Medical Direction

Medical direction is an essential aspect of paramedic care in Ontario. We find it in a number of written forms. We find our foundational medical ‘standing orders” in provincial Paramedic Standards of Care. We also find medical direction in the timely written guidance issued for specific issues.

Medical direction also comes in the form of orders from base hospital physicians. This “online medical direction” provides in the moment consultation, advice and orders for paramedics patching with approved base hospital emergency medical physicians.

The Medical Director

One of the great attributes of paramedic care is the paramedic’s use of skills that they are uniquely able to perform. This ability comes through training, practice, continuing education, safety and quality improvement programming and the authorization to perform certain medical acts.

Paramedic care is regulated under the Ambulance Act. It outlines what medically controlled acts may be performed by a paramedic if that person is authorized to perform the act.

Authorization to perform controlled medical acts may be granted to a paramedic by the the regional Medical Director. The Medical Director is bound by the standards of their college, the College of Physicians and Surgeons of Ontario, which include a policy for Delegation of Controlled Acts.

In order to delegate controlled medical acts to paramedics, the College of Physicians and Surgeons of Ontario requires physicians to

  • Write Medical Directives that the paramedics will use. 
  • Ensure that each delegated paramedic has the appropriate knowledge, skill and judgment to perform the delegated act.
  • Provide supervision, monitoring and evaluation of the delegated acts.
The accountability and responsibility for the act that has been delegated remain with the delegating physician.
from the CPSO policy Delegation of Controlled Acts.

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.

At the RPPEO, paramedic authorization to perform controlled medical acts begins with initial (Certification). Each paramedic’s specific authorizations are outlined in their Certification Letter, issued by the RPPEO and attached to the Paramedic file in (MedicNet). Certification is the mechanism for ensuring that each paramedic has the appropriate knowledge, skill and judgment to perform the delegated act.

The delegating Medical Director is responsible for the quality of the care provided by those they have authorized. The RPPEO monitors the quality of care for each paramedic and for all of the controlled medical acts on an annual cycle. This quality assurance cycle is an important part of a paramedic’s annual (re-Certification).


Written Medical Directives

The (Patient Care Standards) set the expectations for paramedic care across Ontario.  Standards guide many aspects of paramedic practice including assessment, transport, treatment and documentation. Medical directives within the standards refer to the assessment, treatment and patient management expected for patients presenting with certain, defined conditions or signs and symptoms.

Within Eastern Ontario, local hospital programs such as Trauma Bypass and STEMI Bypass specify system capabilities that may alter certain aspects of paramedic practice such as destination planning. Occasionally, special or temporary emergency measures may also impact care. In this case, the Ministry of Health may distribute training bulletins or the medical director may issue (Medical Advisories).

When questions about Patient Care Standards, medical directives or regional protocols come up outside of an active care situation, paramedics can use the (MedicAsk) tool for answers. MedicAsk is a forum where paramedics can expect well-considered medical direction for challenging situations.

Online Medical Direction

Many medical directives include the option or direction to patch to a physician for advice or direct orders. The RPPEO Base Hospital Physician program trains and authorizes physicians in emergency rooms across the region to act as patch physicians. We monitor the quality of all patches on an annual basis.

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