Paramedics

Paramedics are medical professionals who assess and provide emergency care for medical and traumatic emergencies in the prehospital environment, and transport patients to hospital for further assessment and follow up care when necessary.

Levels of Practice

In the province of Ontario, Paramedics are classified according to their level of certification. The minimum level certification required for designation as a Paramedic in Ontario is a Primary Care Paramedic. The Corporation of the County of Simcoe currently employs part-time and full-time Primary Care Paramedics.

Scope of Practice

Paramedic Scope of Practice under the Regulated Health Professions Act (1991)

Primary Care Paramedic (PCP)

The Primary Care Paramedics (PCP) is a graduate of a two year college diploma Paramedic Program. The program emphasizes anatomy, physiology, pharmacology, and mechanisms involved in acute injury and illness. The program involves classroom lectures and labs, clinical hours in hospital Emergency and Obstetric departments, and working directly in the field. Graduates must complete the provincial Advanced Emergency Medical Care Assistant (A-EMCA) exam, in order to practice as a Primary Care Paramedic in Ontario. Following further examination by the local Base Hospital, Primary Care Paramedics are certified by a physician to perform a number of controlled medical acts. Paramedic Services also require each PCP to complete many continuing medical education courses on an annual basis to maintain their qualifications. PCP's can be recognized by the one stripe above the word "Paramedic" on their shoulder epaulettes.

The PCP skill set and medications also include:

• Basic Life Support (BLS)
• International Trauma Life Support (ITLS)
• oxygen therapy
• cardiopulmonary resuscitation (CPR)
• semi-automatic defibrillation
• pulse oxymetry monitoring
• blood glucometry
• administration of the following emergency medications:
  
  • acetylsalicylic acid
  • epinephrine
  • glucagon
  • glucose gel
  • nitroglycerin spray
  • salbutamol

In the County of Simcoe, PCP's are certified in these auxiliary directives:

• Laryngeal Mask Airway
• 12-Lead ECG interpretation for ST Elevation Myocardial Infarctions
• Bypass to Southlake Regional Health Center for PCI for STEMI patients
• Bypass to Royal Victoria Hospital for Acute Stroke patients
• Electronic Control Device probe removal
• Additional medications for designated "Special Events":
  
  • Acetaminophen
  • Dimenhydrinate
  • Diphenhydramine
  • Polymyxin B

In addition, the County of Simcoe Paramedic Services recently implemented a peripheral IV therapy program, which expands IV-trained Paramedic's skill set to include:

• Dextrose
• IV fluid boluses
• expanded indications for nitroglycerin spray

The County of Simcoe Paramedic Services currently employs a staff comprised entirely of Primary Care Paramedics. In a presentation to county Paramedics, Paramedic Services management have stated they support the deployment of an Advanced Care Paramedics program in the county, and have made a preliminary proposal for the implementation of such to county council.

Advanced Care Paramedic (ACP)

The ACP program is an additional 1 year in length and is considered a post-diploma program (1200 hours). The ACP will have had 2 years of training to become a PCP before the addition year to progress to the advanced care level. The ACP course is highly intensive and requires weeks of in class didactic training, weeks of in hospital clinical training where the ACP learner works directly with physicians and months of preceptorship practicum where the ACP must demonstrate competence to multiple preceptors. In addition, each ACP must successfully complete many mandatory and elective continuing medical education courses on an annual basis to maintain their qualifications and certifications. ACP's can be recognized by the two stripes above the word "Paramedic" on their shoulder epaulettes.

In addition to the PCP skill set, ACP providers are qualified to perform and/or use:

• advanced airway management equipment
• orotracheal and nasotracheal intubation equipment
• lighted stylet intubation equipment
• Laryngeal Mask Airways
• orogastric and nasogastric tubes
• SPO2 monitoring
• Side stream ETCO2 monitoring (capnography and capnometry)
• mechanical ventilation
• laryngoscopy and removal of foreign body obstruction using MacGill forceps
• intravenous therapy
• pharmaceutical therapy
• 12 lead ECG interpretation
• needle thoracostomy
• chest tube monitoring
• intraosseous and external jugular IV starts
• manual defibrillation, synchronized cardioversion and external transcutaneous cardiac pacing
• treatment of cardiac emergencies according to Heart & Stroke Foundation Advanced Cardiac Life Support (ACLS) guidelines
• administration of the following emergency medications: Adenosine, ASA, Atropine, Dextrose, Diazepam, Dimenhydrinate, Diphenhydramine, Dopamine, Epinephrine, Fentanyl, Furosemide, Glucagon, Lidocaine, Morphine, Naloxone, Nitroglycerine, Salbutamol, Sodium Bicarbonate, Midazolam and other medications (drug list may vary from one service to another)

Critical Care Paramedic (CCP)

The Critical Care Paramedic (CCP) and Critical Care Flight Paramedic (CCFP) functions with a greatly expanded scope of practice over the Advanced Care Paramedic. The scope of practice of the Critical Care Paramedics is designed to maintain the high level of treatment from Intensive Care Sending Facilities during the out of hospital transport of the patient and until delivery at the Receiving Facility. CCP's can be recognized by the three stripes above the word "Paramedic" on their shoulder epaulettes.

In addition to the skills that ACP's and ACFP's perform, the Critical Care Paramedic and Critical Care Flight Paramedic practice includes:

• transvenous pacing
• greatly expanded pharmaceutical therapy
• invasive patient monitoring