July 28, 2006 Lesson #2 EMS in Canada

So now that we've covered the special case of Alberta...what about Paramedicine in Canada. Well Wikipedia does a wonderful job of summing it all up:

Paramedics in Canada

There are three levels of paramedic qualification:

• Primary Care Paramedic
• Advanced Care Paramedic
• Critical Care Paramedic
  

Primary Care Paramedics (In Alberta this is the EMT-A)

Primary Care Paramedics (PCP) are the basic level of paramedic in most Canadian provinces. They perform semi-automated external defibrillation, initiate IV's, interpret 3-lead ECG's and administer what are called 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 basic medical care. In some cases 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 an ambulance 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 there are several ambulance services that allow Primary Care Paramedics to perform manual defibrillation, 12-lead ECGs, or initiate intravenous therapy to deliver additional medications.

Advanced Care Paramedics (In Alberta this is the EMT-P)

Advanced Care Paramedics (ACP) carry (depending on jurisdiction) approximately 20-60 different medications, perform surgical airways, intravenous therapy, intubation, perform needle decompression of tension pneumothorax, use basic transport ventilators and perform and interpret 12-lead ECGs. Synchronized cardioversion and transcutaneous pacing are also included in their scope of practice. Several sites in Canada have experimented with pre-hospital fibrinolytics and rapid sequence intubation, and this is expected to gradually become a part of the ACP standard of care.

Critical Care Paramedics

Critical Care Paramedics (CCP) carry 70+ medications, interpret basic chest, neck and skeletal x-rays, CT-scans and 12-18 lead ECG's; 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 cooperation with their controlling physicians, and do not require additional medical staff to accompany any of their patients. This level of paramedic usually work on EMS helicopters or aircraft, or in Critical Care Transfer ambulances as their main function is to transfer critical patients between medical facilities. 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 stabilize and 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.

Training

Paramedic training in Canada is intense, as paramedics are seen as health professionals fully akin 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 takes 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.

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 and on in-hospital patient transfer teams. 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).