Editing Emergency medical technician (section)

==Canada==
{{Main|Paramedics in Canada}}
There is considerable degree of inter-provincial variation in the Canadian paramedic practice. Although a national consensus (by way of the National Occupational Competency Profile) identifies certain knowledge, skills, and abilities as being most synonymous with a given level of paramedic practice, each province retains ultimate authority in legislating the actual administration and delivery of emergency medical services within its own borders. For this reason, any discussion of ''paramedic practice'' in Canada is necessarily broad, and general. Specific regulatory frameworks and questions related to paramedic practices can only definitively be answered by consulting relevant provincial legislation, although provincial paramedic associations may often offer a simpler overview of this topic when it is restricted to a province-by-province basis.

In Canada, the levels of paramedic practice as defined by the National Occupational Competency Profile are: emergency medical responder (EMR), primary care paramedic, advanced care paramedic, and critical care paramedic.

Regulatory frameworks vary from [[Canadian provinces|province]] to province, and include direct government regulation (such as Ontario's method of credentialing its practitioners with the title of A-EMCA, or advanced emergency medical care assistant) to professional self-regulating bodies, such as the Alberta College of Paramedics. In Alberta, for instance, only someone registered with the Alberta College of Paramedics can call themselves a paramedic; the title is legally protected. Almost all provinces have moved to adopting the new titles, or have at least recognized the NOCP document as a benchmarking document to permit inter-provincial labour mobility of practitioners, regardless of how titles are specifically regulated within their own provincial systems. In this manner, the confusing myriad of titles and occupational descriptions can at least be discussed using a common language for comparison sake.

===Emergency medical responder===
{{Main|Emergency medical responder}}

Most providers that work in [[ambulances]] are identified as "paramedics" by the public. However, in many cases, the most prevalent level of emergency pre-hospital care is that which is provided by an emergency medical responder (EMR). This is a level of practice recognized under the National Occupational Competency Profile, although unlike the next three successive levels of practice, the high number of EMRs across Canada cannot be ignored as contributing a critical role in the chain of survival, although it is a level of practice that is least comprehensive (clinically speaking), and is also generally not consistent with any medical acts beyond advanced first-aid and oxygen therapy, administration of ASA, I.M. epinephrine and glucagon, oral glucose and administration of intranasal Narcan with the exception of automated external defibrillation (which is still considered a regulated medical act in most provinces in Canada).{{citation needed|date=February 2017}}

===Primary care paramedic===
Primary care paramedics (PCP) are the entry-level of paramedic practice in Canadian provinces. The [[scope of practice]] includes performing [[automated external defibrillator|semi-automated external defibrillation]], interpretation of 4-lead ECGs, administration of [[symptom relief medications]] for a variety of emergency medical conditions (these include oxygen, epinephrine, [[dextrose]], glucagon, [[salbutamol]], ASA and [[nitroglycerine]]), performing [[trauma immobilization]] (including [[cervical immobilization]]), and other fundamental basic medical care. Primary care paramedics may also receive additional training in order to perform certain skills that are normally in the scope of practice of advanced care paramedics. This is regulated both provincially (by statute) and locally (by the medical director), and ordinarily entails an aspect of medical oversight by a specific body or group of physicians. This is often referred to as "[[medical control]]", or a role played by a base hospital. For example, in the provinces of [[Ontario]], Quebec and Newfoundland and Labrador, many paramedic services allow primary care paramedics to perform 12-lead [[electrocardiogram|ECG]] interpretation, or initiate [[intravenous therapy]] to deliver a few additional medications.

===Advanced care paramedic===
Advanced care paramedic (ACP) is a level of practitioner that is in high demand by many services across Canada. However, Quebec only utilizes this level of practice in a very limited fashion as part of a pilot program in Montreal. The ACP typically carries approximately 20 different medications, although the number and type of medications may vary substantially from region to region. ACPs perform advanced airway management including intubation, surgical airways, intravenous therapy, place external jugular IV lines, perform needle thoracotomy, perform and interpret 12-lead ECGs, perform synchronized and chemical cardioversion, transcutaneous pacing, perform obstetrical assessments, and provide pharmacological pain relief for various conditions. Several sites in Canada have adopted pre-hospital fibrinolytics and rapid sequence induction, and prehospital medical research has permitted a great number of variations in the scope of practice for ACPs. Current programs include providing ACPs with discretionary direct 24-hour access to PCI labs, bypassing the emergency department, and representing a fundamental change in both the way that patients with S-T segment elevation myocardial infarctions (STEMI) are treated, but also profoundly affecting survival rates, as well as bypassing closer hospitals to get an identified stroke patient to a stroke centre.

===Critical care paramedic===
[[File:Toronto Paramedic Services Critical Care Transport ambulance.jpg|thumb|A [[Toronto EMS|Toronto]] critical care ambulance]]
Critical care paramedics (CCPs) are paramedics who generally do not respond to 9-1-1 emergency calls, with the exception of helicopter "scene" calls. Instead they focus on transferring patients from the hospital they are currently in to other hospitals that can provide a higher level of care. CCPs often work in collaboration with registered nurses and respiratory therapists during hospital transfers. This ensures continuity of care. However, when acuity is manageable by a CCP or a registered nurse or respiratory therapist is not available, CCPs will work alone. Providing this care to the patient allows the sending hospital to avoid losing highly trained staff on hospital transfers.

CCPs are able to provide all of the care that PCPs and ACPs provide. That being said, CCPs significantly lack practical experience with advanced skills such as IV initiation, peripheral access to cardiovascular system for fluid and drug administration, advanced airway, and many other techniques. While a PCP and ACP may run 40–50 medical codes per year, a CCP may run 1–2 in an entire career. IV/IO starts are nearly non-existent in the field and for this reason CCPs are required to attend nearly double the amount of time in classroom situations or in hospital to keep current. In addition to this, they are trained for other skills such as medication infusion pumps, mechanical ventilation, and arterial line monitoring.

CCPs often work in fixed and rotary wing aircraft when the weather permits and staff are available, but systems such as the Toronto EMS Critical Care Transport Program work in land ambulances. ORNGE transport operates both land and aircraft in Ontario. In British Columbia, CCPs work primarily in aircraft with a dedicated critical care transport crew in Trail for long-distance transfers and a regular CCP street crew stationed in South Vancouver that often also performs [[medevac]]s when necessary.

===Training===
Paramedic training in Canada varies regionally; for example, the length of training may be eight months<ref>{{cite web|url=http://www.jibc.ca/programs-courses/schools-departments/school-health-community-social-justice/paramedic-academy/programs-and-courses/primary-care-paramedic|title=Primary Care Paramedic - Justice Institute of British Columbia|website=www.jibc.ca|access-date=2017-03-24|archive-date=2017-03-14|archive-url=https://web.archive.org/web/20170314141834/http://www.jibc.ca/programs-courses/schools-departments/school-health-community-social-justice/paramedic-academy/programs-and-courses/primary-care-paramedic|url-status=dead}}</ref> in British Columbia or two to four years in Ontario, Alberta, and Quebec. The nature of training and how it is regulated, like actual paramedic practice, varies from province to province.