Canada’s Need for National Paramedic Standards

Healthcare standards in Canada are difficult to assess because each province and territory is unique, and so are their healthcare systems. Emergency Medical Services (EMS) is an example of an area that needs to be nationally standardized, but more specifically, paramedics. A report from almost 20 years ago highlights the need for national paramedic standards, but clearly, achieving this goal has proved challenging. The relatively short history of paramedics, dating to the early 1970s, has resulted in the development of several organizations in an attempt to increase recognition, professional advancement and improve patient care nationally. Yet, the question remains; are separate organizations able to communicate effectively together to advance the profession on a national level? The answer is no. To achieve national paramedic standards, there needs to be a common standard of practice, entry-to-practice standards, and easier job mobility between provinces facilitated by one organization.

Standards of Practice

Paramedics incorrectly administering an oral medication into the rectum of a patient, as seen in an unfortunate case in Alberta, calls attention to the importance of national standards to ensure safe and competent paramedic practices and prevent unprofessional conduct. The standards in place allowed the Alberta College of Paramedics to find the practitioners involved guilty of unprofessional conduct. Having clear national standards ensures that all practitioners can be held to the same accountability, which is in the public's best interest. As a paramedic, clearer expectations will reduce uncertainty in decision-making, resulting in a higher quality of care.

After a biking accident, a physician in B.C. discovered just how limited responding paramedics are in their ability to manage pain when he found himself in the back of an ambulance. A lack of suitable pain medications meant that his pain couldn’t be treated effectively, as ambulances are only stocked with medications that paramedics are allowed to give. From this experience, he conducted a research study that changed policy in B.C. and enabled Primary Care Paramedics to administer a drug called Ketamine for pain relief. Ketamine isn’t routinely tested on the “national” exam or widely used in other Canadian provinces. A consensus on what medications and procedures paramedics can administer and perform is crucial to ensure access to high-quality medical care across Canada.

Entry to Practice

Clarifying the job descriptions is exactly what is needed. One successful feat was the establishment of four national occupation standards. From these standards, strides have been taken to create a national examination which was ultimately implemented in 2012. However, the body that administers these entrance examinations only created exams for three of the four paramedics levels despite occupation standards existing for all four. A great starting point, however, not all provinces have chosen or been able to implement the national exam.

Additionally, the body that controls the regulation of paramedics varies between provinces and territories. This creates confusion because, in some places, paramedics can either self-regulate or are regulated by the government. As an unfortunate result, the exams for two levels of paramedics are used in seven provinces, and an exam for a third level is used in another three. Even though in B.C. and Alberta, new paramedics write the same national exam, the difference in scope of practice between provinces persists. But do we really think the work of paramedics is that different from province to province? This standard discrepancy creates confusion over the role of paramedics in Canada, which is supported by a study conducted in B.C.

Job Mobility

This is about paramedics being able to go where they’re needed. For an Alberta paramedic to work in Ontario, an equivalency exam must be written to determine eligibility to practice. Whereas Saskatchewan describes how gap training may be needed for paramedics looking to work in Saskatchewan. Understandably, these testing and education requirements are in place because the length of education can vary between provinces from weeks to years. Lending the question, does this serve the public interest? Furthering the issue of practitioner mobility is that some provinces don’t recognize the four levels of paramedics. The specialized training that some paramedics do to better serve their patients wouldn’t be recognized in some provinces, such as Alberta. Implementing national standards would allow for greater freedom of movement and minimize the possible labour shortage because of delays in provincial accreditation.

The need for a single unifying organization to promote standardization in paramedic care, education requirements, and improved work mobility are key features to defining the role of paramedics in Canada. As the role is rapidly evolving, the need for further work to create national paramedic standards is crucial to upholding the principles of Canadian healthcare.

Bottom line: Canadians deserve to have standardized and high-quality emergency medical care.

Janna Newton is a Master’s student at the University of Calgary’s School of Public Policy.