EMS education in Ontario: The history
Published: Tue November 10, 2009
This country we know as Canada is a place that is known to be quite diverse in so many different ways. Ethnically, religiously, culturally it is known worldwide as a place that people can come to and potentially have a chance to thrive with just a little hard work. The general consensus at this time seems to be that it's a harder life in this decade than it was, say 30 to 40 years ago.
I tend to agree with that notion, to a point. When it comes to day-to-dayliving, things are certainly different. It costs more to own a home, a car, or anything really. The expenses needed to keep those material things are higher, as are medical expenses, property taxes, and anything and everything to do with keeping our children clothed, fed, healthy and happy. Of course in certain parts of the world they don't have the options we do here. No choices of where to shop, what school to send our children to, or whether to buy a hybrid car in order to save money because the price of gas continually goes "through the roof." We are fortunate to be Canadians.
What about EMS? Has it changed? Has it evolved? Sure it has, and in a relatively short period of time. Does it take hard work to become involved with, and stay within the world of EMS these days? I'd sure say so. But did it always? What is great about these questions and others like them is that everyone is going to have a slightly different answer, depending on where you live within this country. Every single province and territory could have a book written about the beginning and subsequent growth of its EMS system. Of course some books would be longer than others as a few provinces are still just getting their feet wet when it comes to an organized system within them. However, there are a few who -- 30 to 35 years ago -- realized the importance of having the people who work in EMS receive a formal education of some kind in order to do the job. Ontario is one of those provinces. Let's have a quick look back and see what has happened over the past three or four decades in that province.
The beginning
What was the beginning? The beginnings of EMS itself are somewhat open for interpretation, but that isn't what we're discussing here. The first instance when a paramedic, or ambulance driver as we were known back then, required any formal education dates back to before 1975. The first thing that was ever required was what was known as a chauffeurs' licence. This was basically the class F of yesteryear and allowed someone to drive a vehicle the size of a hearse, which was the vehicle of choice for patient transport back then.
As more and more privately owned patient transport companies came to be, some owners decided that in order to get a leg up on their competition they needed to do something. So they decided to have all of their employees trained in first aid and CPR. The companies that were the first ones to initiate this new level of training quickly gained a leg up in the industry and became the transport company of choice for their local communities. But as with most new things or trends, this training became the norm throughout all services so something else had to be done.
When the competition between rival companies began to heat up, educators soon realized that they had an opening and developed what was considered to be an "enhanced" first aid course.
More than one was available, but the most notable one was offered at Camp Borden. The option was for the employers to send their current and new hires to the Camp at the employer's expense to receive this training.
College or bust
In 1975, the government decided it was time to mandate formal education for ambulance attendants within the province and the first Ambulance and Emergency Care programs at the community college level were born. Unfortunately, I've been around long enough to say that I went through a one-year program at Conestoga College in Kitchener. It was a challenging ten months, with a strong curriculum that pushed myself and my classmates both academically and practically.
The practical portion was the best part of these programs as they allowed us to see the real world outside of the classrooms. We were allowed to ride out with the local ambulance services and learn from those already on the job. As well, we were allowed to go into different departments in the hospitals such as obstetrical, surgery, emergency, palliative care and the burn unit to see what happens to people after they leave us and begin their road to recovery.
EMCA
Shortly after the launch of the college programs was the development of a provincial testing format for ambulance attendants to become formally licensed with the province and earn the title of emergency medical care assistant. This was a written test that took six hours and was divided into two three-hour segments. In the beginning,there was also scenario testing being done. However, during the mid-1980s it was decided to suspend the scenario testing and to this point in time scenario testing has not been reinstated in the province of Ontario.
Along the way
The entry level education process has remained virtually the same for over 20 years - one year at college followed by the provincial exam. Along the way, some new diagnostic tools and protocols were added to help enhance the working paramedic's skill set.
The first thing to really change things was the advent of the defibrillator. The ability to, under certain conditions, electrically shock a person's heart and bring them back to life was considered a major medical breakthrough.
Then, in the early 1990s, to take this new knowledge and equipment, intertwine it with CPR, and allow it to be put into ambulances to be used on the side of the road was considered somewhat radical for its time. But thanks to some forward thinking people, most communities now have a public access defibrillator program which gives the general public access to an automatic defibrillator to use in an emergency prior to the arrival of emergency services.
The other thing that really changed the scope of practice for basic life support personnel was the grouping of six different medications and their administrative protocols into one bundle and calling them our symptom relief medications.
These medications included nitroglycerin spray, ASA tablets, epinephrine nebules, glucagon mix, salbutamol nebules and oral glucose tablets or gel.
Depending on where you work, many other medications may have been added to your box, but these were the original six.
One year becomes two
Only a couple of years after I graduated from my one-year college program in 1995, and due to the ever increasing scope of practise for what are now known as Primary Care Paramedics, the one-year program was expanded to two years. Basically, less became more. By that I mean, more of everything was now needed in order to become eligible to work in the EMS field. More time, more knowledge, more experience, more dedication, and perhaps above all else, more money all became required. However, it seems to have been a good move to make.
Only the most dedicated, prepared, and organized students make it through both years, therefore creating the ripple effect of having a smaller number of students slipping through the cracks of the system. In years past, this just wasn't the case.
Today...and tomorrow
In today's modern world where a post-secondary education has become paramount, EMS in the province of Ontario has rolled with the flow of the times. It has gone from needing only a proper driver's licence, to needing a full two years of college education. Potentially there is more to come in this province. With self-regulation on the horizon, which some provinces already have, an increase in continuing education requirements is likely to in store, as well as the necessity to work a minimum number of hours each calendar year in order to keep your licence. A lot has changed over the past 35 years. What will the next 35 hold? There's only one way to find out. Tempest fugit.
Writer's Note: Please remember that this article is intended as a general overview of the educational requirements that have been required by paramedics in the province of Ontario. The timelines given have come from my interviews with senior people that I know within the industry. I will take full responsibility for any inaccuracies found by the readers.
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