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.
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:
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 practising 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.