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===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 40β50 medical codes per year, a CCP may run 1β2 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.
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