A call is received for an ambulance to attend at a residence in Peel Region. The information received by the dispatch center states that there is a 50-year-old male who is Vital Signs Absent (VSA). The closest ambulance is immediately sent to the scene. The crew consists of two Primary Care Paramedics (PCP’s). In addition to providing advanced first aid, oxygen therapy and CPR, they also have six Symptom Relief medications at their disposal and the use of a Semi-Automatic Defibrillator.
Once on the scene, these paramedics begin CPR and with a bag-valve mask, they begin to breathe for the patient. At the same time, a second ambulance is started to the house. This ambulance carries an Advanced Care Paramedic (ACP). The ACP has all the skills and tools that the PCP crew carries, as well as 20 additional drugs, and the ability to perform many other designated medical acts under directives given to them by a Base Hospital Physician.
Bystander CPR, coupled with the performance of early defibrillation by the PCP crew gives this man his best chance at survival. The arrival of the ACP ambulance further improves the likelihood of a successful outcome. The ACP is able to intubate the patient, which allows the patient to be ventilated more efficiently, as well as prevents the regurgitation of stomach contents into the lungs. An intravenous is also started. Through the IV many of the same medications are given to the patient as would be given by a physician at the emergency department. On the way to the hospital the patient regains his pulse and also begins to breathe on his own.
Thirty years ago, when ambulance in Ontario was just getting established, there would have been a much different scenario. Firstly, there were no paramedics, just Ambulance Drivers, a moniker that sends chills down the spines of all paramedics today. To become a paramedic you needed a First Aid Certificate and a chauffeurs driver’s license. Many of the ambulances were operated out of funeral homes and the vehicles used were initially hearse type station wagons, soon to be followed by small vans such as the Ford Econoline.
Today, in the new millennium, things are vastly different in both training and equipment. I graduated from Humber College in 1985. At that time, the Ambulance and Emergency Care course was one year long. Prior to the Community Colleges setting up the courses we now have, training was done on the job until the late 1960’s when the Ministry of Health developed the first “ambulance” school, which was a 160-hour course that was taught at the Canadian Forces Base Borden. Today the Paramedic course is two years long. Upon graduation the successful candidate must write a provincial exam and is then able to practice at the PCP level. Another six months of training is needed after this to become an ACP. Usually this is done after the PCP has several years of experience.
After graduation, I began working as a paramedic in Peel Region and my station was attached to Peel Memorial Hospital in Brampton. Our ambulances were stocked with advanced first aid supplies, immobilization equipment for neck or back injuries as well as oxygen. Oxygen was the only medication that we were authorized to carry.
In the mid 1990’s, the Peel Base hospital was created. Under the medical direction of Dr. Sheldon Cheskes we were now able to administer six Symptom Relief medications. We could now give a patient nitroglycerin and ASA if they were having a heart attack, epinephrine for an allergic reaction and ventolin for asthma attacks. The other two medications were Glucagon and glucose gel that were both administered to diabetics that were experiencing an insulin reaction (or low blood sugar). In addition to these medications, we were also provided with Semi-Automated Defibrillation. Defibrillation is the process of electrically shocking the heart. Many people that suffer heart attacks can develop a fatal heart arrhythmia called Ventricular Fibrillation (VF). The most effective treatment for VF is early defibrillation. The defibrillators also allowed the paramedic to monitor the patient’s heart rhythm or ECG.
In the late 1990’s the City of Mississauga was chosen as a pilot project for advanced care paramedicine. Prior to this, the use of ACP’s had only been introduced in a few select communities, such as Toronto, Hamilton, Durham Region and Kingston. The scope of practice of an ACP included manual defibrillation, intravenous therapy, advanced airway maneuvers (such as intubation) and the ability to administer about 20 medications. On the scene of a cardiac arrest the ACP can perform most of the same procedures and give many of the same Advanced Cardiac Life Support (ACLS) drugs.
For more information on where to receive training to become a PCP, ACP or universities that offer degrees in paramedicine : www.ontarioparamedic.ca