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Levels of Practice

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 two stripes 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:

  • acetylsalicylic acid
  • dimenhydrinate
  • diphenhydramine
  • epinephrine
  • glucagon
  • glucose gel/tabs
  • Acetaminophen
  • Ketorolac
  • Ibuprofen
  • Supraglotic Airway (King-LT) with PETCO2
  • Side stream ETCO2 monitoring (capnography and capnometry)
  • CPAP application
  • nitroglycerine spray
  • salbutamol
  • pulse oximetry monitoring
  • Manual defibrillation
  • 12-Lead ECG application and STEMI interpretation
  • PCP Termination of Resuscitation
  • ECD Probe Removal

Primary Care Flight Paramedic (PCFP) [Currently not available in Niagara]

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/manual defibrillation
  • lifesaving pharmaceutical therapy similar to that of a PCP

Advanced Care Paramedic (ACP)

The Advanced Care Paramedic (ACP) must have experience in the paramedic field before being able to qualify for training at the ACP level. The ACP program is an additional 1.5 years 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 three 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
  • Bougie
  • 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) - [Currently not available in Niagara]

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 ETT and NTT
  • rapid sequence intubation
  • percutaneous Cricothyrotomy
  • laryngoscopy and removal of foreign body obstruction using MacGill forceps
  • og/ng tubes
  • LMA's
  • PETCO2 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) - [Currently not available in Niagara]

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 four 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

Paramedic Scope of Practice under the Regulated Health Professions Act (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 13 main acts. Of these 13 acts, it is within the Paramedic Scope of Practice to perform 8 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.

CONTROLLED ACTS

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,

i. beyond the external ear canal,

ii. beyond the point in the nasal passages where they normally narrow,

iii. beyond the larynx,

iv. beyond the opening of the urethra,

v. beyond the labia majora,

vi. beyond the anal verge, or

vii. 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 subsection 117 (1) of 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.

This website is dedicated to the memory of Olga Andrusiw. The Niagara Paramedic Association is responsible for promoting the practice of Paramedicine and ensuring the highest level of care for our patients. We are leaders in the advancement of Paramedicine and achieve our objectives through public awareness, research and education. We lobby for self-regulation under the Regulated Health Professions Act. We also assist in fundraising for community-based charities. This website contains links to other websites that are created and operated by independent bodies and are therefore, not under the control of the Niagara Paramedic Association. These website links are provided as a public service and do not imply the investigation or verification of the linked websites by the NPA. The NPA is not responsible, and makes no express or implied representations or warranties concerning the products, services and information found on the linked websites. The views expressed on this website are those of the NPA and do not represent the opinions of its partners.