Divining the right role, capabilities, structure, and Regimental System for Canada's Army Reserves

[ueo]

While @mariomike used an SOP from a "base hospital" as reference to support his point, the "employer rule" stems from Regulations to the Ambulance Act.

e-Laws | Ontario.ca

www.ontario.ca

It's been decades since I've had occasion to pay any attention to Ontario's regulations, but there are some similarities in other provinces' regulations. It's not specifically that paramedics can't provide 'care' except when functioning on-duty as part of their service, it is that they are restricted from performing "controlled acts" unless under the license of a medical director, i.e., a physician. Though paramedics may be highly trained and required to maintain proof of competency, they usually (there may be jurisdictions that are an exception) are not permitted to 'independently' perform controlled acts. They do so under delegation from another health professional, specifically a doctor functioning as medical director of an ambulance service, whose legislated scope of practice does permit delegation of controlled acts to others.

If you look at the schedules of controlled acts in Reg 257/00, with one or two exceptions, they require drugs or equipment that far exceed what would be found in a well stocked first aid kit. There may be the odd paramedic out there who might cache some of those items about them in the hope of coming upon an off-duty emergency situation, but (personal opinion) I would consider them cowboys who would be just as likely to overstep their bounds (and skills) on the job. If you take away those drugs and equipment, what they could render is "first aid"; perfectly acceptable assistance from anyone helping others in an emergency.

In a case of life mirrors art or vica versa, wasnt there an installment of NCIS dealing with exactly this? Shows that maybe a small segment of society actually understands and wants/demands positive change. TV writers, who knew?

 

[mariomike]

If its an employer rule, I'd like to see them in court defending the firing of a person who has provided emergency on site care.

It's Base Hospital.

Base Hospital
45.16 (a) TPS* agrees to facilitate a meeting between Local 416, TPS and the Provincial Base Hospital Advisory Group, to discuss issues of mutual concern including, but not limited to, the application of the protections afforded under the Collective Agreement to Paramedics in their relationship with their Base Hospital.

* In this case "TPS" means Toronto Paramedic Services.

45.16 (b) The City confirms that it has liability insurance and agrees to maintain such insurance.

Liability insurance is limited to when the paramedic is on-duty with the City of Toronto.

45.16 (c) Any Paramedic removed from Paramedic duties because of decertification by the Base Hospital, shall be placed in another position until the merits of their decertification are dealt with in a forum that provides due process. If the removal is for just cause, the disciplined Paramedic may grieve under the grievance/arbitration process of the Collective Agreement.

Decertified by Base Hospital? Hello Parks Dept..

It's contrary to decent humanity.

Paramedics can be off-duty Good Samaritans like anyone else.

Just can't perform Controlled Acts on their part-time job.

​

 

[Colin Parkinson]

Nothing says you can't do First Aid and CPR / AED. I could call 9-1-1 with the best of them.



I was a MSE Op. I consider myself a "Good Samaritan" when off-duty. Carry a First Aid kit in my car.

But, if an off-duty Ontario paramedic was considering working a part-time gig for another employer , I would re-read the Act and Base Hospital Directive, before taking advice on the internet.

I think they are pretty clear on the subject.

to be covered by their respective Base Hospital Program Medical Director’s License.

If operating under Military command in a role as a medic, then they are covered by the DND regs. The challenge would be if they incubated someone, because they do that all the time as a paramedic, but their army training does not authorize that level of care. If something goes wrong that could get messy. The medic might get thrown under the bus, despite trying to do their best to assist. In the CCG we trained to do IV starts, but because the CCG was to cheap to keep us certified, that authority was withdrawn and we were given MAST pants instead, much to the delight of receiving ER personal.

 

[mariomike]

The medic might get thrown under the bus, despite trying to do their best to assist.

If the PRes wants off-duty paramedics,

Paramedic Services Event Quote

Fill out this form to request medical coverage at your event from Toronto Paramedic Services.

www.toronto.ca

 

[KevinB]

If the PRes wants off-duty paramedics,

Paramedic Services Event Quote

Fill out this form to request medical coverage at your event from Toronto Paramedic Services.

www.toronto.ca

Nothing stopping the CAF from licensing Federally qualified provincial paramedics etc.

 

[mariomike]

Nothing stopping the CAF from licensing Federally qualified provincial paramedics etc.

That's nice. You guys would know paramedic licensing better than I. I was in a Transportation company.

I would hope Base Hospital sees it that way.

Paramedicine in Ontario is provincially regulated.

Base Hospital licenced me. So, I followed their Directives. And the the Ontario, City, and Departmental Regulations.

No Base Hospital licence = no job. At least not as a paramedic in Ontario.

Base Hospital
45.16 (a) TPS* agrees to facilitate a meeting between Local 416, TPS and the Provincial Base Hospital Advisory Group, to discuss issues of mutual concern including, but not limited to, the application of the protections afforded under the Collective Agreement to Paramedics in their relationship with their Base Hospital.
45.16 (b) The City confirms that it has liability insurance and agrees to maintain such insurance.
45.16 (c) Any Paramedic removed from Paramedic duties because of decertification by the Base Hospital, shall be placed in another position until the merits of their decertification are dealt with in a forum that provides due process. If the removal is for just cause, the disciplined Paramedic may grieve under the grievance/arbitration process of the Collective Agreement.

 

[FJAG]

... It's not specifically that paramedics can't provide 'care' except when functioning on-duty as part of their service, it is that they are restricted from performing "controlled acts" unless under the license of a medical director, i.e., a physician. Though paramedics may be highly trained and required to maintain proof of competency, they usually (there may be jurisdictions that are an exception) are not permitted to 'independently' perform controlled acts. They do so under delegation from another health professional, specifically a doctor functioning as medical director of an ambulance service, whose legislated scope of practice does permit delegation of controlled acts to others.

If you look at the schedules of controlled acts in Reg 257/00, with one or two exceptions, they require drugs or equipment that far exceed what would be found in a well stocked first aid kit. There may be the odd paramedic out there who might cache some of those items about them in the hope of coming upon an off-duty emergency situation, but (personal opinion) I would consider them cowboys who would be just as likely to overstep their bounds (and skills) on the job. If you take away those drugs and equipment, what they could render is "first aid"; perfectly acceptable assistance from anyone helping others in an emergency.

Now that makes sense.

It's quite different from the idea of some total ban, issued by the province, which would prevent a provincially licenced paramedic either acting as a good Samaritan or, more to the point, serving in a dual capacity in the reserves as a medic under federal authority.

 

[KevinB]

That's nice. You would know better than I. I was in a Transportation company.

I would hope Base Hospital sees it that way.

Paramedicine in Ontario is provincially regulated.

Base Hospital licenced me. So, I followed their Directives. And the the Ontario, City, and Departmental Regulations.

An individual Base Hospital?
So you’d need to get licensed if TDY to another facility? Even in the same Province?

I really don’t understand what the issue is with the CAF on this. Down here 18D (SF Medics) and Ranger Medics get Base Hospital privileges across the Nation (according to their training).


DND can license what ever they chose to. It’s how some units can use live ammunition outside ranges and in urban environments for training.
The fact they don’t do something doesn’t mean they can’t.
If DND chose to make a Federal License for Medical staff, and indemnity them for their actions, the Province couldn’t do anything - Civilian Hospitals might not give them privileges, but Base Hospitals would not be an issue then, or actions on Base.

 

[mariomike]

, serving in a dual capacity in the reserves as a medic under federal authority.

If some people are convinced the PRes can licence off-duty Ontario paramedics to two-hat as PRes paramedics
( or "Combat Medics" or whatever you want to call them ), as:
20.0.1 No person other than a paramedic acting in the course of or in relation to his or her duties as a paramedic for an ( Ontario ) ambulance service shall hold himself or herself out as a paramedic. 2017, c. 25, Sched. 1, s. 6.

Why not ask your local Ontario Base Hospital?

All contact information here,

Ontario Base Hospitals – Ontario Base Hospitals

Oshawa - Central East
Hamilton
Sudbury
Thunder Bay
ORNGE
Ottawa
London
Toronto

You might, or might not, like the answer.

An individual Base Hospital?
So you’d need to get licensed if TDY to another facility? Even in the same Province?

Yes. There are eight Base Hospitals in Ontario.

Mine was Sunnybrook Centre for Prehospital Medicine.

Sunnybrook Center for Prehospital Medicine

Sunnybrook Center for Prehospital Medicine

www.prehospitalmedicine.ca

I received this reply in August 2012 from the Toronto Emergency Medical Services Education & Development Unit:

"Back in 2007 the military approached the MOHLTC to accept their QL5 Med Techs if trained at JIBC, to be permitted to challenge the AEMCA. In the past the Ministry has permitted this, but has required an additional of 120 hrs minimum of field placement in Ontario.

To obtain these hours you could participate in a Med Tech Field Placement Program. Currently there are several Military Med Tech Field Placement Programs that have been implemented across Ontario. This Program offers Med Techs both QL3 and QL5 the opportunity to obtain these 120 hours, in addition to having the ability to be Temporarily Certified to perform Medical Directives consist ( sic ) with that of a Primary Care Paramedic in Ontario while doing their ride alongs. Some services that currently offer this program are: Ottawa, Toronto, Renfrew County, and possibly Simcoe County. There may be a couple other services that offer it as well.

In the past three years we have offered this program to 57 Med Techs.

The process generally calls for writing the AEMCA in addition to possibly a practical skills test (has been done in the past - but not always depending on qualifications and education)."

There was an agreement posted on the CFHS website between the CF and the Ontario MOHLTC allowing QL5's to challenge the AEMCA exam.

"Recognition of QL5A & Challenge of AEMCA exam:

Reference A is a confirmation letter by the Ontario Ministry of Health and Long-Term Care, Emergency Health Services Branch, recognizing the CF QL5 Med Tech as meeting the PCP requirements to challenge the AEMCA exam, all QL5 Med Techs are encouraged to prepare for and write this exam with approval through their Chain of Command. Upon successful completion of this exam, those Med Techs will have access to On-car opportunities to complete their MCSP in Ontario."

Paramedicine is provincially regulated. Requirements and issue of a licence to practice are set by the individual regulators.

From the CAF "coal face",

That is when the PCP qualified Med Tech appeared in the Reg F. We (at the coal face) knew from the very outset that it was just not sustainable for a variety of reasons. PCP was seen as the one qual that was accepted (mostly) across Canada, allowing our pers to be posted, or employed on DOMOPS without too much difficulty. Reality was very different though, as has been noted above.

If the PRes wants Ontario paramedics, they might have to ante up,

Paramedic Services Event Quote

Fill out this form to request medical coverage at your event from Toronto Paramedic Services.

www.toronto.ca

 

[FJAG]

You're missing the point.

This isn't about the feds licencing "off duty paramedics".

This is about recruiting and supporting the financing of an individual to get the education to become a paramedic in civilian life AND concurrently providing him with additional military medical training so that in his part-time reserve role he is a fully qualified combat medic.

They aren't being licenced as "off-duty paramedics" by the Feds. They are concurrently being trained and employed as "military medics" during their military duty time.

It's like when I was a civilian lawyer and at the same time a reserve force legal officer. The province licenced me through the Law Society of Manitoba; I practiced civilian law within Manitoba, which at that time was the jurisdiction I was restricted to; as a legal officer, my base qualification was my being licenced by the province but I received umpteen courses in military law and I was authorized to practice military law (such as courts martial and operational law) on behalf of the CAF anywhere in Canada by the feds (for that matter anywhere in the world that they happened to send me). It's two very distinct jobs on behalf of two distinct employers under two distinct jurisdiction that happen to share a base education and skill level that the individual has.

The legal profession has exactly the same type of "holding out" provisions. Those are to protect the public from unlicensed fraudsters. We're talking apples and oranges here. The CAF already has a health services branch with a reserve primary reserve list that employs numerous health care specialists. For medical officers one of the prerequisites is that they have a medical degree and an unrestricted licence to practice in one of the provinces or territories. The same as it was for me as a legal officer. There are numerous sub-trades in the field and Medical Technicians and Medical Assistants are related trades to paramedics. I'd be very surprised if there aren't a few paramedics who are also Med Techs in the CAF Health Svcs PRL.

 

[mariomike]

Thank-you. Well said.

An interesting ( to me, at least ) bit of trivia is, no other health ( or any? ) profession in Ontario has their title restrictively tied to their employer, rather than the individual who possesses the license (such as Nurse, Doctor, Respiratory Therapist etc...).

eg: Ontario paramedics when working off-duty side gigs, other than Paid Duty, are referred to as "Paramedicine Practitioners".

They aren't being licenced as "off-duty paramedics" by the Feds. They are concurrently being trained and employed as "military medics" during their military duty time.

I don't believe my Base Hospital would have GAF what I did, or called myself, as long as it was not on Ontario.

We only got two weeks of ( paid ) military leave each year.

For sure, call it "out of an abundance of caution", if you will but, I would have checked with my Base Hospital on what they were, and were not, ok with me doing as a reservist in Ontario.

I saw them get enough guys transferred to mowing lawns to know to be cautious.

Fortunately, I was in a Service Bn., so I was never put in that position.

 

[FJAG]

We only got two weeks of ( paid ) military leave each year.

Which is better than most by far.

Whenever I look at the issue of how to make a more effective ResF the issue of leave from a civilian employer is a big issue. I'm a believer in a set amount of mandatory training. "Parade when you feel like it" is a destructive philosophy.

I've come to the conclusion that during the majority of the training year it is not an issue so long as you restrict the training to a mandatory one weekend a year. That impact on very few employers and is acceptable for families.

I also don't think that extensive initial training is an issue as long as you tie it to a system of hitting students while they are looking for full-time summer jobs and need a boost with funding post secondary education.

The problem is the summer training sessions needed to maintain sub-unit proficiency where two weeks is pretty much the minimum needed. That impacts both employers and families. Effectively you can turn out a well trained student by the end of community college or university and could maintain his individual "currency" with 10 x 2.5 day weekend sessions per year, but you would not be able to maintain a modest level of sub-unit capability without those two weeks.

That's where we really need legislative changes at the Federal level to mandate two weeks of unpaid military leave in addition to any provincial or contract mandated vacation time. That has a whole hockey sock of complications at the federal/provincial jurisdictional level (uninterrupted pension programs, enforcement mechanisms, employer benefits etc etc.) That's the challenge.

 

[mariomike]

I agree. FJAG. I did my SSEP-GMT ( as they called BMQ then ) when I was 16, with other boys ( there were no girls ) my same age. Spent my high school summers training. Because when you start working full-time, especially shift work, it is not easy.

More importantly, it's hard to describe, but I embraced the training. I felt good about the military, and my small part in it.

Sorry about the Base Hospital paranoia. But, "Doctor God" was a pretty strict old man. Almost had my a$$ once, or twice.

 

[mariomike]

I contacted my former Base Hospital regarding Ontario paramedics working as Pres "Combat Medics" and received this reply,

Hi Michael,

Thank you for reaching out regarding the performance of controlled medical acts by Ontario paramedics outside of their employment of a licenced ambulance service operator.

A Paramedic within Ontario is not a regulated health care profession and therefore can only perform controlled acts through delegation from a licensed Ontario Base Hospital Physician via the Ontario College of Physicians (CPSO) delegation policy. Although the CPSO allows physicians to delegate to anyone as long as they meet the CPSO delegation policy, the Ambulance Act and Regulation 257 only allow paramedics working for an ambulance service operator to be delegated to by a Base Hospital physician while performing duties for the licensed ambulance service operator.

Therefore, a paramedic is only able to perform controlled acts while working or engaged in official duties of the licensed ambulance operator and currently certified by the Base Hospital physician. In the case that you present, a paramedic would not be authorized to perform any controlled medical acts. The paramedic would have to be authorized/delegated to by a Canadian armed forces or other Ontario licenced physician under the CPSO delegation policy.

Please feel free to contact me directly if you would like further clarification.

Kind regards,

 

[mariomike]

In the case that you present, a paramedic would not be authorized to perform any controlled medical acts. The paramedic would have to be authorized/delegated to by a Canadian armed forces or other Ontario licenced physician under the CPSO delegation policy.

Is Delegation of Controlled Medical Acts something the PRes does under the CPSO delegation policy to turn off-duty paramedics into "fully qualified combat medics"?

Have the Military refer to them as "Combat Medics" and allow that a current licence in any province is equivalent to X in the military.

DND can license what ever they chose to.

CPSO - Advice to the Profession: Delegation of Controlled Acts

www.cpso.on.ca

CPSO - Delegation of Controlled Acts

This policy sets expectations for physicians about when and how they may delegate controlled acts, through either direct orders or medical directives.

www.cpso.on.ca

 

[FJAG]

Is Delegation of Controlled Medical Acts something the PRes does under the CPSO delegation policy to turn off-duty paramedics into "fully qualified combat medics"?

I think we'd need someone like @medicineman to tell us exactly how the medical technician and assistant trades operate these days. Clearly they provide forward functions that go beyond the basic first aid level but as to whether or not they perform "controlled acts" is something I'm not aware of.

IMHO whether they do or not is entirely besides the point. My point is simply that there is nothing to prevent a civilian paramedic to be enrolled in the military and to perform the services that the military authorizes them to perform within their ambit as members of a military health services trade.

My suggestion goes no further than to say that we can build up the military's reserve (and RegF) health services manpower by recruiting high school graduates and providing them financial assistance to earn a civilian health care degree or certificate while providing them with full-time summer training on the military component of their trade in exchange for some form of obligatory service. For the reservist it would provide the necessary education to qualify them for a civilian career and to incidentally make them available to perform the requisite military health services functions in an emergency.

 

[Colin Parkinson]

Keep in mind the real reason most professional associations exist these days is to guard their particular sandbox, particularly at the Provincial level. having people qualified in another province and being able to walk in and work directly eats away at the revenues of the schools/training associations of that province or means that enough people apply that wages don't go up.

 

[FJAG]

Keep in mind the real reason most professional associations exist these days is to guard their particular sandbox, particularly at the Provincial level. having people qualified in another province and being able to walk in and work directly eats away at the revenues of the schools/training associations of that province or means that enough people apply that wages don't go up.

Having spent eight years as a bencher of the Law Society of Manitoba I can tell you, without hesitation, that this is not the "real" reason. The "real" reason provincial regulatory professional bodies exist for is to protect the public from charlatans and the incompetent pretending to do a professional's job, often for an outrageous fee. I wouldn't have been paying all that money into compulsory insurance and reimbursement funds all those years if I didn't. Having spent almost all of those years on either the complaints investigation or discipline committees, I have a fairly good idea of what incompetents and unlicensed fraudsters can do. While each of those organizations have a paid professional staff, the governing body itself is made up of volunteers who spend many, many billable hours doing non-billable work.

It's easy to see why many people think otherwise, but the fact of the matter is most professionals work in jobs where they can do untold damage to a member of the public if they are not controlled. There needs to be an organization which not only controls who can do these types of jobs but who also continuously monitors and disciplines its membership. The only other agency that could do this is the government itself and it doesn't want to accept the costs associated with that.

You're also quite wrong about inter-provincial practice. There are numerous professional agencies that permit interprovincial practice such as the law societies. There are a number of inter-jurisdictional agreements that not only allows for the temporary practice by an individual in one jurisdiction to work in another as well as transferring from one jurisdiction to the other. I transferred my ticket from Manitoba to Ontario when I moved here even before many of the new rules went into effect and it was quite simple.

Let me simply say that while there may still be the odd agency out there that is designed for protecting its turf (cough, cough - unions) most professional governing bodies are designed for protection of the public and their structures and rules are designed to minimize the damage that a negligent or untrained individual can do.

 

[Colin Parkinson]

Well having seen my teaching girlfriend and my wife attempt to breech the walls of "Professional Associations" Apparently it was to hard for the BC teachers association to confirm what the University of Montreal was teaching in their special needs course. And a Law Degree from London England is apparently worth nothing in BC and by the way you have to study tax law coming in, despite the course being optional in UBC. The fact that the head of the Law Society at the time was author of said textbook was purely a coincidence. Plus let's have someone with 10 years experience, article with someone who has 5 years experience to "Learn the Canadian way". Where upon she spent most of her time telling her employer " Yea you can't do that and no that won't work, because.....". I have other stories from other people in other associations, I know the purported reasoning behind the idea, but they have becoming the walls to keep out messy foreigners with different ideas.

 

[FJAG]

Well having seen my teaching girlfriend and my wife attempt to breech the walls of "Professional Associations" Apparently it was to hard for the BC teachers association to confirm what the University of Montreal was teaching in their special needs course. And a Law Degree from London England is apparently worth nothing in BC and by the way you have to study tax law coming in, despite the course being optional in UBC. The fact that the head of the Law Society at the time was author of said textbook was purely a coincidence. Plus let's have someone with 10 years experience, article with someone who has 5 years experience to "Learn the Canadian way". Where upon she spent most of her time telling her employer " Yea you can't do that and no that won't work, because.....". I have other stories from other people in other associations, I know the purported reasoning behind the idea, but they have becoming the walls to keep out messy foreigners with different ideas.

Maybe that's because teacher and nurses associations are really just unions in disguise. Anytime that you add bargaining powers to organizations they are really unions in sheep's clothing.

Law degrees from London are not worth nothing. All degrees are evaluated at admission. Do you want to accept law degrees from Kyrgyzstan without vetting? Canadian law schools use uniform standards accepted across all Canadian law jurisdictions. There is no such standard that applies to foreign schools.

The rest is anecdotal and doesn't address systemic issues.

We're off topic here.