Paramedic Practice

Information and guidance to help paramedics apply paramedic standards of care.

• Quality & Patient Safety

  Quality of care and patient safety are at the very core of the RPPEO. We work toward a culture of safety where every patient gets the care we would want for our loved ones.

• Research

  Whether you would like to learn more about RPPEO paramedic involvement in current and past studies, are looking for information on how to conduct prehospital research or are interested in obtaining a specific research article, you’ll find all this information and more under the Research section of the website.

• Medical Direction

  Under the authority of their licence to practice medicine, the regional Medical Director authorizes specific paramedics to perform controlled medical acts. Authorization happens within a system of delegation and quality assurance.

• MedicASK

  All questions will be reviewed and answered by staff within the RPPEO. Please browse through our questions and answers, as well as the latest ALS or BLS Patient Care Standards or Companion Document for the Advanced Life Support Patient Care Standards.

Policies & Practices

Standards of Paramedic Practice

Policies and Practices

• Policy for RPPEO Paramedics

  Policies explain organizational expectations for how paramedics should do things. Paramedics work at the junction of many policies in Ontario.

  Base hospital policies are intended to provide standardized guidance for both paramedics and RPPEO staff – and sometimes paramedics services – on common issues important to the safe and effective provision of ambulance services as defined in legislation. Base hospital policies should not compete with higher level policies. For this reason, we tend to only introduce a base hospital policy when other policy is silent on an issue or when a policy will provide clarity.

  As a base hospital contracted by the Ministry of Health under the Ambulance Act, the RPPEO creates policies to guide what paramedics can expect from us and the way that paramedics certified at the RPPEO should go about certain activities related to patient care, delegated controlled medical acts, continuing education, and certification.

• Policy Hierarchy

  At the highest levels of the policy hierarchy are the laws and regulations governing paramedic care. These are legislated or legal high-level requirements for paramedicine that paramedic services, base hospitals, medical directors and paramedics must follow.

  Federal laws govern some aspects of paramedicine. An important example of a federal law that constrains what paramedics do is the Controlled Drugs and Substances Act. This law allows the federal Minister of Health to issue exemptions to parts of this Act so that health care practitioners may provide certain specified drugs as required. The Subsection 56(1) Class Exemption for Primary Care Paramedics, Advanced Care Paramedics and Critical Care Paramedics in Ontario thus enables emergency paramedics under the RPPEO’s jurisdiction to carry and administer some drugs according to scopes of practice set out in provincial legislation and policy.

  In Canada, health care is the primary responsibility of each of the provinces. This means that most of the legislated policy for paramedicine comes from the Government of Ontario. Some of the most fundamental legislation for us is the Ambulance Act, R.S.O. 1990, c. A.19 and its Regulations.

  The Act and its Regulations set the context for paramedicine in Ontario, linking the title “Paramedic” to ambulance services. The base hospital and the regional Medical Director, along with paramedics and paramedic services, are responsible for the services provided “in connection with the transportation of persons by land” under the Act.

  There are also many other provincial laws that impact paramedic care such as:

  • Child, Youth and Family Services Act
  • Coroners Act
  • Good Samaritan Act
  • Health Care Consent Act
  • Highway Traffic Act
  • Mental Health Act
  • Occupational Health and Safety Act

  In addition to laws, the Ministry of Health provides regulations and standards for health care. Many of these contribute to and direct the standards of care for paramedics practicing within Ontario. These standards of care may be found on the Ministry of Health’s Emergency Health Services website.

  Each level of policy must respect the direction and intent of the superior level of policy. At the RPPEO, our policies must conform to the expectations set out by the Ottawa Hospital, the Ministry of Health, the Government of Ontario and any higher-level legislation. When we provide additional clinical guidance in MedicASK or with continuing medical education (CME), these must also align with base hospital and other policy in the hierarchy.

Quality Review

The RPPEO’s Quality Review processes monitor the quality and safety of controlled medical acts delegated to paramedics. Our mandate is to  track controlled acts to ensure patients receive care consistent with the provincial Advanced Life Support Patient Care Standards.

Our quality processes also identify opportunities to provide treatment when a controlled medical act was indicated by the Standards and not offered or administered in the provision of patient care.

When a paramedic performs controlled medical acts, their Medical Director needs to see that they did so according to the accepted medical direction in the standards. Physicians are compelled by the Ontario College of Physicians and Surgeons to have quality assurance processes in place in order to be able to delegate controlled medical acts.

The Ministry of Health sets minimum requirements for what base hospitals must review in quality assurance programs through a performance agreement.

For precise information about how we approach quality assurance and all other quality and patient safety programming, see the RPPEO’s Quality and Patient Safety (QPS) policies.

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  Auditing

  We look at thousands of Ambulance Call Reports (ACR) every year. Most of the ACRs are as they should be. Regular quality assurance audits or special audits are the result of monitoring specified in our Performance Agreement with the Ministry of Health, complaints related to clinical care, requests for review from the Ministry of Health, patient safety incident reports from paramedics or requests for reviews of care from our stakeholder ambulance services. Paramedics may hear from us about what’s in one of their Ambulance Call Reports if we need to ask a question about the care or when we have some clinical feedback for them.

  Peer Review

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  Improvement Science

  Uncovering best practices and discovering the science to make decisions supports patient safety and quality of paramedic care. We investigate questions systematically to better understand safe and quality care as well as the contextual factors of paramedic practice.

  More and more of the interventions paramedics use are based on recent scientific evidence. The RPPEO contributes to this scientific knowledge and we regularly use the evidence to inform our work.

  Research Posters

Quality & Safety Improvement

Closely related to our research efforts, our quality improvement initiatives rely on strong data and systematic analysis. Whether opportunities for improvement come from quality assurance processes or from patient safety incident data, it’s important to us to work with all our partners to find better, safer methods and means to clinical care.

Some of our recent quality improvement projects include:

Feedback to paramedics on patient outcomes – working with partners at the Ottawa Hospital’s trauma program, we provide information to the treating paramedics about the hospital disposition of the patients transported to the Ottawa Hospital trauma centre. This allows paramedics to reflect on their care given findings at the hospital.

In 2019, we started a similar feedback program with the Children’s Hospital of Eastern Ontario. Paramedics receive information about the in-hospital outcomes of their CTAS 1 and 2 pediatric patients.

Patient Safety Incident Report – the current tool that paramedics use to flag clinical hazards and patient safety incidents is the result of a quality improvement project. Paramedics told us that they were concerned that the previous “self-report” form for reporting safety incidents seemed focused on the paramedic rather than on clinical quality and safety. We re-developed the reporting process to bring it in line with the RPPEO’s (Conceptual Framework for patient safety) and our (Fair and Just Process) for reviewing incidents.