<P> Under the new NOCP most providers that work in ambulances will be identified as' paramedics the most prevalent level of emergency prehospital care is that which is provided by the emergency medical responder (EMR). This is a level of practice recognized under the National Occupational Competency Profile . As a group, EMRs staff rural ambulance stations, internal emergency team in institution, community volunteer ambulance services, industrial ambulances or mobile treatment centers, and for many small communities, without this level of certification, the operation of a much - needed small community ambulance system might not be possible . EMRs working as first responders in Fire Departments, Police Departments and institutions across Canada contribute an important role in the chain of survival . It is a level of practice generally consistent with few acts beyond advanced first - aid including the use and interpretation of a pulse oximeter, use and interpretation of a glucometer, blood pressure assessment by auscultation and palpation, administration of the following oral, sublingual or inhaled medications and intravenous lines without medications or blood products: anti-anginal, anti-hypoglycemic agent, analgesia, platelet inhibitors, (theses include Nitroglycerin, Glucose, nitrous oxide, acetylsalicylic acid, salbutamol), and the use of automated external defibrillation, which is still a regulated medical act in Canada, although one which is increasingly delegated to the general public . </P> <P> Primary Care Paramedics (PCPs) are the entry - level of paramedic practice in some Canadian provinces . The scope of practice includes performing semi-automated external defibrillation . Oxygen administration . Establishing an IV . Cardiac monitoring such as Lead 2 and 12 Lead interpretation . Administration of Symptom Relief Medications for a variety of emergency medical conditions (these include epinephrine, salbutamol, ipratropium bromide, aspirin, nitroglycerine, naloxone, dextrose, thiamine, glucagon, gravol, benadryl and nitrous oxide). In addition, some services have started implementing non-opiate medications so that Primary Care Paramedics can treat patients that require pain management . These medications include ketorolac, aceotominophen and ibuprofen . As of 2015, PCP's can now administer Naloxone for suspected opiate overdose . performing trauma immobilization, including cervical immobilization, and other basic medical care . PCPs may also receive additional training in order to perform certain skills that are normally in the scope of practice of ACPs, such as interpretation or transmission of a 12 lead EKG . This is regulated both provincially (by statute) and locally (by the medical director), and ordinarily entails an aspect of medical oversight by a specific body or group of physicians . This is often referred to as medical control, and is the role played by a base hospital . </P> <P> The Advanced Care Paramedic is a level of practitioner that is in high demand by many services across Canada . However, still not all provinces and jurisdictions have ACPs (Quebec being the exception). The ACP typically carries approximately 20 different medications, although the number and type of medications may vary substantially from region to region . ACPs perform advanced airway management including intubation, surgical airways, intravenous therapy, place external jugular IV lines, perform needle thoracostomy, perform and interpret 12 - lead ECGs, perform synchronized and chemical cardioversion, transcutaneous pacing, perform obstetrical assessments, and provide pharmacological pain relief for various conditions . Several sites in Canada have adopted pre-hospital fibrinolytics and rapid sequence induction, and prehospital medical research has permitted a great number of variations in the scope of practice for ACPs . Current programs include providing ACPs with discretionary direct 24 - hour access to PCI labs, bypassing the emergency department, and representing a fundamental change in both the way that patients with S-T segment elevation myocardial infarctions (STEMI) are treated, but also profoundly affecting survival rates . as well as bypassing a closer hospitals to get an identified stroke patient to a stroke centre . </P> <P> Critical Care Paramedics (CCPs) are paramedics who are generally significantly experienced advanced care paramedics formerly working land ambulance and servicing years of 9 - 1 - 1 emergency calls, a small portion of their call volume remains with helicopter "scene" calls . CCP's expertise focus on critical and ICU level care stabilizing and transporting patients from smaller hospitals with less available resources to tertiary care and regional medical programs in to other hospitals that can provide a higher level of care . CCPs work in pairs of Critical Care Paramedics in the largest systems providing care that would normally be delivered in hospital by a physician, nurse, RRT team . Providing this care to the patient allows the sending hospital to avoid losing highly trained staff on hospital transfers . </P>

How many years of college for a paramedic