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Paramedicine in Ontario: Consideration of the Application for the Regulation of Paramedics Under the Regulated Health Professions Act, 1991

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Paramedicine in Ontario: Consideration of the Application for the Regulation of Paramedics Under the Regulated Health Professions Act, 1991 Paramedicine in Ontario: Consideration of the Application for the Regulation of Paramedics under the Regulated Health Professions Act, 1991 Volume 1 66…. 56 Wellesley St W., 56, rue Wellesley Ouest, 12th Floor 12e étage Toronto ON M5S 2S3 Toronto ON M5S 2S3 Tel (416) 326-1550 Tél (416) 326-1550 Fax (416) 326-1549 Téléc (416) 326-1549 Web site www.hprac.org Site web www.hprac.org E-mail Courriel [email protected] [email protected] December 20, 2013 The Honourable Deb Matthews Minister of Health and Long-Term Care 10th Floor Hepburn Block 80 Grosvenor Street Toronto, ON M7A 2C4 Dear Minister, We are pleased to present our report on whether paramedics should be regulated under the Regulated Health Professions Act, 1991 (RHPA). As part of our standard process, we completed literature, jurisdiction and jurisprudence reviews. We also conducted a consultation program, during which we heard from a range of stakeholders, including members of the profession; other regulated health professions’ colleges and associations; other associations, such as those representing paramedics; unions representing some rank-and file-paramedics; and key stakeholders, such as representatives from MOHLTC and its partners in the delivery of ambulance services, the base hospital system and the municipalities that deliver EMS to their communities. Although we recognize that paramedics are skilled health professionals who have earned the respect of their peers, HPRAC recommends that paramedics not be regulated under the RHPA because the application did not meet our primary criterion threshold for risk of harm and because self-regulation of paramedics is not in the public interest. Although paramedic practice entails a degree of risk of harm to the health and safety of the public, and the current oversight system is overly complex, the oversight system as a whole is sound and adequately addresses risk of harm to patients. We look forward to meeting with you to discuss the findings in this report and our recommendations. Sincerely, Thomas Corcoran, Chair Rex Roman, Vice Chair Bob Carman, Member Said Tsouli, Member Peggy Taillon, Member Jeanette Dias D’Souza, Member Paramedicine in Ontario: Consideration of the Application for the Regulation of Paramedics under the Regulated Health Professions Act, 1991 Report by the Health Professions Regulatory Advisory Council December 2013 Table of Contents Executive Summary ............................................................................................................ 1 Chapter I: Recommendation .............................................................................................. 3 Why This Decision? ..................................................................................................................................... 3 Chapter II: Background ...................................................................................................... 4 Referral Question......................................................................................................................................... 4 Delivering Paramedic Care ......................................................................................................................... 4 Evolution of the Profession ........................................................................................................................ 6 Scene Management ..................................................................................................................................... 7 The Auditor General of Ontario .................................................................................................................. 9 HPRAC’s Criteria ....................................................................................................................................... 10 Chapter III: What We Heard .............................................................................................. 12 Consultation Program ............................................................................................................................... 12 Chapter IV: What We Learned .......................................................................................... 20 Jurisprudence Review ............................................................................................................................... 20 Jurisdictional Review ................................................................................................................................ 21 Literature Review ....................................................................................................................................... 23 Current Protective Measures .................................................................................................................... 25 Initiation of Controlled Acts ...................................................................................................................... 42 Non-Ambulance Care ................................................................................................................................ 44 Interprofessional Care ............................................................................................................................... 52 Chapter V: Rationale and Conclusion ............................................................................. 56 Appendix A: About HPRAC .............................................................................................. 60 Appendix B: Paramedic and EMA Consultation Program ............................................. 61 HPRAC’s Consultation Approach ............................................................................................................ 61 Consultation Questionnaire ...................................................................................................................... 69 HPRAC’s Criteria and Decision-Making Process .................................................................................... 72 Appendix C: OPA Application ......................................................................................... 81 Appendix D: Glossary .................................................................................................... 171 Executive Summary In a referral letter dated June 28, 2007, the Minister of Health and Long-Term Care asked the Health Professions Regulatory Advisory Council (HPRAC) to advise whether paramedics and emergency medical attendants (EMAs) should be regulated in Ontario under the Regulated Health Professions Act, 1991 (RHPA), and, “if so, what would be the appropriate scope of practice, controlled acts, and titles authorized to the profession.” Paramedics deliver emergency health care to individuals in environments that may be chaotic, dangerous and socially complex. The general public accesses paramedic services by calling 911. The ambulance system, which includes paramedics and EMAs, is currently governed by the Ministry of Health and Long-Term Care (MOHLTC) through the Ambulance Act and its regulations, as well as standards and policies. MOHLTC has also developed a system of regional base hospitals to work with the municipal providers of ambulance services in the delivery of pre-hospital emergency medical services. Paramedics are authorized by base hospital physicians to perform controlled acts; as well, a series of other protective measures safeguard public safety. The system has a high rate of paramedic–patient interaction: in a 12- month period, over 1.9 million requests were made for an ambulance and more than 900,000 transports were completed. With the quite recent introduction of community paramedicine programs, the profession is evolving, and outward pressure on paramedics’ scope of practice has been identified as a potential catalyst for change within the profession. HPRAC invited the Ontario Paramedic Association (OPA), the profession’s provincial association, to submit an application for the regulation of paramedics under the RHPA. In March 2013, OPA submitted that application. This report outlines the results of HPRAC’s review of OPA’s application, as well as HPRAC’s assessment of other research available at this time. As part of its assessment, HPRAC conducted an extensive public consultation program between April and July 2013, asking a number of organizations and individuals to comment on the issue. By the close of the consultation period, 444 stakeholders provided submissions. Key informant interviews were also conducted, in order to identify stakeholders’ interests and concerns. In addition, a literature review, jurisdictional review and jurisprudence review were completed and made publicly available during the consultation period. HPRAC conducted further research where warranted, including an assessment of the current oversight system. HPRAC’s criteria are the means by which it decides whether to recommend a health profession for regulation. Applicants from professions seeking regulation under the RHPA must meet a “risk of harm threshold” and demonstrate with evidence that there is a risk to the public and that it is otherwise in the public interest that the particular profession be regulated under the Act. Once an application meets the risk of harm threshold, HPRAC determines whether regulation under the RHPA is the most appropriate course of action or whether another risk mitigation approach would result in a better outcome. HPRAC’s criteria do not include an assessment of the merits
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