Paramedics in Canada
A paramedic is a healthcare professional, providing pre-hospital assessment and medical care to people with acute illnesses or injuries.
To address this there is a national consensus of paramedic and emergency medical responder practice (by way of the National Occupational Competency Profile) identifies the knowledge, skills, and abilities as being most synonymous with a given level of paramedic or emergency medical responder practice.
Each province retains ultimate authority in legislating the actual administration and delivery of paramedicine and its services within its own respective jurisdictions.
Specific paramedic regulatory frameworks and practice is established uniquely in each of the provinces legislature and statute and varies across Canada.
[1] This is a level of practice recognized under the National Occupational Competency Profile and the Paramedic Association of Canada.
It is a level of practice focused primarily on life saving methods and is generally consistent with fewer acts beyond advanced first-aid.
The EMR's scope of practices include oxygen administration, oropharyngeal and nasopharyngeal airway adjuncts, the use and interpretation of a pulse oximeter, use and interpretation of a glucometer, blood pressure assessment by auscultation and palpation, chest auscultation, oropharyngeal airway suctioning, administration of the following oral, sublingual or inhaled medications: anti-anginal, anti-hypoglycemic agent, analgesia, platelet inhibitors (including nitroglycerin, glucose, nitrous oxide, acetylsalicylic acid, salbutamol, intravenous lines without medications or blood products).
The scope of practice includes performing semi-automated external defibrillation, manual defibrillation, oxygen administration, ETCO2 monitoring, supraglottic airways, vascular access, cardiac monitoring such as Lead 2 interpretation and 12 Lead acquisition and interpretation, and administration of Symptom Relief Medications for a variety of emergency medical conditions (these include epinephrine, salbutamol, aspirin, nitroglycerine, naloxone, dextrose, glucagon, gravol, ketorolac, ibuprofen, acetaminophen, benadryl).
PCPs may also receive additional authorization in order to perform certain skills that are normally in the scope of practice of ACPs.
Several sites in Canada have adopted pre-hospital fibrinolytics and rapid sequence induction, and prehospital medical research has permitted a great number of variations in the scope of practice for ACPs.
Current bypass protocols include providing both PCPs and ACPs with discretionary direct 24-hour access to PCI labs, bypassing the emergency department, 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.
The education provided is in the theories of paramedicine and its practice and in related subjects areas such as but not limited to anatomy, physiology, psychology, obstetrics, cardiology, pharmacology, pathology, communications, ethics, driving, research, emergency medicine theory and practical skills.
Nova Scotia,[11] New Brunswick,[12] Newfoundland and Labrador[13] have a two year primary care paramedicine diploma program.
In Quebec since 2015, a formal 2-year advanced care paramedic (ACP) training program was developed at Université de Montréal for experienced PCPs from Urgences-santé.
[16] These programs are often offered through partnerships between Canadian universities and colleges to enhance theory and practical training with higher education.
[21] The accreditation model of Accreditation Canada is an independent body, and draws from The national occupational competency profile (NOCP) as the benchmark document that details the knowledge, skills and abilities outcomes that must be possessed by paramedics or EMRs of each respective level of paramedic or EMR practice.
In addition to this they are trained for other skills such as medication infusion pumps, mechanical ventilation and arterial line monitoring.
Across the prairies, STARS Shock Trauma Air Rescue Society uses rotary wing aircraft to reach many in isolated communities and traumatic situations for faster response time than by ground ambulance.
Some are trained to handle weapons, rappel from buildings, and other skills needed to work alongside tactical police units.
Occupational paramedic responsibilities may include providing pre-employment screening, medical surveillance services and clinical testing for companies and research institutions.
Treatments provided by community paramedics include: fluid rehydration, blood transfusions, urinary catheterization, wound closure & care (tissue adhesive, sutures, dressings), oxygen and nebulizer therapy, medication administration, and coordination of community services.
These paramedics may carry a unique range of medications than and more protective equipment, allowing them to better treat poisonings/overdoses and work closely with firefighters and hazmat technicians.
Paramedics are forming their own professional regulatory college in much of the same manner as physicians, nurses, respiratory therapists and other health professions.
The ministry additionally maintains the provincial standards and medical directives expected of all paramedics in Ontario.
Medical directors are generally emergency medicine specialized physicians who work in a hospital associated with the paramedic service.
The Office provides paramedics with the ability to perform controlled medical acts while working within the public ambulance program.
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.
Due to the challenging working conditions, paramedics, similarly to other first responders, are at a greatly increased risk to develop Post-Traumatic Stress Disorder as compared to the general population.
