Paramedics in Canada - Medical Direction and Oversight

Medical Direction and Oversight

Most jurisdictions in Canada, paramedics do not work under their own medical license. One exception is in British Columbia where each paramedic regardless of level, has their own license to practice. Even so, they, as most other paramedics in Canada, are permitted to perform regulated medical acts by the process of 'delegation'. This means that one medical doctor (the medical director) has become familiar with the individual paramedic and then has delegated authority to that paramedic which allows them to perform specific regulated medical act under defined situations. The scope of practice for the paramedic is defined in paramedic protocols (also referred to as advanced medical directives). These protocols specify which skill and the conditions required for the paramedic to act. Each protocol is signed by the medical director. Medical directors are generally ER physicians who work in a hospital associated with the paramedic service. The relationship between this hospital ('Base Hospital') is formalized through legal agreements. Other physicians in the base hospital who are allowed to give direct orders to paramedics that exceed their protocols (often via telephone) are referred to as delegating physicians. These physicians are usually ER physicians. The British Columbia Ambulance Service is moving away from protocols and towards a process called treatment guidelines allowing much more flexibility at all levels when a patient's condition warrants.

Some Canadian paramedics are moving towards the status of self-regulated health professionals with paramedics forming their own professional Colleges in much the same manner as nurses and other health professions. These organizations are responsible to the government for the examination and licensing of practitioners, the establishment of standards of practice, the investigation of public complaints against members, and the disciplining of members. They are also required to advise the government on all issues and legislation related to the practice of their members. Following the example of their British colleagues, Colleges or Associations have been established in Alberta, Saskatchewan, New Brunswick, and Nova Scotia, with Ontario actively moving towards this type of legislation.