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Paramedic Self-Regulation

The Ministry of Health and Long-Term Care (MOHLTC), through the Health Professions Regulatory Advisory Council (HPRAC) was asked to review Paramedicine for self-regulation under the Regulated Health Professionals Act (1991) (RHPA). Subsequently, the Ontario Paramedic Association was asked by HPRAC to submit an application and did so on March 15, 2013.

The move toward paramedic self-regulation can be understood as a convergence of several trends in the Ontario health care system. First, over the past half-century, the paramedic profession has shifted from a public safety orientation (which includes other services such as fire and police) towards an increasing alignment with health care. This encompasses both pre-hospital emergency medical care (i.e., the care provided through paramedic services, also known as Emergency Medical Services or EMS, in the course of 911 responses) and newer initiatives such as community paramedicine programs, in which paramedics use their skills and training to provide services in the community, such as blood pressure screening, in-home evaluations, flu vaccines and referral to Public Health and other services.

Second, the regulatory framework for health professions in Ontario, and indeed in Canada as a whole, has been evolving away from the regulation of people towards the regulation of practice, particularly of acts involved in administering health care to patients that pose a significant risk of harm (called “controlled acts" in the RHPA).

Third, as a result of advances in health care, Ontario residents are living increasingly longer lives. This has resulted in pressures on the health care system, in terms of both expenditures and health human resources. Ontario is seeking to address these pressures by finding ways to use health human resources more effectively, so as to maintain high standards of care. An important element of this involves fostering interprofessional collaboration amongst health care professionals, so that uniform high-quality standards of care can be developed based on evidence and best practices. In this way, the risk of harm to patients and the public can be better mitigated. It also involves making more effective use of health care providers' training and skills. Paramedics are educated and trained to perform a wide range of controlled acts in unstructured and unsupervised conditions (for instance, at the scene of a vehicle collision). However, the skills and competencies they have are also applicable to other situations, such as in the provision of community health care in collaboration with public health agencies.

Paramedic self-regulation is an appropriate response to the convergence of the above trends, and has been acknowledged as such for more than a decade (see, for example, Review of the Ambulance Regulation, Report of the Land Ambulance Transition Task Force to the Minister of Health and Red Tape Commission, August 1998). This document is intended to clarify the implications of paramedic self-regulation for paramedics.