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Ontario Paramedic Scope of Practice


Primary Care Paramedic (PCP)

(2 Year Community College Diploma Program)

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 (2000 hours) 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 on their shoulder epaulettes.

PCP Scope of Practice

Medications

  • Acetaminophen (PO)
  • Antibiotics (TOP)
  • ASA (PO)
  • Dexamethasone (PO, IM, IV*)
  • Dextrose (IV*)
  • Dimenhydrinate (IM, IV*)
  • Diphenhydramine (IM, IV*, PO)
  • Epinephrine (IM, NEB)
  • Glucagon (IM)
  • Glucose (PO)
  • Glycopyrrolate (SC, IV*)
  • Haloperidol (SC, IV*)
  • Hydrocortisone Sodium Succinate (IM)
  • Ibuprofen (PO)
  • Ketorolac (IM, IV*)
  • NaCl 0.9% (IV*)
  • Naloxone (IM, SC, IN, IV*)
  • Nitroglycerine (SL)
  • Ondansetron (PO, SC, IV*)
  • Oxygen (100%)
  • Oxytocin (IM)
  • Salbutamol (MDI, NEB, BVM)
  • NOTE: IV* is for PCP with autonomous IV certification only

Procedures & Controlled Medical Acts

  • 15 Lead ECG & STEMI Diagnosis
  • Advanced Airway (Supraglottic)
  • Airway Suctioning Capnometry (ETCO2)
  • Capnometry (ETCO2) 
  • CPAP Therapy (PEEP)
  • Defibrillation (Manual & Semi-Automated External)
  • Intravenous Therapy
  • SPO2 / SPCO
  • Taser Probe Removal
  • Tracheostomy Reinsertion
  • *Evidence Based Research

Advanced CBRNE / Tactical Medications

  • Amyl Nitrite (INH)
  • Atropine (IM)
  • Calcium Gluconate 2.5% (NEB, TOP)
  • Diazepam (IM, IV)
  • Hydroxocobalamin (IV)
  • Pralidoxime / Obidoxime (IM)
  • Proparacaine (TOP)

Advanced CBRNE / Tactical Procedures

  • Combat Application Tourniquet
  • Hemostatic Wound Packing Gauze
  • High Risk Transfer Unit
  • Modular Pressure Dressing
  • SCBA certified
  • Tactical Combat Casualty Care (TCCC)
  • Tactical Emergency Casualty Care (TECC)

Advanced Care Paramedic (ACP)

(3 Year Community College Graduate Program)

The Advanced Care Paramedic (ACP) must have a minimum of 2 years of experience in the paramedic field before being able to qualify for academic training at the ACP level. The ACP program is a 3rd year in length and is considered a post-diploma program (total 3200 hours).

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 on their shoulder epaulettes.

ACP Scope of Practice

Medications

  • Acetaminophen (PO)
  • Adenosine (IV)
  • Amiodarone (IV, IO, CVAD)
  • Antibiotics (TOP)
  • ASA (PO)
  • Atropine (IV, IO, SC CVAD)
  • Calcium Gluconate (IV, IO, CVAD)
  • Dexamethasone (PO, IM, IV)
  • Dextrose (IV, IO)
  • Dimenhydrinate (IV, IM, CVAD)
  • Diphenhydramine (IV, IM, PO)
  • Dopamine (IV, IO, CVAD)
  • Epinephrine (IV, IM, NEB, IO, ETT, CVAD)
  • Fentanyl (IV, IM, IO)
  • Glucagon (IM)
  • Glucose (PO)
  • Glycopyrrolate (SC, IV, CVAD)
  • Haloperidol (SC, IV, CVAD)
  • Hydrocortisone Sodium Succinate (IM, IV, IO)
  • Hydromorphone (SC, IV, CVAD)
  • Ibuprofen (PO)
  • Ketamine (IV, IM)
  • Ketorolac (IV, IM)
  • Lidocaine (IV, IO, ETT, TOP, CVAD)
  • Midazolam (IV, IM, IN, BC, IO, CVAD))
  • Morphine (IV, SC, CVAD)
  • NaCl 0.9% (IV, IO, CVAD)
  • Naloxone (IV, IM, IN, SC, IO)
  • Nitroglycerine (SL)
  • Oxygen (100%)
  • Oxytocin (IM)
  • Salbutamol (MDI, NEB, BVM)
  • Sodium Bicarbonate (IV, IO, CVAD)
  •  Xylometazoline / Phenylephrine (IN)

Procedures & Controlled Medical Acts

  • 12 Lead ECG, Posterior, Right & STEMI Diagnosis
  • Advanced Airway (Endotracheal Intubation)
  • Advanced Airway (Supraglottic LMA / KingLT)
  • Advanced Airway (Tracheal Tube Introducer Device)
  • Airway Foreign Body Removal (McGill Forceps)
  • Airway Suctioning & Deep Suctioning
  • Capnometry & Capnography (ETCO2)
  • CPAP Therapy (PEEP)
  • CVAD Infusion
  • Defibrillation (Manual External)
  • Intraosseous Therapy
  • Intravenous Therapy
  • Needle Cricothyrotomy
  • Needle Thoracostomy
  • SpO2 / SpCO
  • Synchronized Cardioversion
  • Taser Probe Removal
  • Transcutaneous Pacing
  • *Evidence Based Research

Advanced CBRNE / Tactical Medications

  • Amyl Nitrite (INH)
  • Atropine (IM, IV)
  • Calcium Gluconate 2.5% (NEB, TOP)
  • Diazepam (IM, IV)
  • Hydroxocobalamin (IV)
  • Pralidoxime / Obidoxime (IM)
  • Proparacaine (TOP)

Advanced CBRNE / Tactical Procedures

  • Combat Application Tourniquet
  • Hemostatic Wound Packing Gauze
  • High Risk Transfer Unit
  • Modular Pressure Dressing
  • SCBA certified
  • Tactical Combat Casualty Care (TCCC)
  • Tactical Emergency Casualty Care (TECC)


Advanced Care Flight Paramedic (ACFP)

The Advanced Care Flight Paramedic (ACFP) functions with an 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 access to acute medical care from nurses, physicians or paramedics.

Download the flight paramedic Scope of Practice here


Critical Care Flight Paramedic (CCFP)

The Critical Care Paramedic (CCP) and Critical Care Flight Paramedic (CCFP) function 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 on their shoulder epaulettes.


Regulated Health Professions Act (RHPA 1991)

The Regulated Health Professions Act details the controlled acts that a physician or his delegate can perform with respect to an individual. The list is comprised of 14 main acts. Of these 14 acts, it is within the Paramedic Scope of Practice to perform 9 procedures (*) on the list when the Paramedic is certified under a Base Hospital Physician who is licensed to practice in the Province of Ontario. This means that aside from Physicians, Paramedics are able to perform more controlled acts under a standing order from their own Base Hospital Physician than any other medical discipline including Nurses, Respiratory Therapists and Midwives.

A "controlled act" is any one of the following done with respect to an individual:

  1. Communicating to the individual or his or her personal representative a diagnosis identifying a disease or disorder as the cause of symptoms of the individual in circumstances in which it is reasonably foreseeable that the individual or his or her personal representative will rely on the diagnosis.*
  2. Performing a procedure on tissue below the dermis, below the surface of a mucous membrane, in or below the surface of the cornea, or in or below the surfaces of the teeth, including the scaling of teeth.*
  3. Setting or casting a fracture of a bone or a dislocation of a joint.*
  4. Moving the joints of the spine beyond the individual’s usual physiological range of motion using a fast, low amplitude thrust.
  5. Administering a substance by injection or inhalation.*
  6. Putting an instrument, hand or finger,*
    1. beyond the external ear canal,
    2. beyond the point in the nasal passages where they normally narrow,
    3. beyond the larynx,
    4. beyond the opening of the urethra,
    5. beyond the labia majora,
    6. beyond the anal verge, or
    7. into an artificial opening into the body.
  7. Applying or ordering the application of a form of energy prescribed by the regulations under this Act.*
  8. Prescribing, dispensing, selling or compounding a drug as defined in the Drug and Pharmacies Regulation Act, or supervising the part of a pharmacy where such drugs are kept.*
  9. Prescribing or dispensing, for vision or eye problems, subnormal vision devices, contact lenses or eye glasses other than simple magnifiers.
  10. Prescribing a hearing aid for a hearing impaired person.
  11. Fitting or dispensing a dental prosthesis, orthodontic or periodontal appliance or a device used inside the mouth to protect teeth from abnormal functioning.
  12. Managing labour or conducting the delivery of a baby.*
  13. Allergy challenge testing of a kind in which a positive result of the test is a significant allergic response.
  14. Treating, by means of psychotherapy technique, delivered through a therapeutic relationship, an individual’s serious disorder of thought, cognition, mood, emotional regulation, perception or memory that may seriously impair the individual’s judgement, insight, behaviour, communication or social functioning. 1991, c. 18, s. 27 (2); 2007, c. 10, Sched. L, s. 32; 2007, c. 10, Sched. R, s. 19 (1).*

 

 

Ontario Paramedic Association

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    Toronto ON M5G 1Z3