531:
patient care equipment. These services can relieve the workload on public EMS through the elimination of some, or most, of the non-emergency transfer volume, and some provide service to the public that is of the highest standard. In many cases, such services are small private businesses, using second-hand ambulances which have been retired from public EMS service, while others use vehicles expressly built for their purposes. There has, however, been some controversy, in some jurisdictions, with respect to the operating procedures of some (but not all) of these services. In some cases, the vehicles are often made to look as much like EMS ambulances as possible, even retaining emergency lights and sirens (which they are forbidden by law to use), and incorporating the word "paramedic" (this term is not protected in Canada yet), variations on "EMS" (in some cases, "event medical services") or spelling variations of "ambulance", such as "ambu-lans", or using the Star of Life logo on their vehicle markings. These services are not generally licensed, or required to meet any recognized standard. These services generally attempt to recruit staff who meet provincial EMS qualification standards, but are under no legal obligation to do so. Such services are not covered by provincial health insurance, operate on a fee-for-service basis, and are not considered to be a legitimate part of mainstream EMS.
510:
particularly true of out of jurisdiction services, with an individual from one province who requires EMS service in another province being required to pay for that service and then submit the receipt to their own provincial health insurance scheme for reimbursement. In some jurisdictions, such as
Ontario, a deterrent fee scheme is used to discourage the medically unnecessary use of EMS by the public. In such cases, the provincial health insurance scheme pays the majority of the cost of EMS service (around 80 per cent) for medically necessary EMS service, but when a physician decides that the service was not medically necessary, they can cause the patient to pay the full, uninsured amount of the charge, with the patient receiving a bill for the additional deterrent fee at some point after the emergency is over. Within Ontario, for example, such deterrent billing occurs through the receiving hospital, despite the fact that the hospital neither provides nor oversees EMS in most cases.
223:
316:
286:
46:
272:
31:
62:
73:
519:
127:
241:" arrangements in which one private company takes the lead on service provision, perhaps even operating some of their own aircraft and providing dispatch services, but subcontracting many of the operations to smaller air charter services. In some cases, the inter-facility transport of high-acuity patients may be a mix of air-based and ground-based resources. Canada is a vast country, and its sheer size dictates that in many cases a
300:
441:
in most urban areas of the country, but there are some jurisdictions that set a second standard for rural areas (the majority of the country). Such standards vary from one jurisdiction to the next. Additionally, there are jurisdictions that do not set specific response time objectives, instead simply reporting average response times for emergency calls.
331:"), and specialized emergency support units, such as equipment vehicles and mass-casualty transport vehicles. Each province or territory, and also the Canadian military, has its own unique ambulance specifications. Individual provinces or territories may also specify types of mandatory equipment in those vehicles, including medical equipment.
428:'s license. The Ministry of Health and Long Term Care has established a minimum standard of care for the province, but base hospitals can add medications at their discretion. The number and type of medications beyond the minimum standard also varies with the paramedic scope of practice (primary, advanced or critical care).
440:
triaged Delta and Echo calls. There is no jurisdiction in Canada that is currently reporting successful achievement of this response time standard, and services cite a variety of reasons for this failure, but continue to aspire to the standard. This approach to response time monitoring is accepted
117:
A rail ambulance is a vehicle used for medical transportation services on railway lines. The first rail ambulance was set up in 1920, in order to enable injured people to be transported to the nearest hospital, was set up in the coal mining community of Cape Breton, Nova Scotia. The car ran between
103:
services, may be provided directly by the province, contracted to a private provider, or delegated to local governments, which may, in turn, create service delivery arrangements with municipal departments, hospitals, or private providers. The approach, and the standards, vary considerably between
530:
In addition to regular EMS, many jurisdictions also operate non-emergency patient transport services. In many jurisdictions, there are also companies who specialize in non-emergency patient transfers. Such companies have their own vehicles, which are similar to ambulances and carry some similar
509:
revenues of municipalities operating such services. In some jurisdictions, funding is at 100 per cent, and occurs without the patient being aware of its existence. Other jurisdictions fund at varying levels, but may require payment up front. In most cases this is later reimbursed. This may be
392:
are served by highly educated paramedics with advanced skills. Other jurisdictions have not yet reached these levels, and some jurisdictions have introduced, or are considering introducing, critical care paramedics. Progress varies, driven primarily by public demand, acceptance by the medical
449:
There are currently major initiatives for improved standardization of staff training underway in
Canadian EMS. The Paramedic Association of Canada has produced the National Occupational Competency Profile (NOCP), and several provinces are working toward meeting these standards. Provinces and
504:
in Canada is universal and publicly funded, so the cost of emergency ambulance services is covered to some degree. The degree to which individual use of EMS is subsidized by provincial health insurance varies by province, and may be supplemented either by partial fees for service, or by the
499:
in which they operate. Paramedics and ambulance services are not mentioned in the Canada Health Act, and are therefore not an insured service. Provinces may choose to subsidize some of the cost, usually just for patients with valid provincial health cards.
458:
approach to the overall management of EMS systems. Several provinces have started testing using the COPR (Canadian
Organization of Paramedic Regulators) licensing exam for both PCP and ACP levels. As of March 2018, these include
198:, or may contract out this responsibility to a private company. The approaches used for service delivery are governed by what is permitted under the legislation of the individual province or territory, or under the
590:
1327:
1037:
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, Labinaz M (2008).
323:
Individual provinces and territories typically specify, generally through legislation and regulations, the specifications and types of vehicles to be used in EMS. These vehicles include
684:
539:
EMS services are publicly operated, and many by the provincial ministry of health (mostly since the 1970s). In
Ontario services were devolved to local municipalities in the 1990s.
162:, which operate their EMS services directly, the method used for service delivery varies between jurisdictions. Typically, the provincial/territorial government provides enabling
934:
966:
1139:
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projects or collaborate with other researchers in the medical community, leading to publication (as with the preceding two references, both of which had paramedics in lead
735:
1164:
237:
services. These arrangements may come in a variety of forms, including direct service provision, contracts between private companies and the provincial government, or "
667:
1279:
1038:
436:
Urban areas such as
Toronto set standards according to percentiles. In Toronto, the standard is 8 minutes and 59 seconds or less 90 percent of the time on
1094:
393:
community, and funding. A great deal of the recent advancement in standards of care and procedures has been driven by formal outcome-based research and
988:
Stiell IG, Nesbitt LP, Pickett W, Munkley D, Spaite DW, Banek J, Field B, Luinstra-Toohey L, Maloney J, Dreyer J, Lyver M, Campeau T, Wells G (2008).
356:
Bus-based and air ambulances are not based on these standards. Buses are mostly for ambulatory transfer only and offer less advanced care services.
1672:
454:
and setting standards. In addition, initiatives by the
Paramedic Chiefs of Canada organization are working towards improved interoperability and a
450:
territories are also responsible for standards with respect to the dispatching of EMS resources, and some jurisdictions are measuring performance,
1334:
1214:
190:. Municipalities or hospitals may also, in turn, elect to provide EMS service directly, as a branch of another municipal department, such as the
1677:
1525:
1742:
1617:
610:
245:-based air ambulance service is impractical as the distances required exceed the flight range of the aircraft. For this reason, the use of
202:
of a municipality that has accepted responsibility for EMS service. Provincial governments may also, as in the case of the provinces of
1657:
941:
17:
1622:
760:
1662:
1632:
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1557:
1143:
739:
1642:
1383:
1168:
214:, contract directly with a single private company, in these cases Medavie Health Services, to provide province-wide services.
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1302:
791:
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1612:
496:
1518:
548:
836:
1716:
54:
935:"Summary of Legislation and Regulations (2007)- Canadian Medical Association Conjoint Accreditation Services</"
76:
Alberta Health
Services EMS Truck 3161. Most Ambulances in Canada use a GMC / Chevrolet cutaway van as their base.
1721:
553:
1077:
911:
1567:
1408:
1511:
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1098:
632:
523:
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Individual provinces and territories also typically specify required levels of mandatory staff training.
1543:
1534:
1218:
568:
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is commonplace. In some jurisdictions, not all air ambulance calls are emergencies, since distances to
143:
80:
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600:
480:
861:
695:
558:
406:
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886:
222:
1696:
637:
543:
563:
398:
50:
1503:
491:
EMS services in Canada are generally funded, at least in part, and to varying degrees, by the
315:
1706:
151:
92:
1701:
642:
614:
476:
385:
211:
767:
8:
990:"The OPALS Major Trauma Study: Impact of Advanced Life Support on Survival and Morbidity"
246:
1069:
1014:
989:
167:
1493:
674:. The Canadian Press. January 3, 1941. p. 6 – via Google Newspaper Archive.
397:, such as the groundbreaking research work on the management of S-T segment elevation
285:
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492:
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centres mean that some patients with lower-acuity medical conditions are also flown.
195:
187:
1387:
1073:
580:
131:
1053:
1039:"A Citywide Protocol for Primary PCI in ST-Segment Elevation Myocardial Infarction"
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are certified to administer symptom relief medications under a base hospital
339:
306:
250:
238:
234:
203:
171:
45:
1259:
346:
Type I Ambulances are based on the chassis-cabs of light duty pickup-trucks.
1065:
1023:
506:
464:
451:
373:
271:
30:
840:
1057:
604:
472:
377:
207:
163:
65:
35:
1446:
1005:
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324:
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118:#3 and #7 mines and Town of Sydney Mines. It was discontinued in 1922.
61:
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100:
96:
72:
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518:
126:
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584:
468:
410:
328:
147:
135:
88:
1441:
327:, but may also include rapid response vehicles (sometimes called "
299:
381:
369:
352:
Type III Ambulances are based on chassis-cabs of light duty vans.
199:
159:
39:
1533:
1498:
1328:"Non-Emergency Ambulance Transfer Issues for Ontario Hospitals"
335:
84:
715:
1711:
1602:
1280:"Saskatchewan Regional Health Services - Road Ambulance Fees"
865:
647:
437:
402:
389:
227:
816:
349:
Type II Ambulances are based on modern passenger/cargo vans.
1431:
987:
696:"Consolidated Newfoundland and Labrador Regulation 999/96"
146:(EMS), as a part of health care in general, lies with the
912:"Ambulance Regulations (1989), Province of Saskatchewan"
1239:
890:
1483:
34:
Emergency
Medical Services on scene of an incident in
1473:
178:, and oversight to a variety of operators, including
1036:
1484:Paramedic Association of Newfoundland and Labrador
49:A small few ambulances in Canada are based on the
534:
1734:
1095:"MOHLTC - EHS - Legislation - Regulation 257/00"
27:Overview of emergency medical services in Canada
1260:"Peace Country Health Region (Alberta) website"
817:"Nova Scotia Emergency Health Services website"
526:, a common private transport service in Canada
1519:
1489:Paramedic Association of Prince Edward Island
716:"Winnipeg Fire and Paramedic Service website"
513:
444:
409:. Some paramedics undertake their own formal
837:"EMS and Hospitals in Prince Edward Island"
1526:
1512:
1215:"National Occupational Competency Profile"
1013:
668:"Ambulance Rail Car Starts Across Canada"
342:federal KKK-1822 Standards requirements:
1469:Quebec Paramedic Association (in French)
591:New Brunswick Emergency Medical Services
517:
359:
314:
221:
125:
87:are the responsibility of each Canadian
71:
60:
44:
29:
964:
493:Ministry of Health or Health Department
57:example, although they are less common.
14:
1735:
1474:Paramedic Association of New Brunswick
967:"Canadian Paramedics Make House Calls"
405:), undertaken in cooperation with the
233:Canadian provinces are also served by
1507:
1743:Emergency medical services in Canada
1409:"Ontario Ministry of Health website"
1384:"First Response Ontario EMS website"
792:"EMS and Hospitals in New Brunswick"
486:
24:
1447:Saskatchewan College of Paramedics
549:British Columbia Ambulance Service
226:Ontario air ambulance operated by
112:
25:
1754:
1425:
1359:"Voyageur Transportation website"
1303:"Wm. Osler Health Centre website"
1190:"Ambulance New Brunswick website"
862:"Medavie Health Services website"
431:
121:
298:
284:
270:
217:
95:. The services, including both
1432:Paramedic Association of Canada
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879:
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554:List of EMS Services in Ontario
291:Toronto paramedic response unit
107:
68:prepare to transport a patient.
1464:Manitoba Paramedic Association
1240:"EMS Chiefs of Canada website"
1120:"BC Ambulance Service website"
829:
809:
784:
753:
728:
708:
688:
678:
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535:Other EMS Operations in Canada
13:
1:
1499:Toronto Paramedic Association
1479:Nova Scotia Paramedic Society
1452:Alberta College of Paramedics
1442:Ontario Paramedic Association
761:"City of Calgary By-law 8118"
653:
307:multi-casualty transport unit
130:A land ambulance operated by
1437:Ambulance Paramedics of B.C.
1140:"Regina Leader-Post article"
633:Emergency Medical Dispatcher
256:
7:
621:
261:
104:provinces and territories.
10:
1759:
1544:Emergency medical services
1535:Emergency medical services
569:Toronto Paramedic Services
514:Private transport services
445:Towards national standards
154:. With the exceptions of
144:emergency medical services
81:Emergency medical services
18:Symptom relief medications
1686:
1542:
887:"ORNGE (Ontario) website"
736:"York Region EMS website"
601:Emergency Health Services
481:Newfoundland and Labrador
1494:Ottawa Paramedic Service
1165:"Ottawa Citizen article"
559:Ottawa Paramedic Service
407:Ottawa Paramedic Service
638:Friendly caller program
544:Alberta Health Services
564:Region of Waterloo EMS
527:
399:myocardial infarctions
320:
230:
139:
77:
69:
58:
51:Mercedes-Benz Sprinter
42:
521:
497:province or territory
360:Staffing and training
318:
225:
152:territories of Canada
129:
75:
64:
48:
33:
1058:10.1056/NEJMoa073102
643:Paramedics in Canada
615:Prince Edward Island
386:Prince Edward Island
212:Prince Edward Island
1006:10.1503/cmaj.071154
334:Ambulances type in
247:fixed-wing aircraft
168:technical standards
142:Responsibility for
53:chassis, like this
1457:2008-08-28 at the
528:
321:
277:Winnipeg ambulance
231:
140:
78:
70:
59:
43:
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524:St John Ambulance
487:Funding and costs
319:Ottawa Rehab Unit
196:health department
188:private companies
16:(Redirected from
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1537:around the world
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965:Garza M (2007).
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1083:on 2019-02-19.
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164:legislation
66:Toronto EMS
36:York Region
1690:by country
1688:Paramedics
1546:by country
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1394:2008-09-25
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1344:2008-09-25
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1225:2008-09-25
1200:2008-09-30
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1105:2013-01-10
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654:References
611:Island EMS
422:paramedics
325:ambulances
243:helicopter
1697:Australia
1663:Sri Lanka
1633:Palestine
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1558:Australia
426:physician
257:Standards
184:hospitals
176:licensing
148:provinces
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411:research
329:fly-cars
305:Toronto
262:Vehicles
138:, Québec
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370:Alberta
200:by-laws
160:Alberta
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1638:Poland
1628:Norway
1608:Israel
1583:France
1573:Canada
1568:Brazil
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477:P.E.I.
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