The Emergency Medical Responder (EMR)
Successfully completed a recognized training program in emergency patient care and transportation. EMR’s are part of the foundation upon which Canadian emergency medical systems are built. They are often associated with volunteer emergency services organizations in rural and remote areas, and may be the sole provider of emergency services in some communities.
EMR’s may be responsible for initial assessments, the provision of safe and prudent care, and the transport of a patient to the most appropriate health care facility. "First Responders" (as found in a tiered response, industrial and / or recreational setting) may be included within the EMR level, although in many settings First Responders do not provide patient transport. The EMR competency profile does not include controlled or delegated medical acts.
The Primary Care Paramedic (PCP)
Successfully completed a recognized educational program in paramedicine at the primary care level. PCP’s are career paramedics associated with urban, suburban, rural, remote, industrial, air ambulance and / or military services.
PCPs constitute the largest group of paramedic practitioners in Canada. They are expected to demonstrate excellent decision-making skills, based on sound knowledge and principles. Controlled or delegated medical acts1 identified in the PCP competency profile include defibrillation and the administration of certain medications.
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The Advanced Care Paramedic (ACP)
Successfully completed a recognized educational program in paramedicine at the advanced care level. Such programs often require prior certification at the PCP level (or equivalent). ACP’s are most often employed by urban, suburban, air ambulance and / or military services. Currently relatively few ACP’s are found in rural areas.
ACP’s are expected to build upon the foundation of PCP competencies, and apply their added knowledge and skills to provide enhanced levels of assessment and care. This includes the added responsibilities and expectations related to an increased number of controlled or delegated medical acts available. Controlled or delegated medical acts1 identified in the ACP competency profile include advanced techniques to manage life-threatening problems affecting patient airway, breathing, and circulation. ACPs may implement treatment measures that are invasive and / or pharmacological in nature.
The Critical Care Paramedic (CCP)
Successfully completed a recognized educational program in paramedicine at the critical care level. This is currently the highest level of paramedic certification available. CCPs are most often associated with large urban and / or air ambulance services, and are not found in all provinces.
The CCP is expected to perform thorough assessments that include the interpretation of patient laboratory and radiological data. CCPs’ high levels of decision-making and differential discrimination skills relating to patient care, result in their implementing treatment measures both autonomously and after consultation with medical authorities. Many controlled or delegated medical acts1 are available to the CCP.
Those identified in the CCP competency profile include the use of invasive hemodynamic monitoring devices and advanced techniques to manage life-threatening problems affecting patient airway, breathing, and circulation. CCPs typically implement treatment measures that are invasive and / or pharmacological in nature.
The competencies at each practitioner level are cumulative, in that each level includes, and exceeds, the competencies of the previous level. Furthermore the competencies defined in these profiles are the minimum required at each practitioner level. Employment jurisdictions can, and frequently do, exceed these requirements.
Regulation of Paramedic Practice and Approval
of Training Programs
The practice of paramedicine in Canada is regulated by each province or, in the case of federal jurisdictions such as the military, by an appropriate federal authority.
Each regulator is free to determine the scope of practice and practitioner classification system that applies in its jurisdiction. Similarly the regulator may approve training program(s) that are a prerequisite to employment. A number of regulators are aligning their practitioner classifications with PAC’s (Paramedic Association of Canada) NOCP levels.
In addition to complying with local regulatory requirements, many training programs across the country have elected to participate in the voluntary national accreditation process for paramedic training administered by the Canadian Medical Association (CMA). CMA issues Requirements for Accreditation that include an expectation that a program ensures that its graduates possess the competencies determined by the national professional association.
CMA accredits paramedic programs at the PCP, ACP and CCP levels. In order to be eligible for CMA accreditation, programs must identify the level that applies to them and must demonstrate that their graduates meet (or exceed) every specific competency listed in corresponding profile contained in this document. The profiles include requirements related to the physical skills of lifting patients and performing certain other physical acts.
In Manitoba on graduation from an EMR, PCP or ACP program a graduate may apply for licensing through Manitoba Health Emergency Health Services at the Technician Level (EMR), Technician – Paramedic Level (PCP) or Technician – Advanced Paramedic Level (ACP). In Manitoba to work for an ambulance service you must hold a provincial license at one of the three aforementioned licensing levels.