In most of Canada there are 3 levels of Paramedics: the Primary Care Paramedic with limited pharmaceutical protocols, the Advanced Care Paramedic with full ACLS qualification, and the Critical Care Transport Paramedic with very advanced qualifications. Several variations to this system occur in the City of Toronto and the province of Saskatchewan, which uses a four level model with Level I (Primary Care), Level II (Intermediate Care), Level III (Advanced Care) and Critical Care Transport Paramedics. It should also be noted that many Canadian jurisdictions do not use multiple levels of paramedics. There are many smaller and isolated communities which, for reasons of potential skills decay, medical control issues, or costs, operate with Primary Care Paramedics only. Paramedics working in these communities are often certified in skills ouside the scope-of-prace of the traditional Primary Care Paramedic including skils such as intravenous therapy, supraglottic airways, CPAP, and an enhanced listing of medications that they are able to administer. In Canada, paramedics provide the most advanced level of emergency medical care available to the general public outside of a hospital setting. Advanced Care and Critical Care Paramedics are able to perform more delegated medical acts than any other health professional besides physicians in the pre-hospital setting.
In a number of Canadian centres, paramedics are currently using a 12-Lead ECG to diagnose ST-Elevated Myocardial Infarction (STEMI), a specific type of heart attack. The experience of paramedics from the City of Ottawa with the use of this procedure was recently a topic of an article in the New England Journal of Medicine.[7][8] Ottawa paramedics were the first paramedic service in Canada to have this STEMI protocol, which is now being implemented across the world, available to treat their patients.
