypoglycemic states. Several sites in Canada have experimented with pre-hospital fibrinolytics and rapid sequence induction

Rapid sequence induction

Rapid Sequence Induction is a medical procedure involving the expeditious induction of general anesthesia and subsequent intubation of the trachea. RSI is generally used in an emergency setting or for patients who have an increased risk of aspirating stomach contents into the lungs...

, and prehospital medical research has permitted a great number of variations in the scope of practice for ACPs. Current programs include providing ACPs with discretionary direct 24-hour access to PCI

Percutaneous coronary intervention

Percutaneous coronary intervention , commonly known as coronary angioplasty or simply angioplasty, is one therapeutic procedure used to treat the stenotic coronary arteries of the heart found in coronary heart disease. These stenotic segments are due to the build up of cholesterol-laden plaques...

labs, bypassing the emergency department

Emergency department

An emergency department , also known as accident & emergency , emergency room , emergency ward , or casualty department is a medical treatment facility specialising in acute care of patients who present without prior appointment, either by their own means or by ambulance...

, and representing a fundamental change in both the way that patients with S-T segment elevation myocardial infarctions (STEMI) are treated, but also profoundly affecting survival rates.

Critical Care Paramedics

Critical Care Paramedics (CCPs) are paramedics who generally do not respond to 9-1-1 emergency calls, with the exception of helicopter "scene" calls. Instead they focus on transferring patients from the hospital they are currently in to other hospitals that can provide a higher level of care. When CCPs are not available, it is usually necessary to have some combination of nurse, and/or respiratory therapist accompany acute patients on inter-facility transfers. Having CCPs provide care to the patient allows the sending hospital to avoid 'losing' their staff on long transfers.

CCPs are able to provide all of the care that PCPs and ACPs are able to provide. In addition to this they are trained for other skills such as medication infusion pumps, mechanical ventillation and advanced monitoring hemodynamic monitoring.

CCPs often work in fixed and rotary wing aircraft, but systems such as the Toronto EMS

Toronto EMS

Toronto 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...

Critical Care Transport Program work in land ambulances. In British Columbia, CCP's work primarily in aircraft with a dedicated CCT crew in Trail for long-distance transfers and a regular CCP street crew stationed in South Vancouver that often also performs medevacs, when necessary.

Medical direction and oversight

Most jurisdictions in Canada, paramedics do not work under their own medical license. One exception is in British Columbia where each paramedic regardless of level, has their own license to practice. Even so, they, as most other paramedics in Canada, are permitted to perform regulated medical acts by the process of 'delegation'. This means that one medical doctor (the medical director) has become familiar with the individual paramedic and then has delegated authority to that paramedic which allows them to perform specific regulated medical act under defined situations. The scope of practice for the paramedic is defined in paramedic protocols (also referred to as advanced medical directives). These protocols specify which skill and the conditions required for the paramedic to act. Each protocol is signed by the medical director. Medical directors are generally ER physicians who work in a hospital associated with the paramedic service. The relationship between this hospital ('Base Hospital') is formalized through legal agreements. Other physicians in the base hospital who are allowed to give direct orders to paramedics that exceed their protocols (often via telephone) are referred to as delegating physicians. These physicians are usually ER physicians. The British Columbia Ambulance Service

British Columbia Ambulance Service

The 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...

is moving away from protocols and towards a process called treatment guidelines allowing much more flexibility at all levels when a patient's condition warrants.

Some Canadian paramedics are moving towards the status of self-regulated health professionals with paramedics forming their own professional Colleges in much the same manner as nurses and other health professions. These organizations are responsible to the government for the examination and licensing of practitioners, the establishment of standards of practice, the investigation of public complaints against members, and the disciplining of members. They are also required to advise the government on all issues and legislation related to the practice of their members. Following the example of their British colleagues, Colleges or Associations have been established in Alberta, Saskatchewan, New Brunswick, and Nova Scotia, with Ontario actively moving towards this type of legislation.

Professional Environment

Paramedics have a close relationship with the physicians who ultimately grant paramedics the legal right to practice their profession with a regulated paramedic service. Also, because physician assistants in Canada exist primarily in the Canadian Forces

Canadian Forces

The Canadian Forces , officially the Canadian Armed Forces , are the unified armed forces of Canada, as constituted by the National Defence Act, which states: "The Canadian Forces are the armed forces of Her Majesty raised by Canada and consist of one Service called the Canadian Armed Forces."...

, the role of clinical paramedic practitioners is under serious study. Both urban and rural centres have begun utilizing paramedics working in-hospital on cardiac arrest

Cardiac arrest

Cardiac arrest, is the cessation of normal circulation of the blood due to failure of the heart to contract effectively...

teams, patient transfer teams, emergency department triage

Triage

Triage or ) is the process of determining the priority of patients' treatments based on the severity of their condition. This rations patient treatment efficiently when resources are insufficient for all to be treated immediately. The term comes from the French verb trier, meaning to separate,...

/treatment and to facilitate faster "off-load" times. Some small hospitals in Alberta and 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....

have engaged paramedics to supervise Emergency Rooms at night in the place of Medical Doctors because of their ability to independently determine a patients immediate health status and assist the rest of the healthcare team in patient care. Similarly, community outreach programs led by paramedics, such as providing tuberculosis

Tuberculosis

Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...

screening and influenza vaccinations to the homeless, are becoming more common.

In Halifax, NS, ACPs and CCPs work side by side with physicians in various emergency departments within the Capital District Health Authority. The responsibilities of these department paramedics varies from ER to ER within CDHA but include advanced airway stabilization, suturing, minor treatment as well as other expanded paramedic roles such as procedural sedations. They have also proven a necessary and integral member of the cardiac arrest and trauma teams. PCPs have been employed by CDHA since the early 1990s to perform triage assessments.

Paramedics often work long hours, most with 12 hour shifts. In some areas, however, 24 and even 96 hour shifts are not unusual. Salary and benefits are generally commensurate with the level of education and certification, though often less than the salary expectations of police officers and firefighters, as well as nurses. This incongruity is often argued as being unfair, especially in light of the relative level of responsibility a paramedic may have for acting decisively and without having direct supervision. However, many paramedics consider their career to offer intangible benefits and reported job satisfaction is generally high. Paramedics in Canada generally work only as paramedics, and only rarely as cross-trained firefighters or police officers, and most are paid full or part-time professionals. In the first quarter of 2005, paramedics were granted status federally as a "Public Safety Occupation" which means that paramedics are now eligible for early retirement, as are police officers and fire fighters. Many EMS agencies run a full range of paramedic speciality squads including: Marine medics, Bike medics, First Response medics, Tactical ERT & CCU medics, CBRNe medics (Chemical, Biological, Radiological, Nuclear and Explosive) and USAR medics (Urban Search And Rescue - specializing in urban disaster rescue recovery) and finally NOHERT medics (members of Provincial or regional Health Emergency Response Teams)

Salary And Employment

Paramedic wages in Canada vary depending on province or territory. Paramedics in Alberta will be earning comparable wages to paramedics in the United States, ranging from $35,000 to $40,000 yearly starting out. However, paramedics in Ontario in such regions or cities as Ottawa, Toronto, Peel Region, or Durham, will have an annual salary starting from $60,000 to $75,000 as a Primary Care Paramedic, an Advanced Care Paramedic salary can on average range from $80,000 to $90,000, and Critical Care Paramedics range from $95,000 to $120,000. Education background, experience, and level of practice all are contributing factors to which salary is established.

External links

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