Becomming a Paramedic

What is a Paramedic?

The vast majority of paramedics in Canada are the persons you see who work on a land ambulance. In a number of sites in Canada, paramedics may also work on an air ambulance helicopter or plane, in the hospital, for pharmaceutical companies, or for the fire department. Paramedics provide emergency medical care to patients in an out-of-hospital and inter-hospital setting.

Ontario Ambulance Act Reg 386-01- defines a paramedic in Ontario

a person employed by or a volunteer in an ambulance service who meets the qualifications for an emergency medical attendant as set out in the regulations, and who is authorized to perform one or more controlled medical acts under the authority of a base hospital medical director, but does not include a physician, nurse or other health care provider who attends on a call for an ambulance

How do I become a Paramedic in Ontario?

Let's start with an overview of the Ontario Paramedic system. There are four levels of prehospital care in Ontario, only three of which, Primary Care Paramedic, Advanced Care Paramedic, and Critical Care Paramedic, are officially recognized in Canada and by the Ontario Ministry of Health as paramedic levels.

The four levels are:

1. Emergency Medical Responder (often used as volunteers in remote communities)
2. Primary Care Paramedic
3. Advanced Care Paramedic
4. Critical Care Paramedic

Those paramedics who work in the flight environment and have additional aeromedical training are called Flight Paramedics. i.e. Primary Care Flight Paramedic or PCP(F), Advanced Care Flight Paramedic or ACP(F), Critical Care Flight Paramedic or CCP(F)

What are the qualifications of the different levels?

Below is a description of the each classification:

Primary Care Paramedic (PCP)

Ontario's Primary Care Paramedic program is a 2 year program. This program is the foundation of paramedic education. Graduates must successfully complete a written provincial exam. Upon successful completion of the provincial exam, they are classified as a Primary Care Paramedic.

N.B.: A PCP is not permitted to practice at this level of training until they have secured employment with an ambulance service and have received approval/certification from their local Medical Director.

PCPs respond to both emergency and non-emergency calls and work in an ambulance with another PCP or ACP partner. PCPs can perform patient assessments, basic airway management, administer oxygen by demand, by bag-valve-mask or basic mechanical ventilation, provide CPR, and trauma care (i.e. spinal and wound care, limb immobilization/traction, etc). PCPs are also trained in the use semi-automated external defibrillators. In addition, a PCP may administer the following medications as per certification through their local Base Hospital:

ASA (for suspected myocardial infarction [heart attack]),
sublingual Nitroglycerin spray for angina pectoris (chest pain),
metered dose inhaler Ventolin for bronchospasm (asthma),
glucagon (or oral glucose gel) for hypoglycemia (diabetes), and
epinephrine for anaphylaxis (allergic reaction).

Advanced Care Paramedic (ACP)

Generally, a minimum of 6 months-2 years of full-time experience in the ambulance field is required to qualify for training at the ACP level. The ACP program is 1 year in length and is considered a post-diploma program (1200 hours).

In addition to the PCP skill set, ACP providers are qualified to perform and/or use: advanced airway management including oral and nasotracheal intubation, laryngoscopy and removal of foreign body obstruction using MacGill forceps, basic field mechanical ventilation, 12 lead ECG interpretation, synchronized cardioversion, manual defibrillation and external cardiac pacing, treatment of cardiac emergencies according to Heart & Stroke Foundation Advanced Cardiac Life Support (ACLS) guidelines, needle thoracostomy, pneumatic anti-shock garment (PASG) inflation, and administration of the following emergency medications: Adenosine, Amiodarone, ASA, Atropine, Diazepam, Dopamine, D50W, Epinephrine, Furosemide, Glucagon, Lidocaine, Morphine, Naloxone, Nitroglycerine, Oxygen, Salbutamol, Sodium Bicarbonate (drug list may vary from one service to another).

Some of the above are controlled acts performed either under direct order from a Base Hospital Physician or by Standing Orders (protocols).

Critical Care Paramedic (CCP)

Critical Care Paramedics are ACP providers with additional training/education. Only a few ambulance services employ Critical Care Paramedics as it is a highly specialized field. The Dedicated Air Ambulance service in Ontario has had Critical Care Flight Paramedics since 1977.

The successful applicant to a CCP must have the following minimal requirements:

	minimum 1 year experience at the ACP level
	Basic Trauma Life Support (BTLS) certification
	Aeromedical Certificate (for the Critical Care Flight Paramedic level)
	recent certification Advanced Cardiac Life Support (ACLS)

The Critical Care Paramedic program is approximately one year in length. In addition to the skills of an ACP, Critical Care Paramedics are trained to perform the following:

	end tidal CO₂
	arterial line monitoring
	monitoring of central lines, including P.A. lines.
	rhythm and 12 lead ECG interpretation
	lab value and ABG interpretation
	x-ray interpretation
	administration of medications (extensive list)
	administration of blood products
	umbilical cord cannulation (northern bases)
	gastric intubation
	foley insertion
	doppler neonatal monitoring

Critical Care Paramedics must maintain their certification in Advanced Cardiac Life Support (ACLS), Advanced Trauma Life Support (ATLS), Neonatal Resuscitation Program (NRP), Pediatric Advanced Life Support (PALS), and Emergency Delivery.

What level do most paramedics in Ontario function at?

Paramedic Programs in Ontario

Most Paramedics in the province of Ontario function at a Primary Care Paramedic level although there is an increasing number of Advanced Care Paramedics.

How do I become a paramedic in Ontario?

Anyone who wishes to enter the field of paramedicine in Ontario is required to complete the PCP program or receive equivalency, then successfully complete a provincial Ministry of Health exam.

What if I'm a prehospital care provider/paramedic from another province or country and I wish to work in Ontario, how do I do that?

If you have training and/or experience in the ambulance field from another province or country and you wish to work in Ontario, you will need to contact the Ontario Ministry of Health (see below).

Ontario Ministry of Health

Emergency Health Services Branch Policy on paramedic "equivalency"

The following process is used to determine paramedic equivalency in the Province of Ontario:

The following is an outline of the Advanced Emergency Medical Care Assistant (A-EMCA) Competencies in Ontario. These competencies will be used when assessing candidates requesting equivalency for programs that have not already been validated in this province.

The Advanced Emergency Medical Care Assistant is expected to:

	Determine and/or ensure the safety of the patient's environment prior to and during patient care;
	select those elements of the primary assessment and immediate priority management that are to be implemented in patient situations of :

obvious threat of life,
potential for threat of life,
non-compromised/stable condition.

Differentiate those elements of history that are significant in:

presenting chief complaint or incident,
information from the environment surrounding the patient, e.g. dynamics of injury, medication prescribed or taken, other suggested sources of data,
presenting manifestations of the patient,
type of trauma or pathological condition of the patient,
progression/deterioration of the condition.

Discriminate those patient situations in which :

a complete secondary assessment (including vital signs) is to be performed,
only priority elements of a priority assessment (including vital signs) are to be selectively performed,
secondary assessments are to be performed during transport,
specific qualitative diagnosed assessments are to be performed.

	provide the rationale to support the discrimination used in selecting the priority and/or diagnostic assessments which are performed;
	interpret the significance of assessment findings pertinent to the :

patient's physical behavioral and physiological manifestations,
potential for deterioration in the patient's status,
obvious manifestations of threat of life,
need for further reassessment.

Implement management priorities, basing the selection on relevance to the :

presenting manifestations of the patient(s),
pathology or trauma involved,
priority management needs of the patient
measures to provide psychological support and therapeutic communication,
patient's age, comprehension ability, coping ability and/or crisis state,
potential for deterioration and/or threat of life,
need for minimal stabilization and immediate transport,
legal implications related to patient care and transport.

	provide the rationale to support the decision making and judgments used in selecting the priorities in patient management;
	implement those measures to ensure safe lifting, transferring and transport;
	report and record the :

chief complaint,
presenting priority assessment findings,
relevant history of the incident or past medical history,
summary of significant changes in status,
response to the provided management.

Apply the principles of assessment and management to the triage situation in which multiple patients are involved.

Emergency Health Services Branch recognizes the interpretation, judgement and critical decision-making skills developed during the educational program for an Ontario Advanced EMCA as essential. Therefore, an equivalency candidate must demonstrate that they have had an opportunity to develop such skills either through a similar educational program or through extensive EMS work experience.

To assist candidates in pre-determining their potential for equivalency, the following components are included within the educational program that an Ontario Advanced EMCA completes.

Theory component (800+ hours), including topics such as :

	anatomy and physiology
	pathophysiology
	disease and trauma processes
	emergency patient care
	legal and ethical issues
	psychology/sociology
	symptom relief (SR)
	pharmacology
	semi-automatic external defibrillation (S-AED)
	supportive and therapeutic communications
	crisis intervention

Practical lab and hospital clinical component (300 hours) including areas such as :

	patient assessment and treatment
	equipment skills
	driver improvement
	intravenous initiation TKO

Land Ambulance Field placement (min. 450 hours) :

Receive a satisfactory evaluation from a preceptor crew following 450 hours of land ambulance experience.

Eligible candidates must forward the following documentation to the Emergency Health Services Branch of the Ontario Ministry of Health and Long Term Care.
(Administration Fee : $50.00* All certified cheques/money orders must be made payable to the Minister of Finance).

a letter of evaluation from a Land Ambulance Manager/Supervisor attesting to :
1. the candidate's competency in delivering pre-hospital patient care,
2. the number of hours of land ambulance pre-hospital patient care experience,
a verified copy of their post secondary educational transcripts,
confirmation of registrations/licenses and/or certificates,
Course outlines, including a breakdown of curriculum hours and learning outcomes.

The candidate's qualifications will be verified and assessed against the standards in Ontario.

The candidates assessed as acceptable will be required to complete a selection of qualifying tests to determine the candidate's knowledge and skills as they pertain to pre-hospital care in Ontario. These tests include:

Ontario Ambulance Legal Test
This written test is designed to assess the candidate's knowledge of the Ontario Legislative framework as it pertains to the ambulance system.
(Administration Fee : $20.00)

Symptom Relief Test
This written test is designed to assess the candidate's knowledge of the Ontario protocols for the delivery of symptom relief drugs. (Nitroglycerin, ASA, Ventolin, Epinephrine and Glucagon).
(Administration Fee : $20.00)

Semi-Automatic External Defibrillator Test
This written test is designed to assess the candidate's knowledge of the Ontario protocols for the delivery of semi-automatic defibrillation.
(Administration Fee : $20.00)

Patient Care Tests
This oral and skills test is designed to assess the candidate's proficiency, based upon Ontario standards, and protocols with

Equipment Practical Test:	various pieces of equipment (stretcher, Sager splint, K.E.D., spinal board, Genesis II ventilator)
Symptom Relief Practical Test:	skills associated with symptom relief
Defibrillation Practical Test:	skills associated with defibrillation
Practical Scenario:	a practical problem solving scenario

(Administration Fee : $100.00)

English proficiency will be assessed throughout the tests.
Please note: All equivalency candidates are offered 3 attempts to complete the testing components. At each re-attempt only the components that are unsuccessful will be retried.

Upon successful completion of the required qualifying tests, the candidate is eligible to write the Advanced Emergency Medical Care Assistant theory exam. (Fee : $250.00)

Note : This exam is conducted twice a year - Winter and Summer.

Upon successful completion of the Advanced EMCA theory exam, the candidate will be issued an Advanced Emergency Medical Care Assistant Certificate.

If you have any questions, please do not hesitate to call:

Ms. Cathy Francis
Ontario Ministry of Health
Emergency Health Services Branch
Resource Development
5700 Yonge Street, 6th Floor
Toronto, Ontario, Canada
M2M 4K5
(416) 327-7843

REVISED AUGUST 2000

What if I work in the ambulance field and I would like to come to Ontario to pursue advanced paramedic education (ACP) and then return to my own province or country?

If you currently work as a prehospital care provider in another province or country and would like to pursue advanced paramedic education (EMT-P, P3 or Advanced Care Paramedic equivalent) and return to work in your own province or country, you can apply as a foreign student to:

Department of Paramedic Studies
The Michener Institute for Applied Health Sciences
222 St. Patrick Street
Toronto, Ontario
M5T 1V4
416-596-3101
www.michener.on.ca
Ask for the coordinator of the Advanced Care Paramedic Program

Candidates are selected on a point system based on previous related education and ambulance experience. Graduation from the Advanced Care Paramedic Program does not guarantee recognition of training or employment in the province of Ontario. To work in Ontario, all candidates must first obtain Primary Care Paramedic status through the Ministry of Health, Emergency Health Services Branch

What is the Primary Care Paramedic Program all about?

The Primary Care Paramedic Program is offered at a number of community colleges throughout Ontario.

Program Eligibility Criteria:
Required Academic Preparation
For course descriptions and additional information, visit any one of the college websites

List of the Colleges offering the Primary Care Paramedic Program

You can write to any one of the Program Coordinators to receive an application or to receive a Prior Learning Assessment. If you are from out of province, you can also contact the Ontario Ministry of Health's Patient Care Standards, Education and Certification department for information on equivalency: 416-327-1540

Primary Care Paramedic Program Coordinators

Attention: Jim Whittle, Coordinator
Paramedic (Level 1) Program
Algonquin College
Rideau Room E124
200 Lees Avenue
Ottawa Ontario K1S 0C5
613-727-4723 ext 3336
613-727-7684 fax or 613-598-3300 fax
www.algonquinc.on.ca

Attention: Bob Mahood, Coordinator
Primary Care Paramedic Program
Connestoga College
Doon Campus
299 Doon Valley Drive
Kitchener Ontario N2G 4M4
519-748-5220 ext 439
519-748-5971 fax

Attention: Brian Marsh, Coordinator
Primary Care Paramedic Program
Cambrian College
885 Regent Street South
Sudbury Ontario P3E 5M4
705-566-8101 ext 7210
705-524-7326 fax

Attention: Debra Walker., Coordinator
Distance Education Program
Primary Care Paramedic Program
Confederation College
P.O. Box 398
Thunder Bay Ontario P7C 4W1
807-475-6346
807-473-5088 fax
walker@confed.confederationc.on.ca

Attention: Richard Yelle, Dept Head
Sylvie Salminen, Coordinator
Secours Ambulancier Program (in french)
College Boreal
21, Boulevard Lasalle
Sudbury, Ontario P3A 6B1
705-675-6673
705-675-0023 fax

Attention: Mark Hunter, Coordinator
Primary Care Paramedic Program
Fanshaw College
P.O. Box 4005
London Ontario N5W 5H1
519-452-4430 ext 4329
519-659-5781 fax
hunter@fanshawwec.on.ca
www.fanshawec.on.ca

Attention: Susan Woollard, Coordinator
Primary Care Paramedic Program
Centennial College
P.O. Box 631, Station "A"
Scarborough Ontario M1K 5E9
416- 289-5307
416-694-5589 fax
www.cencol.on.ca
aswg@cencol.on.ca

Attention: Doug Leonard, Coordinator
Primary Care Paramedic Program
Humber College
North Campus
205 Humber College Blvd.
Etobicoke Ontario M9W 5L7
416-675-3111 ext 4302
416-675-2015 fax

Attention: Greg Skomash, Coordinator
Primary Care Paramedic Program
St. Clair College
2000 Talbot Road West
Windsor Ontario N9A 6S4
519-972-2727 ext 4354
519-972-0801 fax

Attention: Rick Chandler, Coordinator
Primary Care Paramedic Program
Niagara College
P.O. Box 1005, Woodlawn Road
Welland Ontario L3B 5S2
905-735-2211 ext 7591
905-735-5904

Attention: Robert Brunet, Coordinator
Secours Ambulancier Program (in french)
La Cite Collegiale
801, promenade de l'Aviation
Ottawa, Ontario K1K 4R3
613-742-2493 poste 2506
613-742-2480 fax

Attention: Kelly Sheppard, Coordinator
Primary Care Paramedic Program (part-time program)
Loyalist College
Bancroft Campus
P.O. Box 10
Bancroft Ontario K0L 1C0
613-332-1743
613-332-4773 fax
medic@durham.net

Canadian Career College
North Bay Campus
1495 Seymour Street
North Bay, ON
P1B 8G4
Tel (705) 495-1200
Fax (705) 495-0799
1-866-495-1200
http://canadiancareercollege.com/campus/ppcp.htm

Barrie Campus
546 Bryne Drive
Barrie, ON
L4N 9P6
Tel (705) 725-8776
Fax (705) 725-9615
1-877-725-1200
http://canadiancareercollege.com/campus/ppcp.htm

Sudbury Campus
885 Regent Street
Sudbury, ON
P3E 5M4
Tel (705) 688-1200
Fax (705) 670-9439
1-866-688-1200
http://canadiancareercollege.com/campus/ppcp.htm

List of the Colleges/agencies offering the Advanced Care Paramedic and Critical Care Paramedic Programs

You can write to any one of the Program Coordinators to receive an application. If you are from out of province, you can also contact the Ontario Ministry of Health's Patient Care Standards, Education and Certification department for information on equivalency: 416-327-1540

Advanced Care & Critical Care Paramedic Programs
The Michener Institute for Applied Health Sciences
Department of Paramedic Studies
222 St. Patrick Street
Toronto, Ontario M5T 1V4
rtheriault@staff.michener.on.ca
www.michener.ca
416-596-3101 ext 3365
1-800-387-9066 ext 3365

Advanced Care Paramedic Program (only)
Attention: Jim Whittle, Coordinator
Paramedic (Level 1) Program
Algonquin College
Rideau Room E124
200 Lees Avenue
Ottawa Ontario K1S 0C5
613-727-4723 ext 3336
613-727-7684 fax or 613-598-3300 fax

http://canadiancareercollege.com/campus/ppcp.htm

All of the above providers are referred to as Paramedics. Terms such as "ambulance attendant" or "ambulance driver" are outdated terms and no longer used.