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History of Paramedics in Ontario

Date: 2015-07-27

A Timeline History of Paramedics in Ontario

1832 - Due to the demand for help in removing ill and deceased victims during a deadly cholera outbreak in the Town of York (now Toronto), June 22, 1832 saw the establishment of the first organized form of Ambulance transportation with “carter" Mr. John Blevins, staffing the Cholera Cart - it should also be noted that Toronto's first Mayor - Mr. William Lyon McKenzie also served as an attendant on the Cholera Cart.

Formal training of “ Carters" or early Ambulance staff was unnecessary due to the style of treatment for the day. The ill or injured were cared for in their homes by visiting doctors. Once the doctor was all out of options and the patient succumbed to their situation, was an ambulance summoned. It's sole purpose was to transport the dying or deceased to a funeral service provider of their choosing, hence the validation of the hypothesis that the origins of formalized EMS transport fell to undertakers, as they were the only folks to possess a vehicle long enough to house a recumbent human form. This vehicle often performed “double duty" as an Ambulance and Hearse. Hence the beginnings of what was to be called a“Combination Car" in future private EMS advancements.

1880 - Formalized Hospital based Ambulance service began in Toronto with the Toronto General Hospital taking delivery of what is believed to be Canada's first horse drawn Ambulance bequeathed to it by Mrs. Percival Ridout. It's documented that this ambulance provided “effective service"

1888 - The Toronto Police Service got into the act. In June of that year, the Police began operating what would eventually become 4 horse drawn ambulances to meet the demand of emergency calls in Toronto. These vehicles were replaced with motorized ambulances in 1913. The Toronto Police got out of the Ambulance business in 1933.

1889 - First documented formalized training of Ambulance staff occurred for the Toronto Police service by The St. John Ambulance Association - a 5 day training course in the management and transport of the ill and injured.

1905 - This year marked the beginning of the “Privates", independent entrepreneurs and funeral directors who invested in ambulances and combination cars to augment their businesses. This became the start of a proliferation of over 600 different Funeral Home based and Private Ambulance providers all across Ontario until formalized regulations and control of Ambulance services fell under the jurisdiction of the Provincial government in the 1970's.

1911 - The horses were put out to pasture as the mechanical age hit the ambulance service. The first motorized Ambulance came on the scene in February 1911, owned by the A.W. Miles Funeral Home in Toronto. This would be the start of the mechanical era of ambulances and the demise of the once proud Ambulance Horse.

1915 - Ontario Ambulances go overseas. In May, of this year, the Ontario government established a military hospital in Oprington, England. As part of the commitment to the soldiers who fought for His Majesty and the Empire at the time, in addition to not only establishing the Hospital, the Ontario government shipped 6 motorized ambulances overseas to assist in the transportation of the ill and injured soldiers.

1930 - 1966 - In these developing times for EMS in Ontario quite a proliferation of ambulance services sprung into existence. Private operators were plentiful all across Ontario, funeral home based services were also very common, along with Hospital based, Fire Dept. based and Corporate based providers as well. These years also saw the addition of the NGO's in Ambulance and disaster service. Organizations like The St. John Ambulance Brigade and the Canadian Red Cross added staff and vehicles to assist in the treatment and transport of the ill and injured.

In addition to the many new and developing ambulance services of the day, training was also adapting to the need of the time. Organizations like The St. John Ambulance Association and Canadian Red Cross began teaching ambulance staff and the general public first aid courses and adapting injury and illness management techniques to make the treatment of those afflicted with such situations easier and less painful.

1937 - Safety on Ontario's highways becomes front page news. As a result of the ever increasing speeds of motor cars and the ever expanding network of Ontario's highways, a strategy was implemented to mitigate accidents on Ontario's roadways. From 1937 until the early 1970's a series of roadside first aid posts located in many service stations were established and manned by repairmen and gas station attendants who were trained in emergency first aid skills. In addition to these posts, a series of Highway Patrol Ambulances were created in a joint venture by the St. John Ambulance Brigade, Canadian Red Cross and Ontario Motor League. These units, staffed by a 3rd year medical student and driver patrolled Ontario's highways responding to automobile accidents and caring for the sick and injured until the mid 1960's

NGO's and Community Involvement - Often under-rated but critical in Ontario's EMS history is the involvement of Community based organizations like the St. John Ambulance Brigade and the Canadian Red Cross. Together, these organizations have trained millions in life saving skills and have both done their part in the scope of Ontario EMS development. These combined organizations provide dedicated first aid and medical staff at numerous community events and large gatherings, as well as provide manpower during large scale events, war, times of civil unrest and disasters. There have been numerous documented times when the Red Cross and St. John Ambulance have lent assistance to EMS services and communities across Ontario, and with the ever changing climate of our modern day world, these NGO's will continue to exist and provide assistance whenever and wherever required.

Infant Transport - The genesis of today's lift assist at Sick Kids and various Children's Hospitals across Ontario. In the late 1930's a study was conducted by the Hospital for Sick Children on the survivability of infants born and the co-relation of their body temperatures - as a result it was determined that infant survivability was increased 8 times if the baby was kept warm, so the first portable infant incubator was created and available for use in Ontario's ambulances. - Just think of all the back injuries back in the day !!!

The evolving vehicle - Since the demise of the Horse drawn ambulance and the introduction of the new more modern motorized ambulance, the vehicle itself has seen quite a transformation. From the basic wooden cart to the sleek aerodynamic and classic designs of the 1930's to the 1970's, ambulances have come a long way in terms of patient comfort and on-board amenities. In the beginning, there was a wooden cot with maybe an air mattress, rudimentary interior lighting, maybe a speaking tube from the back to the front and no such things as air conditioning or heat. Heck you were even lucky to have the basics like bandages and splints. As society progressed and ambulances became more the norm for the transportation of the sick and injured, service providers began upgrading their vehicles with more comfortable and useable cots or stretchers, patient care tools were introduced like bandages, splints and medications, heating and air conditioning were introduced, radio's replaced whistles and call boxes, sirens and horns replaced gongs and the operator yelling, emergency lighting was added to alert other drivers and pedestrians, the vehicle itself modified from basic wooden carts to sleek long automotive coaches with smooth rides, names like Cadillac, LaSalle, Packard, all produced long coach style cars for ambulance conversions (which was also a burgeoning business during the developing years). As we moved into the 60's and 70's, the vehicle design became more important as newly invoked safety standards were implemented, the long sleek coach style vehicles gave way to more utilitarian type vehicles like Chevrolet Suburbans, and Ford and Dodge Vans. These vehicles came about due to the needs for standardization and more storage space for supplies and rougher terrain for ambulances to traverse.

Uncertain Times, Questionable Business Practices and other events that led to Change - From the 30's to the mid 60's there were many issues facing Ontario's Ambulance systems. Ambulance services were never really taken seriously by municipalities. Insurance providers did not see a need to underwrite the service, and the value of human life was inconsequential. Service operators came and went due to competition, lack of training and lack of monetary gain. Ambulance services certainly did not generate profit. There was more money to be made from funerals than there was from saving people, hence the shady business practices of some funeral based services giving preference to the deceased at scenes as opposed to those who were merely injured.

For many private operators there was a lack of training and ever increasing competition. For the staff there was the obvious lack of financial gain as there was no set pay scale or fee structure for the service provided, often times there would never be any bill collected for the service provided, hence no pay for staff.

All the early problems associated with the early years of EMS in Ontario were to come to a head in the mid 1960's

1966 and the Introduction of Dr. Norman H. McNally MD FRCP - Regarded today as the “Father" of Ontario's EMS system, Dr. McNally, a retired Army surgeon, was hired by the province of Ontario to “ensure the development throughout Ontario of a balanced and integrated system of ambulance services..."

Doctor McNally revolutionized the entire culture of EMS in Ontario, his first act was to establish standardized training for all Ambulance staff in Ontario, and by the fall of 1967, the “Fundamentals of Casualty Care" Course (FCC) a 4 week, 160 hour standardized provincial training course was developed and taught at CFB Borden near Barrie, Ontario. After the initial course in late 1967, regular classes were held, training all Ontario Staff to one standardized way of doing things.

1969 “Cardiac One" Hits the Road in Toronto - With the FCC course now well underway, training took another look to the future with the establishment of a specialized ambulance operating in Toronto equipped with the latest in cardiac telemetry. A large mechanical device weighing in excess of 50 pounds was carried in the ambulance to monitor a patient from the time of pick-up to drop off at hospital. Ambulance attendants were accompanied by an intern from the hospital that was responsible for this ultra-modern advancement in patient care. Formalized Advanced Life Support would not hit the streets in Ontario for over another decade.

1969 - The demise of the Coach Ambulance in Ontario - Now that training was standardized, Dr. McNally turned his attention to the fleet of Ontario's Ambulances. Working with industry professionals, Dr. McNally drafted up a new plan for a standardized Ontario Ambulance, a van capable of carrying a stretcher, attendant bench and possessing enough cabinet storage space for the equipment of the day - oxygen both fixed and portable, bandages, first aid kits, basins, splints and various other sundry items.

The vehicles identity was to be standardized. A wide encirclement of blue wrapped around the vehicle and one 4 beacon sealed beam light with alternating red and white lenses was installed on the roof with red corner markers at each corner of the roof. A siren was mounted ahead of the sealed beam light, and due to the new height and size of the Ambulance; a red flashing light was installed at hood level to signal drivers of cars through their rear view mirror that an ambulance was approaching. The word “AMBULANCE" was affixed the hood and rear doors in red.

Communication Standardization and OASIS - Dr. McNally, pressed on in his revolution of Ontario's EMS system. Now that training and vehicle standardization were completed, he turned his attention to improving communications between services by establishing a common provincial radio frequency that would allow various EMS services to communicate with one another at large scale events while still maintaining their own operations on local radio frequencies, he also put in place the Ontario Ambulance Service Information System, or OASIS for short. This system finally allowed for quantification of EMS and validation of what we do. By matching 2 standardized forms - an ambulance attendants patient care record, and a dispatchers dispatch record, finally concrete evidence and proof of the need and effectiveness of Ontario's newly re-designed EMS System.

The 1970's - This decade was responsible for many changes in EMS in Ontario, we saw the creation of Community College training, Provincial legislation regarding Ambulance service, specialized advanced paramedic training for select Ambulance Officers, women entering the EMS workforce and Ambulance service taking to Ontario's skies.

EMCA - The Emergency Medical Care Assistant course got its start in 1972 at Toronto's Humber College, no doubt due to the visions of Dr. McNally who always wanted the best level of training for Ontario's Ambulance staff. This course eventually replaced the Borden FCC program as the minimum level of training in Ontario in 1975 and was offered at 10 of Ontario's Community Colleges..

The Ontario Ambulance Act - In addition to advancing the standardized training the Ontario Government released the Ontario Ambulance Act in 1975 which legally spelled out the requirements for training, equipment, inspection, documentation and records keeping by all of Ontario's 200+ Ambulance services of the time.

1975 - Not just a man's game anymore - With all the necessary pieces in place now, organized training, standardized vehicles, and Ambulance service now becoming a defined career opportunity, women started to apply for the training and opportunity to become Ontario Ambulance Officers. The District of Halton-Mississauga Ambulance Service (now Peel Paramedic Service) became one of the first services in Ontario to hire a female Ambulance Officer.

1976 - Continuing Training and Education - As interest in pre-hospital emergency care flourished, other specialized training courses were developed and implemented including a revolutionary technique called CPR or Cardiopulmonary Resuscitation, which started in the US and was first taught to Ontario's ambulance attendants at Fanshawe College in London, Ontario.

Backing on to CPR or Basic Cardiac Life Support (BCLS), the ACLS or Advanced Cardiac Life Support, program was introduced into Ontario soon after. These skills, initially taught to Doctors and nurses allowed for arrhythmia recognition, counter-active medications, cardiac monitoring and interpretation and cardiac defibrillation. These skills were eventually rolled out to specific EMS centers in Ontario who were initiating more advanced training for their ambulance staff, centers such as Oshawa, Kingston, North Bay, Sault Ste. Marie and Toronto.

1977 - The Death of Dr. Norman H. McNally - December 7, 1977 was the day Dr. Norman H. McNally answered his final call. The “Father" of Ontario's modern day EMS system passed away. He was the Senior Consultant and Principal advisor to the Emergency health Services Branch of the Ontario Ministry of Health, he was 62 years old.

“In 7 short years, “ The Doctor" as he was affectionately called, molded the diverse ambulance services from the previous 85 years into one cohesive unit. McNally, and “McNally's Rangers", as his loyal supporters were dubbed should have been duly proud". - James Hanna - “A Century of Red Blankets - a History of Ambulance Service in Ontario"

In honour of Dr. McNally's contribution towards the advancement of EMS in Ontario an award was created in his name honouring Ontario Paramedics who perform acts of Bravery while in the performance of their duties. The award is presented annually to deserving recipients at the Ontario Association of Chief's of Paramedics Annual conference.

1977 - The Critical Care Attendant and the Creation of “Bandage 1" - Another aspect of Dr. McNally's influence on EMS was his vision for advanced Paramedic training and aero-medical transportation of patients in Ontario. These two goals were realized in the mid 70's with the creation of the Critical Care Attendant Course and the creation of a Helicopter based means of transportation for patients in Ontario nicknamed “Bandage 1"

The CCA was specially selected from among the ranks of Ontario's ambulance staff and sent off to receive advanced training in IV administration, drug injection, endotracheal tube insertion, and cardiac defibrillation. These skills were learned at Toronto's Sunnybrook Hospital, allowing the Attendants in flight to perform these skills after radio consultation with a land based physician.

These skills were to be performed on Ontario's newly launched Air Ambulance program, a pilot project that eventually received full accreditation and is now know today as ORNGE.

Specialty EMS Vehicles of the mid 70's and onward- Due to the ever growing population and the growth of cities and towns into more rural and remote areas of Ontario, and the increase in multi-casualty situations, ambulance services have had to be creative in how they design their existing fleets to meet the demand. 4×4 ambulances were created to travel in remote rural areas with difficult terrain, multi-stretcher units were designed to carry multiple patients from scenes far away from back-up ambulances, multi-patient capable busses were designed in major urban centres for mass casualty events, small and large emergency supply trucks were developed to bring large amounts of equipment to scenes where they may be needed, the fleet of Ontario's Air Service was increased to meet demand, both fixed and rotary winged aircraft were developed, off-road vehicles and golf-cart ambulances were designed to enable access to more crowd congested, or difficult to access areas, bicycle units were developed. In 1979, Ontario introduced a “raised roof" ambulance which enabled more emergency lighting and equipment storage, not to mention more head room for attendants to work in the back.

1982 - Calling EMS just became simpler - We take it for granted now, but the Ontario-wide 911 telephone number has only been in existence for a little over 10 years. Prior to 1982, a local 7 digit number was required when calling for an ambulance in all areas, until the 911 emergency telephone number began use in the GTA, gradually spreading across the province as telephone systems were upgraded. This initiative came as a result of a huge educational campaign and training initiative, and was finalized when the last areas of northern Ontario were upgraded as we started the 21st century.

1982-1984 - Advanced Life Support Paramedics Hit the Roads in Ontario - Dr. McNally's dream of Ambulance Paramedics became reality in the early 80's. although it was studied and practiced in the early 70's, Paramedics didn't become a reality on the streets until 1982. A few major centres like Oshawa, Toronto, Sault St. Marie and North Bay saw a limited numbers of Advanced Life Support (ALS) providers take to the streets in the early 80's armed with new autonomous skills like IV starts, drug administration, intubation, cardiac monitoring and defibrillation. These Paramedics were selected from various applicants from within their services to receive this additional training, and then be sent to the streets, dispatched to all life threatening calls in their jurisdictions. By the end of the 80's, Paramedics were still only found primarily on the Ontario Air Ambulances and in the GTA.

1992 - Serving with Honour - EMS Staff from Toronto formed what is believed to be the first official EMS Honour Guard in Canada. This select group of individuals received a Class “A" Honour Guard uniform and participated in civic events like parades, and festivals, they were also deployed to funerals for civic leaders and other emergency services personnel who lost their lives in the performance of their duties. This award winning marching contingent has been the genesis for numerous other EMS Honour Guard units which have sprung up not only in Ontario, but all across Canada.

1994 - The OPALS Study - The landmark Ontario Prehospital Advanced Life Support (OPALS) Study officially began to determine the effectiveness and value of ALS for the Ministry of Health. The immediate result was a phased-in, unprecedented expansion of ALS programs throughout 20 centres in the province. This one study would forever change EMS in Ontario. In a few short years, a job had evolved into a full blown health profession. The next decade would see change like never before.

1995 - The creation of the OPA - With the expansion of Advanced Life Support in Ontario and the ability to do much more for our patients, a few dedicated practitioners had begun forming local alliances or service associations outside of the labour unions to promote the advancement of the profession and the education of what it entails. In early 1995, groups like the Toronto Paramedic Association and Ottawa-Carleton Paramedic Association reached out beyond their local boundaries to other practitioners in the province culminating in the formation of the steering committee that would become the Ontario Paramedic Association, a professional association without political or labour affiliations.

1995/1996 - Defibrillation, Symptom Relief and the New 'Paramedics' - The next major step in Ontario came in 1995 when, as a result of preliminary OPALS results, all Ontario ambulance staff, were trained to defibrillate patients in cardiac arrest, and the following year, to administer 6 medications designed to provide “Symptom Relief" for limited emergency medical conditions, thus spreading a few Advanced Life Support skills to everyone.

Over the years, the professionals who worked in EMS had to deal with many titles. Often, lengthy title acronyms required explanations, resulting in confusion for the public and fellow health care professionals. Now, with the introduction of the new skill sets, all qualified Ambulance Attendants met the definition of a Paramedic; finally, a simple identity for all. Even though everyone was now classified as a Paramedic, there still had to be some way to determine between the distinct levels of skill that were practiced, so the titles Primary Care Paramedic, Advanced Care Paramedic and Critical Care Paramedic were created.

1996 - Tactical Medics work with Police Special Weapons Teams - Being a major urban centre with municipally operated EMS, the City of Toronto expanded the roles of Paramedics into specialty teams. In 1996, Toronto EMS launched a Tactical Paramedic Unit. Specially trained Paramedics were sent into volatile calls with the Toronto Police Emergency Task Force. For the first time in Ontario, Paramedics worked alongside Tactical police right in the hot zone. Previously, Paramedics waited out in the cold zone for Police to secure the scene while patients would lay waiting or even suffering. Tactical Paramedics enabled patients to receive immediate life-saving treatments in a hot zone while an incident was live and dynamically unfolding. The concept was "good medicine in bad places". This initial Toronto Tactical Paramedic team sparked many similar units to be formed all across Ontario in the coming years.

1998 - CCTU - In Toronto, a small, specialized and highly trained group of Paramedics were brought together to form the first Critical Care Transport Team. This was the first time that Critical Care level Paramedics (CCPs) would be dedicated to land based ambulances in Canada - Critical Care Transport Units (CCTUs). These teams of 2 CCPs would transport critically ill patients between ICU's without the need of the sending facility to sacrifice any additional staff to send along, thus allowing them to retain their expert staff in house while CCTU Paramedics transported the critically ill patient to another hospital. This program has expanded outside of Toronto and now forms the basis of ORNGE's land based Critical Care Transport program.

2000 - United colours of EMS - With the Provincial Government downloading the costs associated with Ambulance to the Municipalities, local areas once again amalgamated several local services into larger regional models, and adopting new visual identities. Prior to 2000, all ambulances in Ontario had to look the same as they were provided by the same supplier - The Emergency Health Services branch of the Ministry of Health, now that the costs associated with EMS had been downloaded to municipalities, they were free to design and acquire their own ambulances. They had to still meet the Ministry's specifications, but the external colouring was up to the municipality responsible for governing its own ambulance service.

2001 - Scouting Meets EMS - Toronto once again took to the forefront with the introduction of the 1st Downsview Medical Venturer Program in conjunction with Scouts Canada. Since its introduction, in 2001, Medical Venturer and Rover troops have sprung up all across Ontario, grooming future Paramedics from the ranks of the scouting movement.

2002 - Responding to the Changing World - Sadly tragic global events necessitated change in the way EMS operates and prepares for future events. In the wake of the events of 9-11-2001, EMS systems all across the globe re-focused and re-designed their response to potential terrorist attacks and threats against populations. In response to these demands, EMS in Ontario designed and created EMAT, HAZMAT & CBRNE Teams with specialized training and equipment to help mitigate these tragic events once they occur.

Services also began to look at new ways to deliver Paramedic care with the implementation of bike medic teams, high-angle rescue training and other community based initiatives. Paramedics were stepping outside their ambulances and bringing their skills to bear in new ways.

2003 - SARS & the New Normal - The short but deadly outbreak of SARS gripped Ontario and the world with fear. Once again Ontario EMS professionals were the first ones to react and respond to this crisis by developing new universal precautions for EMS staff, and alerting all other Health Care disciplines about the deadly outbreak. These skills and lessons learned have remained until today and have set new standards of practice and safety in Ontario's EMS industry.

2005 - Introduction of Paramedic Services - By 2005, most Ambulance Services had already graduated into Emergency Medical Services where they provided multi-faceted response capabilities and sophisticated treatments during transport. However, in 2005, the Professional Paramedic Association of Ottawa was instrumental in lobbying for Emergency Medical Services to become recognized as Paramedic Services. Ottawa Paramedic Service became the first provider in Ontario to redefine the profession and to contribute to development of a trusted academic brand across Canada.

2005 - Stroke Protocols - Always increasing our ability to react and respond appropriately to whatever conditions may arise, Ontario's Paramedics were given the ability to prioritize stroke patients and bypass hospitals under specific conditions to afford those suffering a stroke the best possible chance for care by seeking medical confirmation and transporting patients suffering from an acute stroke directly to a designated stroke centre.

2007 - STEMI Protocols - Similar to CODE Stroke initiatives, all of Ontario's Paramedics were trained in ECG interpretation and 12 lead ECG acquisition and interpretation. This allowed, under specific protocols, Ontario Paramedics to bypass local ER's and transport patients suffering from ST segment elevation MI's to be transported directly to a STEMI Cardiac centre for PCI care and management. These skills have enhanced the Ontario Paramedics ability to recognize life threatening conditions and react appropriately to them and provide the best possible care for patients suffering from these ailments.

2008 - A Degree in Paramedicine - What was once a job for someone with a heavy foot, chauffeur's license, and a strong back has now evolved into a minimum 2 year Community College certificate program and a bridged additional 2 year University degree program in Paramedicine graduating with a BSc.

2014 and Beyond - 'Community Paramedicine' is rapidly becoming another way in which the unique skill set of Paramedics can be adapted for outreach to at risk patients and filling gaps in the healthcare system. With all the current and future studies being performed by Ontario's Paramedics the future looks great for those who may need our services in the future. Ontario will always be on the cutting edge of research and development in the field of Paramedicine, we're striving towards self regulation also which will allow Ontario's Paramedics to be in control of their professional growth and development.

...and the journey continues...



Ontario Paramedic Association

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