Paramedics in Canada

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In Canada the scope of practice of Paramedics is described by the National Occupation Competency Profile for Paramedics document developed by the Paramedic Association of Canada for the Federal Government. Unlike the United States, in Canada all providers that work in Ambulances are identified as 'Paramedics'. There is currently some minor variation in this - for example, the province of Alberta still uses the title 'EMT' for lower levels of training and 'Paramedic' only for those qualified as Advanced Life Support (ALS) providers - but almost all provinces are moving to using the new titles.

Contents

[edit] Qualifications

There are three levels of paramedic qualification:

  • Primary Care Paramedic (Primarily Pre-Hospital Care)
  • Advanced Care Paramedic (Primarily Pre-Hospital Care)
  • Critical Care Paramedic (Primarily Inter-Hospital Care)

[edit] Primary Care Paramedics

Primary Care Paramedics (PCP) are the fundamental level of paramedic in Canadian provinces. They perform semi-automated external defibrillation, initiate IV's, interpret 3-lead ECG's and administer Symptom Relief Medications for a variety of emergency medical conditions (these include Oxygen, Epinephrine, Glucagon, Ventolin, ASA, Nitroglycerine, etc.) and perform spinal immobilization and other fundamental medical care. Primary Care Paramedics may also receive additional training in order to perform skills that are normally in the scope of practice of Advanced Care Paramedics. This is both provincially (by statute) and locally (by the medical director) regulated by a paramedic service's base hospital physician, a medical doctor who certifies the paramedics under his license to perform controlled medical acts. For example, in the province of Ontario many paramedic services allow Primary Care Paramedics to perform manual defibrillation, 12-lead ECG interpretation (questionable .. is there a reference for this?), or initiate intravenous therapy to deliver additional medications.

[edit] Advanced Care Paramedics

Advanced Care Paramedics (ACP) are quickly becoming the most common level seen in Canada. This level, unlike any other level carry, and frequently use, approximately 20-60 different medications, perform surgical airways, intravenous therapy, intubation, place external jugular IV lines, perform needle decompression, use transport ventilators and perform and interpret 12-lead ECGs, perform synchronized and chemical cardioversion, transcutaneous pacing, perform limited obstetrical assessments, provide chemical pain relief from trauma and reverse hypoglycemic states. Several sites in Canada have experimented with pre-hospital fibrinolytics and rapid sequence intubation, and this is expected to become a part of the ACP standard of care.

[edit] Critical Care Paramedics

Critical Care Paramedics (CCP) carry 70+ medications, can perform cursory interpretation of basic chest, neck and skeletal x-rays, CT-scans and 12-18 lead ECG's, can perform rapid sequence intubation and surgical airway management, place external jugular and femoral lines, program medication pumps, use ICU-quality transport ventilators and isolettes, run intra-aortic balloon pumps on their own, use transvenous pacers, administer blood, perform obstetrical assessments, and monitor central lines and chest tubes - among other things. Essentially, they run a mobile intensive care unit. CCPs work in close communication with their controlling physicians and often do not require additional medical staff to accompany their patients. This level of paramedic usually work on aircraft, or in Critical Care Transfer ambulances and their primary function is to transfer critical patients between medical facilities. Provincially (by statute) and locally (by the medical director) regulated by a paramedic service's base hospital physician, a medical doctor who certifies the paramedics under his license to perform delegated controlled medical acts. Often upon arriving at a peripheral or rural hospital, the CCPs will take over care from the ER staff of a critical emergency patient in order to prepare them for transport to a more specialized facility. Critical Care Paramedics do not exist in many jurisdictions; most Paramedics with CCP training are employed in Ontario, Nova Scotia and Alberta.

[edit] Training

Paramedic training in Canada is intense, as paramedics are seen as health professionals, equal to nurses, respiratory therapists, cardiac perfusionists and others. Training varies regionally with Primary Care Paramedicine being a 6 month (Alberta) to two year (Ontario) program. Training as an Advanced Care Paramedic requires that the student be a practicing Primary Care Paramedic. Eligibility varies from immediate (self funded) to a mandatory period of experience working as a Primary Care Paramedic - usually one to three years (employer sponsored training). The Advanced Care Paramedic training can take from 2-3 semesters to 2 years. The short programs build upon the education already learned in a 2 year Primary Care Paramedic training program to introduce additional skill-sets, while the two year college programs will take a student as a newly graduated Primary Care Paramedic from a 6 month program. Either route will require that the student complete about 2.5 years of study and total about 3000-3500 hours (including clinical placements). Training as a Critical Care Paramedic follows the same sort of system, usually requiring mandatory field experience as an Advanced Care Paramedic. Studies can range from 2-3 semesters of study for the basic Advanced Care Paramedic program graduate to a few weeks of inservice training for the 2 year college ACP program graduate. Paramedic training at all levels involves supervised, intensive classroom, lab, clinical and field experience. There is a strong movement toward degree paramedicine in Canada and several Universities are offering degree programs in conjunction with Community Colleges. The education of paramedics in Canada is accredited by the Canadian Medical Association's Committee on Conjoint Accreditation and a list of accredited programs can be found on their site. The "National Occupational Competency Profile" or skill set and didactic competencies required to graduate from the various levels of Paramedic training can be found on the Paramedic Association of Canada website at [1]

Paramedic Training in the province of Quebec is anomalous to the rest of Canada. Until very recently Quebec was alone in following the European model of staffing ambulances with physicians. For various reasons this model is being abandoned and Quebec is slowly beginning to follow the general standards of EMS in the rest of the country.

There are only two organizations offering training in the province. Both are Community Colleges that only offer courses in French. Collège Ahuntsic in Montreal and Collège Sainte-Foy in Quebec City. Both of these Colleges offer PCP training only. According to the L'Association Professionnelle des Paramédics du Québec (APPQ) website these programs do not follow the NOCP guidelines are not accredited by the Canadian Medical Association.

According to the APPQ site, PCP training from the rest of Canada is not recognized in Quebec. A 2005 press release from the Ontario Paramedic Association referred to the fact that the Quebec government is blocking trained ACPs from utilizing their skills in the province.

[edit] Professional Environment

Because paramedics are seen as 'physician extenders' they enjoy a close relationship with physicians who ultimately grant paramedics the legal right to practice their profession. Also, because physician assistants exist primarily only in the military in Canada, the role of 'Clinical Paramedic' is gradually expanding. Centres such as Halifax, Nova Scotia have paramedics working in-hospital on cardiac arrest teams, on in-hospital patient transfer teams and emergency department triage.

Nova Scotia Paramedics through Emergency Health Services Nova Scotia and Emergency Medical Care Inc. [2] are the only service in Canada that are CAAS accredited (Commission on Accreditation of Ambulance Services) [3].

Paramedics are well paid and enjoy good benefits in most provinces. Paramedics in Canada generally work only as paramedics, not as cross-trained firefighters or police officers, and most are full 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 such as Toronto EMS run a full range of paramedic specialty squads including Marine medics, Bike medics, First Response medics, Tactical medics, CBRN medics (Chemical, Biological, Radiological and Nuclear) and HUSAR medics (Heavy Urban Search And Rescue - specializing in urban disaster recovery).

[edit] Notable Paramedic Associations

[edit] British Columbia Ambulance Service

The British Columbia Ambulance Service, is the sole provider of pre-hospital emergency care, in the province of British Columbia, at the paramedic level of care. Some stats:

Coverage

  • 4.2 Million Population
  • 926,492 km². coverage area
  • 551,290 Total Responses (Fiscal 2004/2005)

Paramedics and Equipment

  • 3,177 Total field paramedics/EMA's
  • 450 Total ambulances and support units
  • 190 Total paramedic stations

[edit] Alberta College of Paramedics

The Alberta College of Paramedics, a regulatory college in the name of public safety towards the code of conduct towards the profession of paramedic within the province of Alberta.

[edit] Toronto EMS

Toronto EMS is also the largest municipal paramedic service in Canada with 920 active paramedics in 146 ambulance transport units and a 2002 call volume of:

  • 425,000 Phone Calls via the 9-1-1 system
  • 247,000 Requests for service
  • 187,000 Responses
  • 140,000 Emergency patient transports

On December 7, 2004 TEMS was awarded "Queen's Colours" (a royal heraldic emblem, approved by the Queen)in recognition of services rendered to the community. The only other non-military organization to receive this honour is the Royal Canadian Mounted Police. More information is available on the Ontario Paramedic Association website here

The Association representing close to 300 of Toronto's Paramedics is known as the Toronto Paramedic Association, and can be reached at their website.

[edit] See also

[edit] External links

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