There are a few steps that you need to take to become a paramedic in Ontario:

  • Complete a 2-year diploma program at an Ontario College
  • Successfully pass the provincial certification exam to become an Advanced Emergency medical Care attendant (A-EMCA)
  • Become employed by an ambulance service
  • Be delegated to perform delegated controlled medical acts by a Base Hospital physician.

What are the qualifications of the different levels?

Primary Care Paramedic (PCP)

Ontario's Primary Care Paramedic program is a 2-year program. This program is the foundation of paramedic education. Graduates must successfully complete a written provincial exam. Upon successful completion of the provincial exam, they are classified as a Primary Care Paramedic.

A PCP is not permitted to practice at this level of training until they have secured employment with an ambulance service and have received approval/certification from their local Medical Director.

PCPs respond to both emergency and non-emergency calls and work in an ambulance with another PCP or ACP partner. PCPs can perform patient assessments, basic airway management, administer oxygen by demand, by bag-valve-mask or basic mechanical ventilation, provide CPR, and trauma care (i.e. spinal and wound care, limb immobilization/traction, etc.). PCPs are also trained in the use semi-automated external defibrillators. In addition, a PCP may administer the following medications as per certification through their local Base Hospital:

  • ASA (for suspected myocardial infarction [heart attack])
  • sublingual Nitroglycerin spray for angina pectoris (chest pain)
  • metered dose inhaler Salbutamol for bronchospasm (asthma)
  • glucagon (or oral glucose gel) for hypoglycemia (low blood sugar)
  • epinephrine for anaphylaxis (severe allergic reaction)

Advanced Care Paramedic (ACP)

The ACP program is 1 year in length and is considered a post-diploma program (1200 hours). In addition to the PCP skill set, ACP providers are qualified to perform and/or use:

  • Advanced airway management including oral and nasotracheal intubation
  • Laryngoscopy and removal of foreign body obstruction using MacGill forceps
  • Basic field mechanical ventilation
  • 12 lead ECG interpretation
  • Synchronized cardioversion
  • Manual defibrillation and external cardiac pacing
  • Treatment of cardiac emergencies according to Heart & Stroke Foundation Advanced Cardiac Life Support (ACLS) guidelines
  • Needle thoracostomy
  • Administration of the following emergency medications: Adenosine, Amiodarone, ASA, Atropine, Diazepam, Dopamine, D50W, Epinephrine, Furosemide, Glucagon, Lidocaine, Morphine, Naloxone, Nitroglycerine, Oxygen, Salbutamol, Sodium Bicarbonate (the medications may vary from one service to another)

Some of the above are controlled acts performed either under direct order from a Base Hospital Physician or by Standing Orders (protocols). With authorization of the Base Hospital Physician, a PCP may perform any of the above acts.

Critical Care Paramedic (CCP)

Critical Care Paramedics are ACP providers with additional training/education. Only a few ambulance services employ Critical Care Paramedics, as it is a highly specialized field. Ontario Air Ambulances have had Critical Care Flight Paramedics since 1977. To become a CCP, a paramedic must have the following minimal requirements:

  • Minimum 1 year experience at the ACP level
  • Basic Trauma Life Support (BTLS) certification
  • Aeromedical Certificate (for the Critical Care Flight Paramedic level)
  • Recent certification Advanced Cardiac Life Support (ACLS)

The CCP program is approximately one year in length. In addition to the skills of an ACP, Critical Care Paramedics are trained to perform the following:

  • end tidal CO2 
  • arterial line monitoring 
  • Monitoring of central lines, including P.A. lines 
  • rhythm and 12 lead ECG interpretation 
  • lab value and ABG interpretation 
  • x-ray interpretation 
  • administration of medications (extensive list) 
  • administration of blood products 
  • umbilical cord cannulation (northern bases) 
  • gastric intubation 
  • foley insertion 
  • doppler neonatal monitoring

CCPs must maintain their certification in Advanced Cardiac Life Support (ACLS), Advanced Trauma Life Support (ATLS), Neonatal Resuscitation Program (NRP), Pediatric Advanced Life Support (PALS), and Emergency Delivery.

At what level do most paramedics in Ontario function?

Most paramedics in Ontario are PCPs.

Providers and paramedics from other provinces

If you are a prehospital care provider or paramedic from another province or country and wish to work in Ontario, please view the Ministry of Health and Long-Term Care’s Paramedic Equivalency Process.

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