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Ontario Paramedic Association Application for Regulation of Paramedics Under the Rhpa, 1991

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Ontario Paramedic Association Application for Regulation of Paramedics Under the Rhpa, 1991 ONTARIO PARAMEDIC ASSOCIATION APPLICATION FOR REGULATION OF PARAMEDICS UNDER THE RHPA, 1991 Table of Contents Introduction ..................................................................................................................... 1 Risk of Harm ................................................................................................................... 3 General Description of Services Provided by Paramedics ........................................... 3 Diagnostic Modalities ................................................................................................... 5 Paramedics’ Areas of Practice ..................................................................................... 6 Acts that entail a Risk of Harm to Patients ................................................................... 9 Risk to Public Safety from Lack of Regulation of “Unlicensed” Paramedics............... 12 The Rate and Nature of Complaints of Harm ............................................................. 13 Anticipated Effect of Regulation under the RHPA on the Current Risk of Harm......... 14 Mechanisms in Place to Ensure the Delivery of Safe Care by Paramedics ............... 14 Supervision ................................................................................................................ 15 Contribution of Advances in Technology and Treatment to Risk of Harm .................. 16 Liability/insurance Protection ..................................................................................... 17 Processes Undertaken to Determine Public Need for Regulation .............................. 17 Professional Titles ...................................................................................................... 17 Circumstances requiring Referral to another Health Profession ................................ 18 Professional Autonomy ................................................................................................. 18 Autonomous Practice ................................................................................................. 18 Accountability ............................................................................................................. 19 Performance of Controlled Acts under Delegation ..................................................... 19 Educational Requirements for Entry to Practice ............................................................ 22 Programs Available in Ontario ................................................................................... 22 Accreditation of Programs .......................................................................................... 25 Requirements for Academic Credentials .................................................................... 26 Varying Levels of Registration ................................................................................... 28 Body of Knowledge and Scope of Practice ................................................................... 28 Overlaps with other Regulated Professions ............................................................... 30 Evidence-based Practice ........................................................................................... 30 Standards of Practice set by the OPA or other Organizations ................................... 33 Continuous Professional Development ...................................................................... 33 Proposed Scope of Practice ....................................................................................... 33 i ONTARIO PARAMEDIC ASSOCIATION APPLICATION FOR REGULATION OF PARAMEDICS UNDER THE RHPA, 1991 Economic Impact of Regulation ..................................................................................... 34 Ontario College of Paramedics Business Plan ........................................................... 34 Economic and Financial Implications ......................................................................... 34 Costs to Employers .................................................................................................... 36 Costs to Professionals’ Time ...................................................................................... 36 Regulatory Mechanisms ................................................................................................ 36 Paramedic Regulation under its own College ............................................................ 36 Alternative Forms of Regulation ................................................................................. 37 Legislation in Other Jurisdictions ............................................................................... 38 Leadership’s Ability to Favour the Public Interest and Membership Support and Willingness of the Profession to be regulated ............................................................... 38 Complaints and Disciplinary Procedures.................................................................... 39 Survey of Ontario Paramedics Support for Self-Regulation ....................................... 39 Support from Related Organizations .......................................................................... 40 Number of Paramedics in Ontario .............................................................................. 40 Alignment with an Existing Regulatory College .......................................................... 40 Proposed Fee Structure ............................................................................................. 41 Health System Impact ................................................................................................... 41 Interprofessional Collaboration .................................................................................. 41 Labour Mobility ........................................................................................................... 43 Access to Care ........................................................................................................... 44 Health Human Resource Productivity ........................................................................ 44 Health Outcomes ....................................................................................................... 45 Appendices ................................................................................................................... 46 Appendix A. Glossary of Terms ............................................................................... 46 Appendix B. References .......................................................................................... 47 Appendix C. College of Paramedics of Ontario Business Plan ................................ 58 Appendix D. Legislation in Other Jurisdictions ........................................................ 62 Appendix E. Ontario Paramedic Association Code of Ethics ................................... 64 Appendix F. Ontario Paramedic Association 2013 Survey of Support for Paramedic Self-Regulation .......................................................................................................... 65 Appendix G. Letters of Support ............................................................................... 74 ii ONTARIO PARAMEDIC ASSOCIATION APPLICATION FOR REGULATION OF PARAMEDICS UNDER THE RHPA, 1991 Introduction …the responsible and experienced members of a profession or occupation on whom the power of self-government is conferred should be in the best position to set the standards to be met and the qualifications of anyone who aspires to enter the profession or occupation (Casey, 2005, p. 16-1). Self-regulation of paramedics in Ontario under the Regulated Health Professions Act, 1991 (RHPA) has been an issue for many years, dating back at least to the 1998 report of the Land Ambulance Transition Task Force (LATT), which recommended this step “to address the key deficiency of the ambulance service regulatory framework” (1998, p. 7). The Task Force’s reasons for recommending this step were to recognize: • the enhanced need for consistent training and regulation of paramedics in a decentralized management system to ensure integration and accountability; • the need to update the status and responsibilities of paramedics consistent with the evolution of the nature of their work – from untrained transportation provider to highly trained health professional; • the need to remedy the inconsistency of giving self-regulatory status to professionals, such as opticians, who perform non-invasive acts but not to paramedics who are delegated to administer powerful drugs and perform invasive acts; and • the nature of the responsibility given to paramedics to make decisions about pre- hospital care for, and to take action on patients who may be helpless or unconscious (1998, p. 7). If anything, these needs have only grown more urgent since the LATT report was issued, as paramedic practice continues to evolve and the circumstances in which paramedics are called upon to deliver health care continue to extend, such as with recent initiatives in Canada and other countries to introduce Community Paramedic Programs (Nolan, Hillier & D’Angelo, 2012). In considering self-regulation of paramedics under the RHPA, it is essential to recognize that “licensed” paramedics1 (those working for Paramedic Services or Emergency Medical Services (EMS)) in Ontario are not currently unregulated (although practitioners 1 Terminology used in Ontario’s current regulatory system for paramedics is not consistent with the
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