Paramedical training in Canada

[paramedicdeb]

In Canada each province has their own levels of care. I will discuss Alberta's level of care today as that is where I am a registared paramedic. Alberta has the highest level of training in all of the provinces. Alberta has three levels of care: EMR (Emergency Medical Responder) "2 week course to introduce ambulance care attendants to the basic life support care of patients including 02 admin.,defibrillation, emergency care in medical and trauma, immobilization skills and transportation of patients, used a lot with volunteer ambulance attendants, fire departments, and oil field standby's." EMT-A (Emergency Medical Technician - Ambulance) "4-5 month course to expand the scope of practise of the ambulance attendant, includes EMR scope of practise plus the benefit of emergency medication admin., cardiac monitoring, intravenous fluid care, with a more advance assessment of the patient and further knowledge and care, most ambulance services have this level of care BLS on their ambulance cars as a minum standard of care." EMT-P (Emergency Medical Technician - Paramedic) "2 year diploma course that qualifies the attendant to be trained as a critical care paramedic, intensive studies with the care of patients in medical & trauma situations. Inclusive of the above scope of practise is the ALS (advanced life support) level of care with the capabilities of cardioversion, pacing, extensive medication administration, IO access, External jugular access, lab reading, with drawl of blood for tests, xray interpretation, cricothyriod access, chest decompression, advanced differential diagnosis of patients, advanced pediatric & neonatal care, urinary cath., endotracheal & naso intubation, gastric tube insertion, any other advanced techniques within their scope of practise as approved by medical direction. All ambulance attendants must pass an CMA (Canadian Medical Association) approved training institute course and then provincial testing before they can use the registered title and move on to the next level of care, all levels work under a medical director that dictates through standing and verbal orders as the care accepted with their service area. Medical direction can be obtain through any emergency department as needed outside the standing orders. Minimum requirements through the governing body (ACP - Alberta College of Paramedics) are to be maintained each year to be qualified to renew the license to practise. Paramedicine in Alberta is going through a lot of changes right now and increasing the scope of practise on all levels of care. In Alberta the industry consists of private, municipality, hospital, and city run services which allows for a great diversity in what medical direction is allowing the attendants to use. Each department has their own set of protocols the attendants must follow with strict regulations. The move to one medical direction and a standard set of protocols provincial wide has been in the works for several years as well as the a possibility of provincially being run by the hospitals, there has been some health regions piloting this project and we will see what comes of in the future. Most Alberta paramedics can transfer to all provinces and internationally with little or no cross over problems due to the higher level or care taught at in this province. Please post any comments on this subject as you see fit. I will discuss other provinces care as I am aware of as well as the volunteer aspects in Canada as time goes on. Please post on your province as to the scope of practise and levels of care so we can educate and learn about the world of paramedicine in all countries. Hope you enjoyed this posting and look forward to learning about your countries levels of care.
paramedicdeb )

[Admin]

Great post, paramedicdeb!

[sivakumar]

dear deb,

let me share with you the paramedic training in my country, Malaysia...

it is indeed shameful for me to tell this, but i have to say that the paramedic training in Msia is way behind as compared to yours or in the UK or Aust.and the sad part is, the government is not seriously looking into improving pre-hosp care. many good small changes only occur at state level and this is done by the respective head of dept of the EM of the state's hosp. currently, besides Klang Valley, the other state that is doing well is Penang Island as the Emerg Physician there is highly motivated in making those good change. he has created a vital link in communication betwn the hosp and fire brigade to respond to any disaster that may hit the island.

coming back to paramedic training, there was a university (HUKM) that trained and produced 2 batches of Emergency Medical Technician, ie EMT-B (yours truly is one of them) and the total number was 50 odd personnel.there were mainly from the st john ambulance, red crescent society, fire brigade, SMART team, civil defence and private ambulance attendants.that was in year 2000 and 2001. today,many of them are doing something else other than paramedic work. some are teaching first aid,some continue to run the ambulance service, but hey, there was no continuity of training for them and no more similar trainings were done to prod more EMTs as the university had shortage of teaching staff from the Emerg dept to teach.hence, the effort was stopped there.

hence, the ambulance crew that we have today are majority just either First Aid levels or First Reponder.its a sad number and sad level of expertise to cater for the high number of emerg cases, esp the Klang Valley. only a hangful of the crew from the red crescent society and st john ambulance are trained EMTs. this can be seen when they handle an emerg case on scene (they will appear professional and able to provide good standard of stay-and-play care) as compared to the rest who still scoop-and-run the casualty.

some parties claim that they need more ambulance, but hey, how abt the personnel? what is the point of having more ambulances when you do not have proper crew to handle it.

well, that is how sad Malaysia's state of pre-hosp care is.a lot of things need to be done and looked into.where is Malaysia heading to in this? only God knows.

feel free to ask more.

frustrated....     

[paramedicdeb]

Hi Dr. Kumar:
In reading your response to paramedical training in Malaysia I can truely see why you are frustrated. I would be the exact same way I get frustrated when I cannot do something I know how to do and held back by our protocols that are very libereal in comparison to yours. Is your EMS funded by government or private industry in Mayasia?
I have done lots of training in your areas of response levels, you do have a long way to go.
The tax payers here demand a certain amount of care level.
And occupational health and safety sets forth the rules and regulations based in the workplace reaquirements.
That is how as well as some very motivated medical directors.
We are really short of paramedics here as well.
Your country must recruit more educators and proactive medical directors as well as education of the people to increase your pre hospital level of care.
I wish you all the best of luck in getting better health care for your people.
Regards Deb
 

[sivakumar]

dear deb,
thank you for understanding my frustration. it has been in me for the past 5 years or so ever since i started working as a paramedic.
well, you see, the root of the problem here in Malaysia is that the AWARENESS of how IMPORTANT pre-hosp care is low.it is mainly funded by the government hence there is block there.it is only when a minister suffers a heart attack or gets involve in an accident and the response of an ambulance is late or standard of care provided is substandard, only then will they take action since it has happen to themselves and it was an eye opener for them.

another problem in this country is we have quite a number of private companies running emergency ambulance service, esp in the Klang Valley.they charge for their service, whereas government hosp's ambulances and the NGOs like st john ambulance and red crescent are provided free.

we do not have qualified ppl to teach or train paramedics.and as you have said it right, we are WAY behind man!

but i do like your idea of the taxpayer's power to ask for better health care. but then again, awareness in them needs to be there.

sigh...

yes, i do hope i can make some change one day.

[drvolcanoe]

Deb> Seems like we in Malaysia are indeed light-years behind Canada in this aspect.

Siva> I remember u mentioning Malaysia lacks proper paramedic training, but didn’t know it was this bad shape! What about Universities other than HUKM? Given that paramedics play an important role as 1st responders in A&E (ER) situations, how can their training be compromised??!
Maybe some private institutions should take up the challenge of running this course (instead of only the conventional medic, pharm, dentistry), by importing teaching staffs from overseas, instead of just depending on our busy local EM-specialists alone.
Really hope some change will come to M’sia some day soon...


Hope to hear more from other countries.

[sivakumar]

well lava, that is a true fact!
no other Uni offers such trainings, and as i have mentioned earlier, HUKM only managed to prod 2 batches of EMTs, and due to lack of teaching staff, they have stopped.
another hosp, UMMC did a small stint by training the Civil Defence personnel, but that also went to the dustbin as there were many complaints abt their level of care and ambulance being poorly equipped.
your suggestion is a good one, but if a private centre or uni trains paramedics, are the Gov ready and willing to accept these 'graduates'? meaning to say, where will they put their face? and will Gov create a 'post' for them in the hosp to work? as it is now they are heavily using the Medical Assistants to respond in an ambulance, esp true for other states incl Batu Pahat. The MAs there are complaining to me that it is not safe for them "to go out there" as there is no insurance for them out of hosp. remember the poor house officer dr who died in an ambulance crash months ago?
so, as u can see,pre-hosp care in Msia is poor, lacking behind and future is uncertain.
sigh.....................sigh.............................

[razmi4ever]

well lava, that is a true fact!
no other Uni offers such trainings, and as i have mentioned earlier, HUKM only managed to prod 2 batches of EMTs, and due to lack of teaching staff, they have stopped.
another hosp, UMMC did a small stint by training the Civil Defence personnel, but that also went to the dustbin as there were many complaints abt their level of care and ambulance being poorly equipped.
your suggestion is a good one, but if a private centre or uni trains paramedics, are the Gov ready and willing to accept these 'graduates'? meaning to say, where will they put their face? and will Gov create a 'post' for them in the hosp to work? as it is now they are heavily using the Medical Assistants to respond in an ambulance, esp true for other states incl Batu Pahat. The MAs there are complaining to me that it is not safe for them "to go out there" as there is no insurance for them out of hosp. remember the poor house officer dr who died in an ambulance crash months ago?
so, as u can see,pre-hosp care in Msia is poor, lacking behind and future is uncertain.
sigh.....................sigh.............................

Dear Dr. Siva.
I do understand your frustration but instead of telling how bad the situation is, why don't you tell us what can be done to improve the situation.
I believe the government has been trying their best to improve the quality of the healthcare system in Malaysia and there are so many aspects in the healthcare system that need attention. With limited financial budget, it is very difficult to fulfill all needs.
Dr. Siva, you have my respect for your dedication in pre-hospital care. I think this is quite a new area that just starts gaining atention and is still developing. It takes time to catch up with other developed countries like Canada as what mentioned by paramedicdeb (you have my respect too )
I am not speaking on behalf of the government but in my opinion, it is just not too fair
Let's us work together to further improve the quality of healthcare in our country (Malaysia)

"Berkhidmat Untuk Negara"   

[drvolcanoe]

razmi> well....we (the country) jst needs much much more health care personel..be they medical or paramedical!
seriously...i dream of the day when every hosp will have not only nurses, but docs & all other staffs who work on shifts...and make sure every hospital is fully staffed all around the clock

i know this dream's to much..but i am a dreamer, and stubbornly optimistic. hope the day come when nobody has to do on-call & go on throughout their working days like a zombie due to sleep deprivation

siva> yea...tat HOs case' a real tragedy. gomen 'servants' need better protection la. but arent HOs generally accepted as kulis in white coat, so jus have to do all and any job assigned by our superiors (without complaining)

[herny]

I can see how established in the training of paramedic in Canada. How long to you take to become a qualified paramedic?

[paramedicdeb]

It takes about 3 years to complete your paramedic training in Canada from start to finish every province has different levels of paramedic training and protocols they can do under medical direction as well as each medical director can establish what you can and cannot do in the field I am most familiar with Alberta and it is the province with the highest level of training and the most liberal protocols in Canada under medical direction. It would be nice if it was standarized across the country but only if the rest of the country comes up to the level of training Alberta has because I would not like to lose the skills I have been trained to do to a lesser amount that does not benefit any patient care to go down in scope of practise, especially when you are working in rural and isolation areas where it is not so easy or fast to get to a hospital to hand over to a doctor.

Paramedicdeb 

[drstress]

Hi paramediced, I can see that the training in your country is excellent! This reflects how advanced your country is! I hope you read my post: http://www.emedinews.com/index.php/topic,1009.0.html and give me your opinion. How are doctors been trated in your country?

[paramedicdeb]

I have read about your life style. It is hectic here but we are not as big of center in most areas as what you are talikng about. The pace can be quite and the hours long, but in the nursing area there are unions and they are paid well. The doctors especially the specialists get paid very well and do have time to confer with other doctors and ask questions. Some seem abrasive but most are open to question asking and answering if the time permits. It is about team work most of the time and scolding does happen but not often and usually the result of stress or a power trip rather than incompetetence or the need to rush so fast that things may go missed. I can see it is very different in your country and I hope that with time and as the country develops things will change. Doctors are treated and respected as top of the field and with most places respect is earned through hard work and perseverence. Good luck to you in your everyday struggles. Just remember to stop and smell the roses as one day they will not be there for you to smell. Life is way too short.

Cheer
Paramedicdeb

[naturalimmunity]

It is strange that level of training is higher only in one province of the same country.

[Ben_Swann77]

This is a wonderful post you share and very useful information in it. You doing such a good job i appreciate your work.