# What Is It Like To Work In Canadian EMS?



## Boopadoo (Mar 12, 2017)

Hello everyone, I'm a 2 year University Graduate Paramedic in the UK.

For the past few months, I've become increasingly set on relocating to Canada. I see on the government website that currently, a Paramedic is classed as a skilled profession in Canada, and the immigration process doesn't look horrendous.

I just have some questions about what it's like to work there. I would ideally like to be based close to the Canadian / USA border, so that I can be nosey on my days off and travel around a bit. Toronto looks close to New York state, but of course I haven't absolutely decided on where I would like to go. I would love to work somewhere warm, but Canada seems like it's basically cold no matter where you go!

1) *What autonomy do you have?* We can intubate and use supraglottic airways (and laryngoscopy with forceps for airway obstruction / choking), use Oral/EJV/IV/IM/IO/Sub-Cut drug routes, needle chest decompression, needle cricothyroidotomy (or however you spell it), interpret 12 Lead ECGs, manual defibrillation, confirm life extinct etc. We pretty much do whatever we want within our scope of practice, and never have to gain permission to do anything as we are registered Health Care Professionals, including administering 40+ drugs etc. The only things we can't do are pacing, cardioversion, or sedation. What autonomy and skills do Paramedics in Canada have?

2) *What is the quality of patients like?* In short, we go out to some absolute garbage here in the UK. Coughs, colds, D+V, chronic pains, minor cuts, low speed non-injury RTCs where someone is 'shaken up', generally unwell adults and children. Not what you would call a '999 emergency' ambulance for, yet people do. What is the situation with things like this in Canada?

3) *Telephone triage. Are you sent out to everybody who calls 911*, or do you have clinicians in the control room that can refuse an ambulance response? Over here, because we have such a massive national shortage of registered Paramedics, the ambulance and health services do everything they can to stop people calling 999 for low-acuity problems, and we have Paramedics in control that can triage over the telephone to stop a response going to that patient. Some people actually call 999 every day, and we are sent to them every day. Not joking.

4) *Do you convey everybody who calls 911?* Here because we are so stretched, we are actively encouraged to leave as many people at home as possible. We refer them to their GP, or out of hours urgent care services, community nurses, basically anything we can to stop them going in. And if they do need to go, we try as much as possible to tell them to go in their own car, or a taxi, or to get a lift from a friend. What is the situation with this in Canada? Do you have the autonomy to leave people at home, or refer them elsewhere?

5) *Education?* I have what you guys would call an 'Associates Degree' in Paramedic Practice. I am thinking of upgrading to a BSc in Emergency Pre Hospital Care as a 1 year top up. Would this help me in Canada? Is it worth it?

6) *Shift patterns?* This one is self explanatory. Here we do 12 hour shifts. 2 days, 2 nights, 4 off.

7) *Utilisation?* We are very busy here. From the moment you sign on to sign off, you are out on jobs. How is it in Canada?

8) *Career progression?* I read that you have to be a PCP for 3 years before going up to ACP. In England, we are basically ACPs. But in Canada, from what I can ascertain from the internet, our registration is only good for PCP. Would I really have to work as a PCP for 3 years before becoming an ACP? It would be like going backwards and down-skilling!

9) *Salary?* So in England, you start on £21,000 after graduating. You also get a 25% 'unsocial hours' allowance for work between 7pm to 7am, and weekends. So let's call this £26,000 a year total. As recently as a few months ago, a new national agreement was reached to raise our basic from £21,000 to £26,000 after being a registered Paramedic for 2 years. So with the unsocial allowance, let's call it maybe £31,000 after 2 years experience. What is the salary in Canada for PCP and ACP, do you have annual increments etc? How does it compare to cost of living?

10) *Finish times?* We finish late quite often in England. Nothing major, maybe 30 minutes to an hour. Does this happen in Canada? Are there any systems in place to prevent this?

Thanks everybody


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## EpiEMS (Mar 13, 2017)

Boopadoo said:


> We pretty much do whatever we want within our scope of practice, and never have to gain permission to do anything as we are registered Health Care Professionals, including administering 40+ drugs etc.



So, both the US and Canada don't compare favorably to the UK or AUS or NZ as far as authority to practice goes. I can speak with reasonable authority for the U.S., though only on the basis of research for Canada.

Here's Toronto for an example, and the Canadian scope of practice model more generally.



Boopadoo said:


> Toronto looks close to New York state, but of course I haven't absolutely decided on where I would like to go.



I am under the impression that it is fairly hard to get a paramedic job in Toronto.

That being said, residents of NYS that are near Toronto actually tend to go to Toronto for cultural amenities, while the reverse case happens for shopping (less taxes in 'Murica).


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## DesertMedic66 (Mar 13, 2017)

Maple syrup and hockey everywhere


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## cprted (Mar 13, 2017)

Boopadoo said:


> I would ideally like to be based close to the Canadian / USA border


 90% of our population lives within 100km of the southern border, so that'll pretty much be wherever you want ... lol



> I would love to work somewhere warm, but Canada seems like it's basically cold no matter where you go!


The west coast is very mild (though we did break a 50 year snow fall record this year  ... lol), the north, well, you get used to it ... or you go crazy ... 

It's hard to generalize about all of Canada as there can be some variation between systems. Each Canadian province regulates their own prehospital health care, and while we have much more in common than different, there are 'regional flavours' if you will. But I'll answer based on my experience where I am.


> 1) *What autonomy do you have?* We can intubate and use supraglottic airways (and laryngoscopy with forceps for airway obstruction / choking), use Oral/EJV/IV/IM/IO/Sub-Cut drug routes, needle chest decompression, needle cricothyroidotomy (or however you spell it), interpret 12 Lead ECGs, manual defibrillation, confirm life extinct etc. We pretty much do whatever we want within our scope of practice, and never have to gain permission to do anything as we are registered Health Care Professionals, including administering 40+ drugs etc. The only things we can't do are pacing, cardioversion, or sedation. What autonomy and skills do Paramedics in Canada have?


We have quite a bit of autonomy. In my system we can do all of the above (including pacing, cardioversion, etc) based on our clinical judgement. We do have online medical control that we can call 24/7, however the system is set up more for consults/discussion as opposed to a "mother may I" system as we pejoratively refer to it. Navigating complex patient consent issues, odd pt presentations, maybe a treatment plan that falls a little outside normal convention, all things where we'd make a call to get the Doc's input. 



> 2) *What is the quality of patients like?* In short, we go out to some absolute garbage here in the UK. Coughs, colds, D+V, chronic pains, minor cuts, low speed non-injury RTCs where someone is 'shaken up', generally unwell adults and children. Not what you would call a '999 emergency' ambulance for, yet people do. What is the situation with things like this in Canada?


 100% the same. 

Painting in some very broad brush strokes, when you get away from the major cities and into the rural areas there tends to be less nonsense calls ... don't know if people out there are a little tougher [inset joke about Canadian lumberjacks here], have better coping skills, but the ratio of low acuity to high acuity calls seems lean more on higher acuity calls. 



> 3) *Telephone triage. Are you sent out to everybody who calls 911*, or do you have clinicians in the control room that can refuse an ambulance response? Over here, because we have such a massive national shortage of registered Paramedics, the ambulance and health services do everything they can to stop people calling 999 for low-acuity problems, and we have Paramedics in control that can triage over the telephone to stop a response going to that patient. Some people actually call 999 every day, and we are sent to them every day. Not joking.


 We deal with frequent fliers all the time. Every area has them, we all know them by name, some of us even have their health numbers memorized. 
 We are slowly, very slowly, coming around to programs to start referring patients to other services that are more appropriate. They are in their infancy at the moment. 



> 4) *Do you convey everybody who calls 911?* Here because we are so stretched, we are actively encouraged to leave as many people at home as possible. We refer them to their GP, or out of hours urgent care services, community nurses, basically anything we can to stop them going in. And if they do need to go, we try as much as possible to tell them to go in their own car, or a taxi, or to get a lift from a friend. What is the situation with this in Canada? Do you have the autonomy to leave people at home, or refer them elsewhere?


 Generally, the expectation is 'you called, we haul ... to the emergency department' and our employers expect us to transport patients to the emergency. There are means to arrange alternatives in some case (buses that take drunks to the detox centre, etc), but that isn't the case on most calls. At least in my system we're starting to develop alternate destination guidelines, where we can take intoxicated patients direct to the sobering centre, or mental health patients direct to a 24 hour mental health centre, but these programs are still small and have very specific criteria as to which patients are eligible to be transported to somewhere other than a hospital emergency department.



> 5) *Education?* I have what you guys would call an 'Associates Degree' in Paramedic Practice. I am thinking of upgrading to a BSc in Emergency Pre Hospital Care as a 1 year top up. Would this help me in Canada? Is it worth it?


 At the moment, having a BSc would look great, but in the sense that it does for anyone holding a bachelor level degree. Over the next 10 years we are moving paramedic training in Canada to a degree based system, but the planning is in its infancy and we really don't know what that will look like or what it will mean yet.



> 6) *Shift patterns?* This one is self explanatory. Here we do 12 hour shifts. 2 days, 2 nights, 4 off.


 This is going to vary from place to place. In my system, most people work 2 days, 2 nights, 4 off, with 12 hours shifts.



> 7) *Utilisation?* We are very busy here. From the moment you sign on to sign off, you are out on jobs. How is it in Canada?


 In my area, basically the same. All the major cities are very busy places to work. Rural areas will get you a more of a leisurely pace. 



> 8) *Career progression?* I read that you have to be a PCP for 3 years before going up to ACP. In England, we are basically ACPs. But in Canada, from what I can ascertain from the internet, our registration is only good for PCP. Would I really have to work as a PCP for 3 years before becoming an ACP? It would be like going backwards and down-skilling!


 Generally people work as a PCP for a few years before they go into ACP, but that isn't really a rule anywhere that I know of. I'm not sure about getting a Canadian license, I know 3 English paramedics (all of whom are presently licensed as ACP), 2 were able to get ACP licenses directly without any additional training, though they both came from a HEMS service in the UK, so that might have something to do with it. The other transferred as a PCP and did the ACP training here.



> 9) *Salary?* So in England, you start on £21,000 after graduating. You also get a 25% 'unsocial hours' allowance for work between 7pm to 7am, and weekends. So let's call this £26,000 a year total. As recently as a few months ago, a new national agreement was reached to raise our basic from £21,000 to £26,000 after being a registered Paramedic for 2 years. So with the unsocial allowance, let's call it maybe £31,000 after 2 years experience. What is the salary in Canada for PCP and ACP, do you have annual increments etc? How does it compare to cost of living?


Hugely variable from place to place. 



> 10) *Finish times?* We finish late quite often in England. Nothing major, maybe 30 minutes to an hour. Does this happen in Canada? Are there any systems in place to prevent this?


 In system, late calls are just a fact of life.


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## Boopadoo (Mar 14, 2017)

cprted said:


> Generally people work as a PCP for a few years before they go into ACP, but that isn't really a rule anywhere that I know of. I'm not sure about getting a Canadian license, I know 3 English paramedics (all of whom are presently licensed as ACP), 2 were able to get ACP licenses directly without any additional training, though they both came from a HEMS service in the UK, so that might have something to do with it. The other transferred as a PCP and did the ACP training here.



I see that you work in BC. Vancouver also looks quite appealing to me! I guess I will have to enter as a PCP unfortunately in this case. From the internet it appears that to upskill to ACP costs around $15,000? That's insane!

Thank you for your answers to all those questions.

Is there any areas of Canada that recognise UK Paramedics to ACP directly? I know this is something you may not know, but I thought it would be worth asking.


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## cprted (Mar 15, 2017)

Boopadoo said:


> I see that you work in BC. Vancouver also looks quite appealing to me! I guess I will have to enter as a PCP unfortunately in this case. From the internet it appears that to upskill to ACP costs around $15,000? That's insane!
> 
> Thank you for your answers to all those questions.
> 
> Is there any areas of Canada that recognise UK Paramedics to ACP directly? I know this is something you may not know, but I thought it would be worth asking.


As far as BC goes, the people to ask is the Emergency Health Assistants Licensing Board. 

http://www2.gov.bc.ca/gov/content/h...ts-licensing-board/out-of-province-applicants

They handle all matters relating to paramedic licensing here.  Best to contact them and find out from them what your training in the UK would translate to in BC. 

ACP in BC is also a somewhat different beast than elsewhere. Without getting into too much agency specific stuff, at present, there is no opportunity to hire on with BCAS as an ACP practitioner. That could change tomorrow, but today, you need time in with the organization to move into an ACP role.


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## Boopadoo (Mar 15, 2017)

Thank you, I have read on their website that I have to match my skills profile to Schedule I and Schedule II competencies, then apply for whatever registration I think best fits.

I meet basically all of the Schedule I competencies for ACP, but almost none of the Schedule II ones.

Are Schedule II competencies things which you *can* be trained to do, but don't *have* to do to obtain that license?

Sorry to be such a pain, I won't ask many more questions!


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## cprted (Mar 19, 2017)

The board will review it on a case by case basis.  Honestly the only Sched 2 stuff we actually do on the street is 12 Leads. Urinary Caths, Chest Tubes, etc, isn't part of the ACP practice on our street units.


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