[accordion] [acc_item title=”General”] Capital – Ottawa
Land Size – 9,093,507 sq km
Population – 33,759,742
Language(s) – English (official) 58.8%; French (official) 21.6%; Other 19.6%
[/acc_item] [acc_item title=”Overview”]

  • “… in some cases as sophisticated as any in the world and in other cases is very basic.  The lack of federal regulation and the high cost of providing service to what is often and widely scattered and rural population, results in an uneven service from province to province and from region to region within provinces” (Symons, 122).
  • “Unfortunately, given the fragmented responsibility for EMS in Canada, there is little prospect of a nation-wide standard of EMS care” (Symons, 122)
  • Currently, no way to compare system outcomes.
  • Slash in Health Care expenditures in early 1990’s Þ overcrowding in EDs:
    • “Overcrowding has a cascading effect on EMS services, which are forced to commit resources to looking after patients in emergency departments, thus reducing their availability to respond to community emergency calls” (Symons, 122)
[/acc_item] [acc_item title=”EMS System Model”]
  • EMS delivery is not publicly administered
  • Fed Gov’t has no direct control over ambulance service delivery
    • Level of available care AND occupational titles for EMS providers (and meanings) differ considerably from province to province
  • Every funding and service delivery model, except fully private, is represented.
    • System Models:
      • Wholly Gov’t-funded systems
      • Heavily subsidized with nominal charge to Pt (majority)
      • Lightly subsidized with large part of cost borne by Pt
    • Delivery Models:
      • Fully Provincial
      • Regional/Municipal
      • Municipal/Regional contracted services
    • Service Providers:
      • Free-Standing
      • Fire Department-based
      • Hospital-based
    • Operational Models:
      • Publicly-operated
      • Publicly-contracted
      • Mix of public/private (minority)


[/acc_item] [acc_item title=”Lead Agency”]

  • Each province/territory is responsible for own EMS system
    • 13 distinct EMS systems in Canada
[/acc_item] [acc_item title=”Funding”]
  • Medicare– universal health insurance plan, legislated through Canada
    • 5 Prinicipals:
      • Health Care Plans must be publicly administered and operated as nonprofit system
      • Must be comprehensive, covering all medically necessary hospital, physician and surgical-dental services provided to insured persons
      • All insured residents must be entitled to insured health services on uniform terms and conditions
      • Residents moving from one province/territory to another must continue to be covered for insured health care services
      • Access to health care must be unimpeded by financial or other barriers
  • “Most regulations are quite broad and allow a great deal of latitude in the type of service that can operate” (Symons, 121).
  • Funding is provided:
    • Fully, by province
    • Partially, by province
    • Responsibility and funding delegated to regional/municipal government
  • Pt Costs are determined by different factors and vary between provinces
  • Rates are set depending on base of funding and whether service is government-provided ($0-$700 for initial response to residents in home province)

[/acc_item] [acc_item title=”Levels of Care, Education and Training”]

  • National Occupation Competency Profiles(NOCP) – developed by Paramedic Association of Canada (PAC) to establish detailed educational criteria for EMS providers and organizes practitioners into four levels:
    • Emergency Medical Responder(EMR)
      • Primary Responders in rural areas.
      • Basic Qualifications (provincial driver’s license)
      • Equipped with BLS Skills
        • CPR with O2
        • OPA
        • BVM
        • Spinal Immobilization (“Movement Restriction Devices”)
        • AED (some areas)
        • No Invasive Interventions, IVs or Med Admin
    • Primary Care Paramedic(PCP)
      • Simple Invasive Procedures: Glucose monitor, IV
      • Limited # of Meds:
        • ASA
        • D50
        • Epi SC
        • Nitro SL
        • Salbutamol Inhaler
      • 3-Lead EKG monitoring
      • AED
      • Basic Airway
      • No Manual Defibrillation
    • Advanced Care Paramedic(ACP)
      • Non-drug assisted airway management: ET Intubation
      • 3-Lead EKG
      • Electrical Therapy: Defib, Cardioversion, Transthoracic Pacing
      • Needle Thoracostomy
      • IV/IO Drug Admin:
        • All/Most first-line ACLS drugs and certain antiemetics
        • Antibiotics
        • Bronchodilators
        • Adrenergic/Cholinergic agonists/antagonists
        • Uterotonics
        • Tocolytics
        • Poison Antidotes
        • Neutralizing Agents
    • Critical Care Paramedic(CCP)
      • ACP training
      • 12-Lead EKG
      • RSI
      • Urinary Catherization
      • Monitor/Transport Pt’s with chest tubes/arterial lines
      • Lab result interpretation
        • Hematology
        • Biochemistry
      • X-Ray result interpretation
        • Chest
        • Back
        • C-Spine
    • Intermediate Care Paramedic (ICP) – describes practitioners in grey area between new classifications set by NOCP
    • Providers now being trained according to new NOCP model may or may not be allowed to practice to full extent of their training, depending on provincial/local regulations
      • May find it difficult/impossible to transfer to other provinces
[/acc_item] [acc_item title=”Specialty Services”]
  • HEMS
    • Air ambulance available in all provinces and provided without charge to residents for medically necessary flights
[/acc_item] [acc_item title=”Dispatch”]
  • 911 – Police, Fire, Ambulance for all urban and much of rural areas
    • Connects caller to centralized call center, forwarded to appropriate local emergency service provider
    • Service depends on willingness of municipality to pay for basic v. enhanced 911
[/acc_item] [acc_item title=”References”] [/acc_item] [/accordion]
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Comments
  • GK

    Great site. Some outdated information about Canada though. Thanks for compiling this information.

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