January 18, 1999
To: Emergency and Protective Services Committee
From:Barry Gutteridge
Commissioner, Works and Emergency Services
Subject: Ministry of Health, Emergency Health Services (EHS) and Toronto Base Hospital,
Mandatory Training for Paramedics.
Purpose:
To provide Emergency and Protective Services Committee with the requirements as mandated
by the Ministry of Health, EHS for ambulance operators, to provide annual mandatory
training, certification maintenance and continuing medical education programs to all
paramedic staff
Funding Resources, Financial Implications and Impact Statement:
Funds for these programs must be identified within the existing Toronto Ambulance budget.
Any decreases in available funding may impact the ability to meet these requirements.
Recommendation:
It is recommended that this report be received for information.
Background:
Regulation 19 of the Ambulance Act of Ontario defines the qualifications, continuing medical
education and certification requirements for paramedics working in Ontario.
Requirements to become a paramedic include completion of the Ambulance and Emergency
Care program offered at Community Colleges in Ontario and the successful completion of a
Provincial registry exams.
The skill level of a newly graduated paramedics (Level I) now includes the Medical
Controlled acts of defibrillation and administration of symptom relief drugs for use in
emergencies such as, angina, asthma or anaphylactic shock.
Toronto Ambulance, as well as other communities in Ontario, also provides a higher level of
care through an advanced level program. Paramedics that fall into this category in Toronto are
known as Level II or Level III paramedics. While Level I paramedics perform two medical
controlled acts, Level II and III paramedics skill set includes a number of other medical
controlled acts. All Toronto paramedics who perform medical controlled acts work under the
license of a physician and are certified by the Toronto Base Hospital program Medical
Director.
Under the regulations, it is the ambulance operator's responsibility to ensure all paramedics in
their employ attend all training and continuing education courses approved by the director of
the Emergency Health Services Branch.
The costs for mandated Ministry of Health, EHS programs, including operational coverage
must be absorbed by Toronto Ambulance. All paramedics must participate in these sessions
consisting of 16 hours annually.
Level II / III paramedics must complete additional continuing medical education programs to
maintain their certification required by the base hospital medical director. This consists of an
additional 24 hours training annually.
Ministry of Health mandatory programs are completed through an inservice training process
provided by Toronto Ambulance training staff. Paramedics are scheduled into training
programs on a regular scheduled shift. Operational coverage is maintained through backfill of
positions as required to maintain minimum requirements.
Base hospital programs are provided utilizing the same scheduling process.
Funds for the provision of instructors and materials for continuing medical education of Level
II / III paramedics is the responsibility of the base hospital program. Toronto Ambulance
training staff is contracted to the base hospital for the delivery of many of the continuing
medical education topics. This provides some revenue to offset the costs to Toronto
Ambulance.
Mandatory programs include skills recertification, introduction of new equipment / health and
safety issues, policy issues and continuing medical education.
Comments and / or Discussion and / or Justification:
Toronto Ambulance has always maintained flexibility in the budget to accommodate the need
for Provincial and Municipal training programs. The demand for skills recertification and
continuing education programs has increased along with the skill level of the profession.
Toronto Ambulance, Toronto Base Hospital program and the Ministry of Health, EHS have
agreed to work together to find common programs for paramedics which can be grouped
together with Ministry of Health, EHS programs to keep the total hours of mandatory training
to a minimum.
Over the last four years Toronto Ambulance has continued to provide upgrade training of
paramedics to meet the goal of a full ALS service. Today we employ 630 paramedics,
(407 level I, 96 level III and 130 level III). It is anticipated that a total of 16,272 hours will be
required to fulfill mandatory programs. This does not include training hours required to
complete continued paramedic upgrade programs, Corporate training programs or other
training requirements.
In order to maintain the level of service being provided to the citizens of Toronto it is of the
utmost importance that Toronto Ambulance continue to meet the requirements for continuing
medical education and training programs. Toronto Ambulance training staff are certified and
approved by the Ministry of Health and Base Hospital Program Medical Director to provide
these programs. This again allows flexibility in the scheduling and delivery of the programs.
Summary:
The goal of Toronto Ambulance is to ensure the most appropriate level of care is available to
the citizens of Toronto. In order to meet this goal continued training and upgrading of
paramedics has occurred on an ongoing basis.
Toronto Ambulance as the ambulance service operator, must ensure that all mandatory
training and certification requirements identified by the Ministry of Health and Base Hospital
program are completed annually utilizing funds with in the Divisions existing operating
budget.
The inability to maintain this requirement may impact the existing level of care provided.
Contact Name:
Norm Lambert, Manager, EMS Education and Development
Phone 392 - 2061
Fax: 392 - 2149
R.L. KeluskyBarry Gutteridge
General ManagerCommissioner
Toronto AmbulanceWorks and Emergency
