PCP vrs. EMT- can’t we all just get along?

Sirens-007

I’ve been meaning to write this entry for a while, but haven’t because it is going to take some major effort and explaining. The topic: The differences between Ontario and Saskatchewan in paramedic SOP’s and professional organization/designation. Oh and a little bit about how to get employed (or not). Unless you have some interest in working as a medic in either of these provinces, this will likely be an incredibly boring read. But, as far as I know there is no document like this written and it would make a handful of peoples’ lives easier (mine included) if there was. So here goes.

I’ll start at the beginning with fair warning that this is just my experience and yes I sound a wee bit bitter in some parts. Because I was.

As I mentioned in a past blog, I was trained as a PCP (Primary Care Paramedic) in Ontario. I attended a private school and finished my diploma in 1 year of fulltime studies (no summer break) which included 450 hours of practicum. Non-privatized, the program takes 2 years with breaks. Anyways, I wrote and passed the AEMCA (which thankfully is a nationally recognized exam, so I didn’t have to re-test when I got to Saskatchewan.)

AEMCA-Flyer-Top

Wait, why did I leave Ontario to come to Saskatchewan?

Well, to get a job of course. They have those here. Jobs that is. And lots of them, with decent pay, and the opportunity to gain hours and seniority in a reasonable amount of time.

Before I was hired in the prairies, I had begun two hiring processes in Ontario. One was in the Kawartha Lakes region, for a part time posting promising up to 24 hours biweekly…for potentially 5-7 years before gaining full time. That means living by your phone, with no benefits, and no stable income for FIVE TO SEVEN YEARS. Not to toot my own horn but I, for one, am too old, too educated, and too experienced for that noise. (Also, one of the reasons I probably didn’t get that job was because I called them out on these issues during phase three- the interview. My bad. But I think job parameters are something employers should be forthcoming with before getting to the interview phase.) And I haven’t even mentioned the tough competition. There were approximately 200 people who had made it to phase two- the written test…..and this was for ONE part time position. I talked to a few of my fellow competitors, and some of them had been out of school for over two years! No thank you- private school wasn’t cheap and I was going to have OSAP breaking down my door in a few months.

I had also started the hiring process with Peel Region. Basically the same situation, part time gig, no guaranteed schedule. It required three college campuses to hold the written testing. I can only estimate that about 2000 grads were competing for 30 part time jobs. I passed the test but realized, I don’t want to live in Peel. It’s just so….busy. I don’t even mean patient care wise- I’m just talking traffic! Ew stress. Not for this country girl thank you very much. Yes, I was being picky but I had already left one career due to stress and dissatisfaction and knew better than to repeat the process.

I was also quickly learning that most services wanted to hire their own brew. Aka- students who went to school, lived, or did their practicum in the area. This makes sense, each service has its own nuances and it’s much easier to train a person who already knows the roads, hospitals, high call volume areas, etc. However, many regions that have a paramedic school will only allow students from that school to do their practicum there. For example, I went to school in Sudbury but had wanted to do my practicum in Peterborough or the Kawartha’s. However I was denied because placement spots were reserved for Flemming students. Pardon my French but had it been my life long dream to work in either of those places, I was virtually f*cked before I even got started. Luckily, it was not my life long dream but it still pissed me off that no one informs you of these politics before taking your tuition money.

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My best chances of getting a part time job, would have been to apply for Sudbury since that is where I ended up doing my preceptorship. Which I would have done, even though I didn’t really want to live there either (maybe I am a snob). Now in order to apply, you are required to do a fitness test. The fitness test is organized and held by one of the OTHER paramedic schools (Sudbury has three schools that offer the course). Funny, NONE of the students in my class got the test date memo until it was too late. Some of us (myself included) had emailed, placed phone calls, and physically gone to the school (I’m struggling not to name names here) prior to and were ignored or lied to. They refused to hold a second test for us. Oh, politics. “Angry face.”

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Luckily I’ve always been a believer in keeping your options open- wide open. I had already learned the importance of this as an education grad in Ontario (I’ve have taught in 5 different places…none of them Ontario). I had sent my resume to a private service out in Canada’s bread bowl. That same week I had a nice chat with the hiring manager over Skype. He offered me a “part time” position with a regular schedule of full time hours. Full benny’s after 3 months. Boot allowance. RSP initiatives. Licensing fees paid for after one year. In house training. The whole gammit. All I had to do was get there. Uh, where do I sign up? Fortunately my fiancée’s skills allow him to be flexible job wise, and we have no kids, and no house, (aka- no responsibilities?) so we could embrace a big move easier than some of my peers.

FutureEMT

I just made it sound horribly easy didn’t I? Well I ran into a few surprises. I just want to clarify that by no means is the list below completely comprehensive. I am simply outlining a bit of my journey between provinces so others who may wish to do the same don’t have so many surprises in store.

Surprise #1: Licensing fees aren’t exactly cheap. Since this was my first time enrolling with SCOP (Saskatchewan College of Paramedics), it cost me 500 doubloons. Ouch. Luckily, my service pays for the fee ever after. Ontario does not have a Paramedic College so your AMECA fee is a one time thing of $250. Which I also had to pay for. My credit card hates me.

Surprise #2: It costs $15 for the Ontario Ministry of Health to sign a paper from SCOP stating you wrote and passed the AEMCA. No one will phone and tell you that they require this fee, nor is it listed anywhere to my knowledge. So if things seem to be taking a long time, get on the horn because no one is going to help you! The OMH will also tell SCOP whether or not you have worked in Ontario as a medic. That comes into play in a minute.

Surprise #3: Why are there so many jobs in Sask? Do employers secretly beat their medics so no one wants to work for them? Nope. It seems that someone in the past made a wee mistake when scheduling the licensing exams. They were only holding testing once a year. That means if you didn’t graduate at the right time of year….you could be waiting a lonnnggg time before being able to work. And I thought waiting four months to write and get my results in Ontario was torture! There also aren’t that many schools in Sask teaching paramedicine. Granted, the province’s population could fit inside the Greater Toronto Area, but they still aren’t pushing through more grads than the market can sustain (AHEM-ONTARIO). The testing situation has since been rectified and they are now testing grads three times a year. But there is still a gap to be filled. Aka- me.

Surprise #4: Remember how I mentioned that Ontario will let SCOP know if you have previously worked as a medic- aka- been enrolled with a base hospital? Well, unless you have graduated within the last two years, you HAVE to have worked for a base hospital Ontario in order to get licensed in Saskatchewan. I found this out AFTER I already moved!!! Could you imagine my pickle if I wasn’t a new grad? SCOP required copies of my diploma/transcript in order to finish the licensing process. They don’t phone you. They sent an email which had conveniently got lost in my junk mail. Again, if things don’t feel right- harass the hell out of everyone involved with phone calls!

Surprise #5: I had started the licensing process in order to work in Sask two months prior to my start date. I received my certification on day two of my orientation here. I have more grey hair.

189.-grey-hair-dye

Surprise #6: Oh ya, I now work for a privatized service. The two men who own the business actually work as EMT-A’s (I will explain) along side their employees. Some people have issues with this, but so far I happen to like it. It avoids the age old complaint about Admin not caring about employee issues. They have to talk to me because we are stuck in a bus together! My issues are literally your issues pal. Being in a privatized service also means they can modify to an extent what equipment/services they provide. I cover that in more detail in the table below.

Surpise #7: Hold on to your hat for this one. In Saskatchewan I am now considered an EMT (Emergency Medical Technician). I believe this structure of designation is borrowed from the USA. However, these days SCOP can’t seem to make up its mind about whether to use the designation PCP or EMT. From what I understand people who do the PCP program have a bigger skill set and at one time a bridging program was available to EMT’s. SIAST (the main paramedic college) calls their program a PCP program. Yet, my uniform states I am an EMT. There are also EMT-As (ICP: intermediate care paramedic) that work at my base. In my opinion their skill set more closely represents Ontario PCP’s, the main difference being they are certified to do IV’s in school and not if your base hospital feels like it. There are no EMT-P’s (advanced, like ACP in Ontario) in our particular service, but SCOP has given the ok for us to hire some in July. There are also a handful of critical care paramedics that work for STARS (like ORNGE). Confused? Me too.  But I hear they are working on it.

Surprise #8: My skill set got blown up. I rationalize my inability to use some of my skills like this: I am making the same amount of money. Ok, that probably won’t make me feel better the first time I encounter a patient I could do something for in Ontario, but can’t in Saskatchewan. There are a couple new things I can do that make up for it- like Nitrous Oxide. Yay for a nod at pain control. Having activated charcoal is pretty cool too. So go on, OD and break your leg when I’m on call- just don’t have an asthma attack! Fortunately, SCOP in their wisdom does a lot of studies and has realized they are getting behind the times in some aspects of patient care. They have promised some pretty significant updates by 2019 including IV therapy. Fingers crossed.

Here is the skill set comparison gist…

SOP PCP (Ontario) EMT (Saskatchewan) Private Service (Saskatchewan)
Airway management Oro/nasopharyngeal airwayKing LT Oro/nasopharyngeal airwayKing LT Oropharyngeal airwayKing LT
Breathing BVMCPAP BVMCPAP BVMOrdered CPAP machine J
Circulation Automatic DefibSager Automatic DefibSager Automatic DefibSagerMAST pants (for shizzle ma nizzle, I saw them!)
Epi 1:1000 Allergic reactionAsthmatic bronchoconstrictionCroup

(IM and/or Nebulized)

Allergic Reaction(IM only) Allergic Reaction(IM only)
Nitro Cardiac IschemiaACPE Cardiac chest pain(Tabs + Spray) Cardiac chest pain(Spray)
Ventolin BronchoconstrictionMDI or Nebulized N/A N/A
ASA Cardiac Ischemia Cardiac Ischemia Cardiac Ischemia
Diphenhydrinate Nausea/Vomitting N/A N/A
Diphenhydramine Minor Allergic reaction N/A N/A
IV monitoring See BLS See ETPM See ETPM
IV initiation If certified by base hospital N/A N/A
Catheterization N/A Yep N/A
Outbreak Inoculation Assistance N/A Yep Not sure
Entonox (Nitrous Oxide) N/A Musculoskeletal pain Musculoskeletal pain (yay!)
Activated Charcoal N/A OD OD
Glucagon Hypoglycemia N/A N/A
Oral Glucose Hypoglycemia +(If maintaining own airway) Hypoglycemia(Can be given buccally)  Hypoglycemia(Can be given buccally) 
Amyl Nitrate N/A Yes No

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For more protocol information including criteria/contraindications please see either:

For Ontario

http://www.paramedipedia.net/Ontario/index.php?title=BLS_-_Patient_Care_Standards

For Saskatchewan:

http://www.health.gov.sk.ca/ems-protocol

Annnyyyywayyyys, I’m sure I have many more surprises in store. For example: Goodbye 10-codes, hello patching to the hospital over a cell phone. Hello rodeo and roller derby stand-bys. Hello weekly transports to Regina/Saskatoon. Goodbye ORNGE, hello again STARS (also in Alberta). Thank goodness for working in a smaller service so I actually have time to digest all the changes. Everyone here has been very supportive and has great things to say about working here for the most part, which is an encouraging sign. Swift Current has some of the cleanest air in Canada, one of the fastest growing populations, and one of the highest employment rates, which I think all contribute to peoples generally great attitudes. Ambulance fees are also pretty high which I think keeps away a lot of the BS calls (aka- I need a ride to the other end of town and it’s cheaper than a taxi- eye roll). But I wouldn’t want to live here without health insurance.

Anyways, that’s my rant. Feel free to add anything I forgot.

And good luck.

Happy_smiley_face

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17 thoughts on “PCP vrs. EMT- can’t we all just get along?

  1. A very interesting read, as always. Now I have a bit better understanding of how the system works or not. You would definitely think that there would be a more standardized system in place, but I take it that this is where you feel they are heading. And being a newer element of the healthcare field, it too will have it’s share of growing pains. I’m sure it will make things so much easier on so many levels once there is more standardization in place. So glad to hear just how enthralled you are with your career. Jennie

  2. Your blog is amazing!! This entry in particular was quite interesting. I can only imagine how helpful this would be for a new paramedic (or EMT or PCP or whatever they’re calling it)! I think you really must have found a profession that you’re passionate about, seeing as you’re writing all about it in your free time. Miss you!! xo

  3. Wow thanks for reading Steph and Mom! What sweet compliments. I am really enjoying my work, and as always, writing 🙂 Still have a steep learning curve ahead of me! People say writer’s write about what worries them….might be something to that.

  4. Alright, so I gave this one a read and I’m brave enough (ha-ha) to comment! Very well written. I agree with nearly everything in this and it’s good to see you’re getting a grasp on how stuff works (albeit backwards) in Saskatchewan.

    However, a few things I’d like to share (maybe this is where the bravery comes in…) to help solidify your already stellar blog.

    Disclaimer: The following information cannot be verified as 100% accurate, but I assure you I’ve tried to compile my information as best as I could.

    PCP vs. EMT is a simple game of new vs. old terminology. You are a PCP. I am a PCP. Everyone at work that is called an EMT is a PCP (and let the confusion begin…) So way back when, Saskatchewan had 3 levels of EMS providers: EMT, EMT-A (Advanced) and EMT-P (Paramedic). Then the CMA decided it was time to begin the nationalisation of EMS personel. The first item on the docket was to change the terminology of the providers: EMTs became PCPs, EMT-As became ICPs and EMT-Ps became ACPs.

    Still with me? Good.

    Now Saskatchewan followed suit with this and went with the new terms. As well, the schools also began advertising their courses with the new terms. The skill set for the levels didn’t change. Some provinces (cough- Alberta) did their own thing and still stick with the older terms. As you know, Vanessa, Saskatchewan EMS is, well, a little behind. So the province basically still juggles and mixes old and new terms; hence why were are called EMTs at work while being PCPs and EMT-As when actually they are ICPs.

    A few years ago, PCPs got a skill upgrade (yay!) and the schools started teaching the course with these upgrades which include King Airways, 12-lead placement (not interpretation) CPAP and Entonox/Nitrous Oxide. The PCPs that chose not to upgrade their skills through a bridge course remained PCPs but were unable to perform their full skill-set. (A few of our co-workers just recently upgraded and got signed off.) So now you have EMTs, old PCPs and new PCPs all working in one province. Yuck. However, with the skills that PCPs are getting in the very near future (yay again!) anyone who does not take the bridging course will be downgraded to EMRs. I know that sounds shocking, but I think if you’re not going to upgrade your skills to come to parity with the rest of the province (and Canada) then there is no choice but to downgrade your title.

    Harsh? Maybe. Fair? Most definitely.

    Again, this is just meant to clear up some of the stuff that surprised you when you came to our wonderful province! Excellent writing and the grammar is top-notch. Although, a few semi-colons wouldn’t hurt; I’m all about the semi-colons.

    • This is fabulous Trav; thanks so much for participating. Great clarification for anyone making the switch over here in the next few years as well! I look forward to hearing about your adventures as you head back to school and get your “paramedic” cape 😉 And yes, I will try to include more semicolons in the future, although brackets are really my thing. haha!

  5. This post is EXACTLY what I have been scouring the internet for! I’m so happy to have stumbled across this.

    First off: hi! My name’s Bonnie and I’m going into my second year of Paramedic at a college here in Ontario. Lambton College; you may be familiar. My goal is to work in Saskatchewan after I graduate, just as you did! (I’m crossing my fingers for Saskatoon or the surrounding area.) I’m really set on this goal.

    This post was extremely helpful. And funny, too! I hear you about the politics down here, it’s wild! I feel a tad sorry for all my eager classmates looking to stay in this area – I don’t think some of them realize how tough it can be.

    For whatever reason, not many of the students before me, those who have already graduated, jumped ship to Saskatchwan (tons went to NFLD though!) so I don’t have many people to talk about this with. I was about to start going on a wild phone-call chase until I got a hold of someone knowledgable! If you wouldn’t mind, would it be okay to ask you some further questions about your transition?

    🙂 Bonnie

    • Ask away Bonnie and I’ll try to help the best I can! I have been working here three months and am still learning the ropes. For example, medical directives (such as a DNR) can be in the form of a living will- written by the patient alone with no witnesses/lawyer/doctor- a lot different than what we are trained to accept in Ontario! Thanks for reading and the kind compliments 🙂

      • I’ve been compiling a lot of research so all the financial things you mentioned aren’t news to me – but dang do I agree that they should really tip you off on this stuff before you go through for paramedic! (Although at the end of the day I don’t mind – this is definitely what I want to do in life.)

        I have some questions concerning this paragraph:

        “Luckily I’ve always been a believer in keeping your options open- wide open. I had already learned the importance of this as an education grad in Ontario (I’ve have taught in 5 different places…none of them Ontario). I had sent my resume to a private service out in Canada’s bread bowl. That same week I had a nice chat with the hiring manager over Skype. He offered me a “part time” position with a regular schedule of full time hours. Full benny’s after 3 months. Boot allowance. RSP initiatives. Licensing fees paid for after one year. In house training. The whole gammit. All I had to do was get there. Uh, where do I sign up? Fortunately my fiancée’s skills allow him to be flexible job wise, and we have no kids, and no house, (aka- no responsibilities?) so we could embrace a big move easier than some of my peers.”

        Where did you find the posting from and how long after you graduated did this take place (or before you graduated perhaps?) I’m so incredibly excited to graduate (in fact I wish I’d fast-tracked as you did) and begin working; I’m just wondering how long after graduation, this coming April, I could expect to be moving out west, that is if all went smoothly of course (!!). Did you have to wait until after your AEMCA results? And when you say “All I had to do was get there.” Do you mean the employer allowed you to come on, and let you be there under probation while you completed the necessary transitional requirements?

        And lastly, how’s the job market; still golden? How many resumes did ya shoot out, and how many replied? Do you think I’ll still have a good shot in a year?

        Thank you for replying :D! I read every other entry of yours after I found this one — great stuff!
        Bonnie

      • Thanks again Bonnie.
        To answer your question, I definitely took a leap of faith that I passed my AEMCA. I sent the MOHLTC my transfer papers around the time I figured they’d have it marked.You have to have passed in order to get registered in another province. It was a nail biter!
        I also signed my contract before I got the pass because it takes at least 2 months to get your AEMCA results and I wanted to start working ASAP! It was a leap of faith on my employers end as well- but honestly I’m not sure how versed they are on out of province transfers to begin with. I was the first to get a job among my peers because of my giant balls (or foolishness).
        Even when I had my pass, I couldn’t start work until everything was finalized with SCOP…and they don’t move fast either- at least 3 weeks waiting for them. I literally got the go ahead to work here the day before my probation start date (ya, I already moved and everything- phewf!) So I would say, once you have written your exam you have about 3 months until you can work at a MINIMUM. Brutal right! I felt like my skill set was just sitting around getting stale.
        Anyways, like you I started my job search way before graduation. I signed up for every possible job search site online. My favorite is http://www.simplyhired.ca They seem to get most of the postings and send notice weekly to your email. But if I remember correctly I found my actual posting on Saskatchewan’s kijiji.
        Job market here is still good, but who knows how long it will last in our crazy economy, but it looks promising to me. I had also talked to the people out in Newfoundland but something didn’t feel right, less perks, less pay, more remote (but beautiful country).
        Anyways, sounds like you are passionate about this line of work so I’m sure you will have no trouble finding something (even though the journey may be frustrating at times.)
        Vanessa

  6. (For whatever reason the site isn’t letting me reply to your above comment so I’m just starting up a new thread!)

    Thank you for all the info! 🙂 Just out of curiousity; did you move out to Saskatchewan shortly after you signed the contract or did you wait? How long after grad did ya bounce over to Sask?

    I hear ya about the skills going stale — I’m currently on my four month summer break. Every one of my classmates including myself just wants to get back into it already!

    Thanks for the faith! I’ll be sure to contact ya if I run into hitches when it comes time to start applying to jobs (feels so far away…!)

    • I moved to Sask 4.5 months after grad! I signed my contract but told the company I had to wait on my national results, so I gave them a tentative start date. I would recommend getting a related part time job for those in-between waiting periods- I taught CPR/First Aid and it helped keep me a little fresh. Good luck!!

  7. Hi there! I was just wondering how you went about getting your grey hair? I have a daughter who is trying desperately to get grey hair and it just isn’t working!

  8. Interesting read. A few flaws; the PCP program wasn’t a national program until 2004, so prior to this, the EMT existed in many provinces still. This made mobility to other provinces quite the nightmare. In 2004, the Canadian Medical association (CMA) recognized the need for a national standard and made the PCP the new gold standard of BLS care. This lead to EMT’s needing to bridge to PCP, if they wanted to. I upgraded my EMT to PCP in 2004 by participating in a couple of lab weekends and a little home study. It basically added ECG interpretation and a couple of meds to my scope, not a drastic change. Provincial Mobility also wasn’t a smooth transition until April of 2009 when AIT (agreement on internation trade) came in to effect.

    The CMA requires that every PCP course in Canada, that wants to be accredited, meet a minimum standard, presently the 2001 NOCP, but soon to be 2011. That being said, many provinces not only meet that standard, but exceed it; AB, for example, has a far larger scope of practice than most. On a side note, any Alberta EMT-A course that is CMA accredited is a PCP course. They simply choose to use the old designation.

    You made a mention of EMT-A not being in SK. This isn’t true. The prvious EMT- B (Basic) became the new PCP, The prvious EMT-A (advanced) became the new ICP (strictly a SK course and not CMA accredited), not to mention recently phased out, and the previous EMT-P became the ACP, not CCP or critical Care Paramedic. All of these were bridge courses for existing practitioners and optional. There are still some EMT’s, EMT-A’s and EMT-P’s who chose not to bridge.

    I took my SK EMT-B in 1999 and upgraded to PCP in 2004. I have been in the full time EMS system to date. Also registered in AB as an EMT-A.

    • Thanks again for adding that. I had been meaning to amend that post for a while. I can’t tell you how confused I was when I first moved! Wayyy too many letters getting tossed at me. lol.

  9. Very helpful read! I’m a PCP (with I.V) in Ontario, but I’m stuck in the same part-time with no hope of full-time position you talked about and I’ve been looking at Saskatchewan as an option. How do you like it now that you’ve been working out there for a few years?

    • Hey Tim, I’m actually back in Ontario now taking the ACP(f) program at Cambrian. Saskatchewan was a great place to make some money and get my feet wet. There are lots of opportunities out there for sure. My advice would be to really think about what you are looking for in both a service and a place to call home. Sask has 1.1 million people total. The demographics meant that the service I chose required a lot of looooong patient transfers to Saskatoon and Regina. A lot of services have extremely low call volume and you end up spending a lot of time on call. Skill wise the PCP level between the provinces has equilibiated which is great and makes the transfer process smooth. That being said, I’ve heard that they are going to be restructuring the provincial delivery model and I can’t speak to that at all. Did you have any other specific questions I can help you with?

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