692:(also referred to as medical directives). These directives specify which skill and the conditions required for the paramedic to act. Each directive is signed by the medical director. Medical directors are generally emergency medicine specialized 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 emergency medicine specialized physicians. In Ontario, paramedics are actively advocating for some form of self-regulation to remove the multiple layers and complexities of regulation and paramedic practice.
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Nova Scotia currently utilize this model. In these centres, paramedics and nurses work together as a patient-centred team to assess and treat patients without a physician or physician assistant on-site. The paramedic and nurse consult with a provider over the phone for particular patients, and the three disciplines work together to develop a care plan for the patient. This care plan might involve treating the patient that night and then have the patient come back the next day to follow-up with a provider. If the patient needs urgent care that cannot be provided at the CEC, the patient can be transferred by ambulance to the closest regional facility. A paramedic working in a CEC may be a
Primary Care Paramedic or Advanced Care Paramedic.
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other healthcare providers, conducting assessments, treating, and doing/ordering tests. Diagnostics provided by community paramedics include: specimen collection (blood, urine, swabs), electrocardiogram interpretation, vital signs, and facilitate transports for diagnostic imaging. Treatments provided by community paramedics include: fluid rehydration, blood transfusions, urinary catheterization, wound closure & care (tissue adhesive, sutures, dressings), oxygen and nebulizer therapy, medication administration, and coordination of community services. In
Saskatchewan, paramedics may become endorsed as community paramedics by the Saskatchewan College of Paramedics upon the completion of an accredited community paramedicine program.
488:
758:, and most are paid full or part-time professionals. In the first quarter of 2005, paramedics were granted status federally as a "Public Safety Occupation" which means that paramedics are now eligible for early retirement, as are police officers and fire fighters. Many paramedic services provide a full range of paramedic specialty squads including: Marine medics, Bike medics, First Response medics, Tactical ERT & CCU medics, CBRNe medics (Chemical, Biological, Radiological, Nuclear and Explosive) and USAR medics (Urban Search And Rescue - specializing in urban disaster rescue recovery) and finally NOHERT medics (members of Provincial or regional Health Emergency Response Teams)
676:, Emergency Health Services Branch, credentials successful graduates of paramedic programs which have completed the provincial paramedic examination as maintained and administered by the ministry. The ministry can also revocate paramedic credentials from currently practising paramedics. The ministry additionally maintains the provincial standards and medical directives expected of all paramedics in Ontario. The second mechanism of regulation is by a designated base hospital which grants paramedics the legal authority to practice. Paramedics are permitted to perform controlled medical acts by the process of 'delegation'. This means that one
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police officers and firefighters. This incongruity is often argued as being unfair, especially in light of the relative level of responsibility a paramedic may have for acting decisively and without having direct supervision. However, many paramedics consider their career to offer intangible benefits and reported job satisfaction is generally high. Due to the challenging working conditions, paramedics, similarly to other first responders, are at a greatly increased risk to develop Post-Traumatic Stress
Disorder as compared to the general population.
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the knowledge, skills, and abilities as being most synonymous with a given level of paramedic or emergency medical responder practice. Each province retains ultimate authority in legislating the actual administration and delivery of paramedicine and its services within its own respective jurisdictions. Specific paramedic regulatory frameworks and practice is established uniquely in each of the provinces legislature and statute and varies across Canada.
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mining sites, oil rigs or other high risk areas. Occupational paramedics may work under the direction of occupational physicians, physician assistants and nurse practitioners. Occupational paramedics may also work collaboratively with registered nurses and registered/licensed practical nurses in the field or may work alone with clinical supports available from electronic means.
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completed the prerequisite PCP training. Shorter primary care paramedicine programs (around one to two years) would require an additional minimum of two years of advanced care paramedicine graduate study. Graduates of longer primary care paramedicine programs (two to four years) would require an additional minimum of one year of graduate advanced care paramedicine study. In
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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. Many
Canadian paramedics are currently advocating to empower government to work towards becoming a self-regulated health profession. Paramedics are forming their own professional
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programs are often offered through partnerships between
Canadian universities and colleges to enhance theory and practical training with higher education. These programs also allow bridging for registered paramedics to complete the degree program in a shorter, accelerated format. These programs currently are available in Ontario, Alberta and Prince Edward Island.
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treatment centres. For many small communities, without this level of certification, the operation of a much-needed rural and remote community ambulance services might not be as feasible. EMRs working as first responders in fire departments, police departments and institutions across Canada contribute an important role in the
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In
British Columbia, The Emergency Health Services Act directly regulates paramedicine. This act requires emergency medical assistants (paramedics) working in British Columbia to be licensed by the Emergency Medical Assistants Licensing Board. Paramedics hold their own licenses under the authority of
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Transport operates both land and aircraft in
Ontario. In British Columbia, CCP's work primarily in aircraft with a dedicated Critical Care Transport crew in several cities for long-distance/high acuity transfers and as regular CCP street crews who may do major trauma calls or, performs medevacs, when
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In some localities in Canada, paramedics may work under the direction of physicians, physician assistants and nurse practitioners in various emergency or related hospital departments. Collaborative emergency centres (CECs), collaborative care clinics, and community health centres in rural regions of
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where each paramedic regardless of level has an independent license to practice and is solely responsible for their paramedic practice. These organizations are responsible to the government for the examination and licensing of paramedics, the establishment of standards of practice, the investigation
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training, antidote, medical countermeasures, MCI, and protective equipment training. For day-to-day operations, incident response paramedics respond to hazmat- and toxicology-related incidents. These paramedics may carry a unique range of medications than and more protective equipment, allowing them
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Critical care paramedics' expertise focus on critical and ICU level care, stabilizing and transporting patients from smaller hospitals with less available resources to tertiary care, and regional medical programs in to other hospitals that can provide a higher level of care. CCPs generally work with
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or university or similar academic institution. Uniquely some programs may be offered collaboratively and shared between both academic institutions. The education provided is in the theories of paramedicine and its practice and in related subjects areas such as but not limited to anatomy, physiology,
717:
In
Newfoundland and Labrador, paramedics are regulated through the Newfoundland and Labrador Paramedicine Regulator and must have active medical authorization from the Office of the Provincial Medical Director. The Office provides paramedics with the ability to perform controlled medical acts while
540:
Occupational paramedic responsibilities may include providing pre-employment screening, medical surveillance services and clinical testing for companies and research institutions. Occupational paramedics may work in a variety of environments including in a clinical setting or in the field including
133:
The
National Occupational Competency Profile (NOCP) outlines four different competencies. The Competencies in the NOCP are described using a hierarchy of terms: competency area, general competency, specific competency and sub-competency. The framework includes the following eight master categories
129:
Titles of paramedics may vary between provinces. For example, in
Ontario, primary care paramedics post the graduation of an approved primary care paramedic education program and upon successful completion of the provincial examination process are awarded the title of Advanced Emergency Medical Care
84:
or air ambulances providing paramedic services. Paramedics are increasingly being utilized in hospitals, emergency rooms, clinics and community health care services by providing care in collaboration with registered nurses, registered/licensed practical nurses and registered respiratory therapists.
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There is a considerable degree to inter-provincial variations on paramedic and emergency medical responder practice across Canada. To address this there is a national consensus of paramedic and emergency medical responder practice (by way of the National Occupational Competency Profile) identifies
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Paramedics often work long hours; with a variety of 8-, 10-, 12- and 14-hour shifts. In some areas, however, 24- and even 96-hour shifts are not unusual. Salary and benefits are generally commensurate with the level of education and certification, though often less than the salary expectations of
549:
One of the more recent roles for paramedics in Canada is the community paramedic. These specialized paramedics work in clinics, hospitals, and in patient's homes. They provide immediate or scheduled primary, urgent and specialized healthcare to vulnerable patient populations by collaborating with
460:
The accreditation of paramedic educational programs in Canada also varies from province to province. Primarily the regulatory body for paramedicine of their respective provinces reserves the right to approve of paramedic programs. Nationally, Accreditation Canada offers the most comprehensive and
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degree programs currently available in Canada. These programs are increasingly becoming the standard of paramedic education as the profession progresses. This would be comparable to when nursing moved from the college based program to the collaborative or university based program in Canada. These
522:
uses rotary wing aircraft to reach many in isolated communities and traumatic situations for faster response time than by ground ambulance. In Saskatchewan they also use fixed wing air ambulances. The service, called LIFEGUARD, can respond a greater distance and to more northern communities than
402:
has been standardized and now requires all new paramedics to hold a three-year Diploma of College Studies in Emergency Prehospital Care, or Soins préhospitaliers d'urgence (SPU) in French, from a recognized CEGEP (college) program. Upon completion of this diploma and successful completion of the
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education programs. The accreditation model of Accreditation Canada is an independent body, and draws from The national occupational competency profile (NOCP) as the benchmark document that details the knowledge, skills and abilities outcomes that must be possessed by paramedics or EMRs of each
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This is a level of practice recognized under the National Occupational Competency Profile and the Paramedic Association of Canada. EMRs staff rural ambulance stations, patient transfer services, community medical event coverage, industrial ambulances, university campus response teams, or mobile
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Training as an advanced care paramedic (ACP) requires that the student be first registered as a primary care paramedic. The length of time required to complete the ACP graduate program also varies between provinces, and it is generally inversely related to the length of time required to have
531:
Tactical paramedics are specialized paramedics who undergo additional training to allow them to perform their usual tasks in a high-risk and dangerous scenarios. Some are trained to handle weapons, rappel from buildings, and other skills needed to work alongside tactical police units. These
478:
Training for specialization as a paramedic is most often provided by employers who select paramedics that have gone through an internal competition. There are very few specialization education programs open to the public currently. Most specializations require the applicant to already be an
151:. The EMR's scope of practices include oxygen administration, oropharyngeal and nasopharyngeal airway adjuncts, the use and interpretation of a pulse oximeter, use and interpretation of a glucometer, blood pressure assessment by auscultation and palpation, chest auscultation,
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another CCP, ACP, registered nurse or under the direction of a physician, physician assistant or nurse practitioner. Sometimes ad hoc teams, with multiple practitioners (RTs, emergency physicians, physician assistants, surgeons, etc.) are assembled for certain patients.
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best known system of national accreditation for paramedics. Previously, the Canadian Medical Association accredited paramedic training programs. This accreditation model was phased out by the Canadian Medical Association. The CMA only continues to accredit
684:, 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
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of paramedics and emergency medical responders: professional responsibilities, communication, health and safety, assessment and diagnostics, therapeutics, integration, transportation and health promotion and public safety.
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the Board. The Government of British Columbia has prioritized the review of paramedics for self-regulation under the Health Professions Act through modernization of the provincial health profession regulatory framework.
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psychology, obstetrics, cardiology, pharmacology, pathology, communications, ethics, driving, research, emergency medicine theory and practical skills. Theoretical and practical training is in combination of both in
502:
CCPs are able to provide all of the care that PCPs and ACPs provide. In addition to this they are trained for other skills such as medication infusion pumps, mechanical ventilation and arterial line monitoring.
579:
Paramedics across Canada have various formats for regulation. Paramedics in all provinces are regulated by provincial legislation and regulations directly by government, or rather by a designated
863:+Le May MR, So DY, Dionne R, Glover CA, Froeschl M, Wells GA, Davies RF, Sherrard HL, Maloney J, Marquis, J-F, O'Brien ER, Trickett J, Poirier P, Ryan S, Ha A, Joseph PG, and Labinaz M. (2008).
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In Canada the scope of practice of paramedics and emergency medical responders is described by the National Occupational Competency Profile (NOCP) document which was developed by the
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airway suctioning, administration of the following oral, sublingual or inhaled medications: anti-anginal, anti-hypoglycemic agent, analgesia, platelet inhibitors (including
80:, providing pre-hospital assessment and medical care to people with acute illnesses or injuries. In Canada, the title paramedic generally refers to those who work on land
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monitoring, supraglottic airways, vascular access, cardiac monitoring such as Lead 2 interpretation and 12 Lead acquisition and interpretation, and administration of
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Primary care paramedicine education may be a one year primary care paramedicine certificate to two year primary care paramedicine diploma program in the province of
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The Advanced Care Paramedic is a level of practitioner that is in high demand by many services across Canada. The ACP typically carries approximately 20 different
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STARS. Sask air ambulance service was the first non-military air ambulance service in the world. These air ambulances are crewed by Flight Nurses and CCPs.
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since 2015, a formal 2-year advanced care paramedic (ACP) training program was developed at Université de Montréal for experienced PCPs from Urgences-santé.
330:) are treated, but also profoundly affecting survival rates. as well as bypassing a closer hospitals to get an identified stroke patient to a stroke centre.
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In Quebec, paramedics are directly regulated by the Ministry of Health & Social Services, established by the Pre-Hospital Emergency Services Act.
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271:, although the number and type of medications may vary substantially from region to region. ACPs perform advanced airway management including
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980:"Paramedic Courses - Education and Patient Care Standards - Emergency Health Services - Programs and Services - Public Information - MOHLTC"
259:). PCPs may also receive additional authorization in order to perform certain skills that are normally in the scope of practice of ACPs.
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147:. It is a level of practice focused primarily on life saving methods and is generally consistent with fewer acts beyond advanced
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clinical experiences. The didactic and clinical components of the programs may vary from province to province across Canada.
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CCPs often work in fixed and rotary wing aircraft when the weather permits and staff are available, but systems such as the
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In the province of Prince Edward Island, paramedics are regulated by the College of Paramedicine of Prince Edward Island.
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672:, paramedics are regulated through two mechanisms in which the Ambulance Act indirectly regulates paramedicine. The
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311:, and prehospital medical research has permitted a great number of variations in the scope of practice for ACPs.
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provides a two year primary care paramedicine diploma program or four year baccalaureate paramedicine degree.
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provides a one year primary care paramedicine certificate and a four year baccalaureate paramedicine degree.
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Current bypass protocols include providing both PCPs and ACPs with discretionary direct 24-hour access to
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paramedics are required to wear protective gear but are usually unarmed in civilian environments.
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to better treat poisonings/overdoses and work closely with firefighters and hazmat technicians.
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Paramedics in Canada generally work only as paramedics, but occasionally are cross-trained as
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Primary care paramedics (PCPs) are the entry level of paramedic practice across Canada. The
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1586:"Information aux intervenants en soins préhospitaliers d'urgence | Gouvernement du Québec"
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1255:"HealthLine - Accessing Health Care Services in Saskatchewan - Government of Saskatchewan"
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provincial examination, one is certified at the level of primary care paramedic (PCP).
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1071:"Soins préhospitaliers d'urgence avancés - Université de Montréal - Guide d'admission"
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pain relief for various conditions. Several sites in Canada have adopted pre-hospital
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1516:"Recommendations to modernize the provincial health profession regulatory framework"
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865:"A Citywide Protocol for Primary PCI in ST-Segment Elevation Myocardial Infarction"
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Incident response paramedics receive intensive training, including toxicology,
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1131:"Paramedicine (Joint Centennial) | Admissions & Student Recruitment"
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hazmat awareness and operations certifications, as well as three weeks of
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1273:"Simcoe County News - Latest Daily Breaking News Stories - Simcoe.com"
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1043:"College of the North Atlantic - Program (Primary Care Paramedicine)"
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648:, paramedics are regulated by the College of Paramedics of Manitoba.
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IV lines, perform needle thoracostomy, perform and interpret 12-lead
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1311:"Calgary Zone Community Paramedic Program - Alberta Health Services"
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1198:"Committee on Accreditation of Canadian Medical Schools (CACMS)"
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provides a two year primary care paramedicine diploma program.
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for a variety of emergency medical conditions (these include
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Primary care paramedicine training in the maritime provinces
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without medications or blood products). EMRs may administer
1329:"Licence Endorsements – Saskatchewan College of Paramedics"
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have a two year primary care paramedicine diploma program.
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in Canada, involves post-secondary education provided by a
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1057:"Paramedic Education | Paramedic Association of PEI"
807:"National Occupational Competency Profile for Paramedics"
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Critical Care Transport Program work in land ambulances.
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1170:"Paramedicine | University of Prince Edward Island"
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Primary care paramedic training in the western provinces
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1614:"Collaborative Emergency Centres | novascotia.ca"
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National Association of Emergency Medical Technicians
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Association Professionnelle des Paramédics du Québec
955:"Primary Care Paramedic and Advanced Care Paramedic"
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Types of paramedics and emergency medical responders
1558:"Newfoundland and Labrador Paramedicine Regulation"
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1711:National Registry of Emergency Medical Technicians
1701:Paramedic Association of Newfoundland and Labrador
1015:"Holland College | Primary Care Paramedicine"
918:"EMA Licensing Board Recognized Training Programs"
825:"Ambulance Act, Revised Statutes of Ontario, 1990"
1544:"College of Paramedicine of Prince Edward Island"
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1292:"Community Paramedics - Alberta Health Services"
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203:, manual defibrillation, oxygen administration,
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470:respective level of paramedic or EMR practice.
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121:National occupational competency profile (NOCP)
1721:NHTSA Emergency Medical Services National Page
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713:Newfoundland and Labrador paramedic regulation
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718:working within the public ambulance program.
430:Advanced care paramedicine training in Canada
383:Primary care paramedicine training in Ontario
40:Paramedics prepare to transport a patient in
1375:"College of Paramedics of Nova Scotia: Home"
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394:Primary care paramedicine training in Quebec
1389:"Home – Saskatchewan College of Paramedics"
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1403:"Home — College of Paramedics of Manitoba"
101:. The NOCP outlines four provider levels:
1696:Emergency Medical Care Inc. (Nova Scotia)
1029:"Primary Care Paramedic | Oulton College"
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846:"Emergency Medical Assistants Regulation"
705:Prince Edward Island paramedic regulation
575:Regulation of the paramedicine profession
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491:A Critical Care Paramedic ambulance in
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1156:"Paramedic| Medicine Hat College"
1115:: CS1 maint: archived copy as title (
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201:semi-automated external defibrillation
25:Paramedics on scene of an incident in
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1600:"Système préhospitalier - SPU Québec"
696:British Columbia paramedic regulation
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479:experienced advanced care paramedic.
338:Paramedic education, or the study of
1980:Emergency medical services in Canada
1686:Peel Paramedic Association (Ontario)
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768:Emergency Medical Services in Canada
564:National Fire Protection Association
287:, perform synchronized and chemical
449:Bachelor of Science in Paramedicine
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1736:Saskatchewan College of Paramedics
935:Saskatchewan College of Paramedics
931:"Initial Education & Training"
604:New Brunswick paramedic regulation
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1991:
1681:Paramedic Association of Manitoba
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1223:"Paramedic Association of Canada"
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628:Saskatchewan paramedic regulation
456:Paramedic education accreditation
138:Emergency medical responder (EMR)
616:Nova Scotia paramedic regulation
443:University paramedicine training
97:with financial support from the
16:Overview of paramedics in Canada
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811:Paramedic Association of Canada
778:Shock Trauma Air Rescue Society
773:List of EMS Services in Ontario
520:Shock Trauma Air Rescue Society
353:pre-hospital emergency medicine
187:by generally an auto-injector.
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600:and other health professions.
588:in much of the same manner as
334:Paramedicine training overview
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1731:Nova Scotia Paramedic Society
1706:Alberta College of Paramedics
1481:Ontario Paramedic Association
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640:Manitoba paramedic regulation
483:Critical care paramedic (CCP)
263:Advanced care paramedic (ACP)
1347:"Paramedics To The Response"
1202:Canadian Medical Association
690:Ministry of Health (Ontario)
674:Ministry of Health (Ontario)
664:Ontario paramedic regulation
652:Alberta paramedic regulation
191:Primary care paramedic (PCP)
7:
1477:"Paramedic Self-Regulation"
1438:"Law Document English View"
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722:Quebec paramedic regulation
554:Incident response paramedic
518:Across the prairies, STARS
447:There are three university
103:Emergency Medical Responder
10:
1996:
1781:Emergency medical services
1772:Emergency medical services
1309:Services, Alberta Health.
1290:Services, Alberta Health.
1259:Government of Saskatchewan
783:Saskatchewan Air Ambulance
209:Symptom Relief Medications
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994:"OĂą obtenir la formation"
420:Newfoundland and Labrador
299:assessments, and provide
756:law enforcement officers
730:Professional environment
309:rapid sequence induction
1315:Alberta Health Services
1296:Alberta Health Services
115:Critical Care Paramedic
111:Advanced Care Paramedic
78:healthcare professional
1184:"Educational Programs"
598:respiratory therapists
536:Occupational paramedic
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474:Specialized paramedics
324:myocardial infarctions
107:Primary Care Paramedic
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1237:"STARS air ambulance"
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293:transcutaneous pacing
68:Toronto Paramedic Bus
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1135:www.utsc.utoronto.ca
882:10.1056/NEJMoa073102
424:Prince Edward Island
320:emergency department
318:labs, bypassing the
275:, surgical airways,
199:includes performing
169:acetylsalicylic acid
99:Government of Canada
52:Ottawa Paramedic Bus
1241:STARS Air Ambulance
967:"Approved Programs"
748:security contractor
688:established by the
656:In the province of
644:In the province of
632:In the province of
620:In the province of
608:In the province of
545:Community paramedic
467:physician assistant
277:intravenous therapy
130:Assistant (AEMCA).
1335:on August 5, 2020.
1031:. August 22, 2019.
586:regulatory college
581:regulatory college
527:Tactical paramedic
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62:
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34:
1967:
1966:
1602:. April 26, 2021.
1361:"About Us - PANB"
752:search and rescue
197:scope of practice
177:intravenous lines
145:chain of survival
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1774:around the world
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1331:. Archived from
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1279:. July 12, 2023.
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1560:. May 13, 2021.
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680:, known as the
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165:nitrous oxide
162:
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157:nitroglycerin
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153:oropharyngeal
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1658:November 14,
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1480:
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1455:
1446:
1432:
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1411:
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1369:
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1341:
1333:the original
1323:
1314:
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1276:
1267:
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1201:
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988:
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934:
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899:cite journal
872:
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840:
830:November 14,
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819:
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744:firefighters
741:
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1855:Netherlands
622:Nova Scotia
562:chemistry,
515:necessary.
508:Toronto EMS
412:Nova Scotia
297:obstetrical
269:medications
213:epinephrine
185:epinephrine
113:(ACP), and
27:York Region
1927:by country
1925:Paramedics
1783:by country
1277:Simcoe.com
789:References
590:physicians
295:, perform
273:intubation
217:salbutamol
173:salbutamol
82:ambulances
1934:Australia
1900:Sri Lanka
1870:Palestine
1830:Hong Kong
1795:Australia
1623:August 3,
1528:August 3,
1523:gov.bc.ca
1486:August 3,
1461:August 3,
1422:August 3,
1207:August 3,
1140:August 3,
999:August 3,
940:March 13,
686:protocols
678:physician
463:physician
249:ibuprofen
245:ketorolac
149:first-aid
74:paramedic
1974:Category
1880:Portugal
1111:cite web
1101:July 30,
891:18199862
762:See also
646:Manitoba
373:Manitoba
349:hospital
279:, place
257:benadryl
237:glucagon
233:dextrose
229:naloxone
181:naloxone
1949:Ireland
1944:Germany
1905:Ukraine
1840:Ireland
1835:Iceland
1825:Germany
1815:Finland
1800:Belgium
1790:Austria
813:. 2011.
670:Ontario
658:Alberta
493:Toronto
388:Ontario
377:Alberta
221:aspirin
161:glucose
109:(PCP),
105:(EMR),
42:Toronto
31:Ontario
1939:Canada
1885:Russia
1875:Poland
1865:Norway
1845:Israel
1820:France
1810:Canada
1805:Brazil
1639:"Home"
1417:"Home"
889:
594:nurses
560:hazmat
437:Quebec
400:Quebec
241:gravol
117:(CCP)
1890:Spain
1850:Italy
1519:(PDF)
1095:(PDF)
1088:(PDF)
568:CBRNE
512:ORNGE
328:STEMI
205:ETCO2
76:is a
1660:2008
1625:2023
1530:2023
1488:2023
1463:2023
1424:2023
1209:2023
1142:2023
1117:link
1103:2020
1001:2023
942:2023
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887:PMID
869:NEJM
832:2008
465:and
371:and
351:and
307:and
285:ECGs
183:and
877:doi
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754:or
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316:PCI
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