Primary Care Paramedic (PCP)
The Primary Care Paramedic (PCP) is a community college graduate of a program dedicated to the Paramedic profession. The diploma in "Paramedic Studies" is two years in duration and emphasizes anatomy, physiology, pharmacology, and mechanisms involved in acute injury and illness. The program involves classroom learning and clinical hours working directly in the field. Once the college program is successfully completed, a paramedic must complete a provincial examination. This certification, known as the Paramedic exam or Advanced Emergency Medical Care Assistant (A-EMCA) exam, must be successfully completed to practice as a primary care paramedic in Ontario. In addition, each PCP must complete many continuing medical education courses on an annual basis to maintain their qualifications. The PCP is also certified by a physician to perform a number of controlled medical acts for individuals experiencing acute injury or illness. PCP's can be recognized by the one stripe above the word "Paramedic" on their shoulder epaulettes.
The PCP functions to provide:
- emergency patient care
- cardiopulmonary resuscitation (CPR)
- patient immobilization
- oxygen therapy
- basic trauma life support
- blood glucose testing
The PCP skill set and medications also include:
- semi-automatic defibrillation
- acetylsalicylic acid
- epinephrine
- glucagon
- glucose gel
- nitroglycerine spray
- salbutamol
- peripheral IV starts
- 12-Lead ECG application
- pulse oxymetry monitoring
Primary Care Flight Paramedic (PCFP)
The Primary Care Flight Paramedic (PCFP) functions to safely transfer stable patients across the province to appointments and further medical care. They are also responsible for returning patients to their homes towns after treatment and to begin their recovery.
The PCFP scope of practice includes:
- semi-automatic defibrillation
- lifesaving pharmaceutical therapy similar to that of a PCP
Advanced Care Paramedic (ACP)
The Advanced Care Paramedic (ACP) must have a minimum of 2 years of experience in the paramedic field before being able to qualify for training at the ACP level. 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 he/she spends 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
- LMA's
- 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)
Advanced Care Flight Paramedic (ACFP)
The Advanced Care Flight Paramedic (ACFP) functions with a greatly expanded scope of practice over the Advanced Care Paramedic. The main function is to make available Advanced Life Support treatment modalities to patients in areas of the Province that may not have this level of prehospital care available.
In addition to the skills that ACP's perform, the ACFP scope of practice includes:
- intravenous therapy
- pharmaceutical therapy
- advanced airway management including oral and nasotracheal intubation
- rapid sequence intubation
- percutaneous Cricothyrotomy
- laryngoscopy and removal of foreign body obstruction using MacGill forceps
- og/ng tubes
- LMA's
- ETCO2 monitoring
- mechanical ventilation
- 12 lead ECG interpretation
- needle thoracostomy
- chest tube monitoring
- intraosseous and external jugular IV starts
- blood product administration
- foley catheters
- IV pumps
- 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 over 40 emergency medications including some of the following: Adenosine, ASA, Ativan, Atropine, Demerol, Dextrose, Diazepam, Dimenhydrinate, Diphenhydramine, Dopamine, Epinephrine, Fentanyl, Furosemide, Glucagon, Lidocaine, Morphine, Naloxone, Neuromuscular Blockers, Nitroglycerine, Salbutamol, Sodium Bicarbonate, Midazolam and other medications
Critical Care Paramedic and Critical Care Flight Paramedic (CCP and CCFP)
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