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Paramedic Credentials and Levels of Care

What's the difference between an emergency medical responder and a primary care paramedic? What are advanced care paramedics and critical care paramedics? Find out more about the levels of care provided by BCEHS paramedics.

BC paramedic credentials and levels of care

Basic version

Click on the infographic above for a larger version in PDF format.

  • Emergency Medical Responder: Licensed to administer basic life-saving emergency medical care.
  • Primary Care Paramedic: Licensed to administer more advanced patient care than EMRs, the majority of BC paramedics are PCPs, and they handle the majority of 911 calls.
  • Community Paramedic: Licensed at the PCP-IV level or higher to provide non-emergency and scheduled care to patients as part of an integrated healthcare team.
  • Advanced Care Paramedic: Specialize in advanced care of medical and trauma patients with a focus on advanced cardiac resuscitation.
  • Critical Care Paramedic: Highest level of specialized care with a focus on acute interfacility transport, air medical response, and infant, child and perinatal care.
  • Paramedic Specialist: Advanced Care and Critical Care paramedics who provide on-scene technical support for high-risk situations, mass and complex patient events as well as telephone support to paramedics and patients. 
Complex version

Download the full infographic and explanation: First Responder and Paramedic Credentials in BC (PDF)

Emergency Medical Assistant: First Responder (EMA FR)

  • Scene assessment
  • Vital signs
  • Patient assessment
  • Basic wound care
  • Fracture management
  • Basic airway  management
  • CPR

Endorsements (with additional training, EMA FRs may be approved for the following skills):

  • Oral airways, oral suction, ventilation – oxygenation, pocket mask, bag valve mask
  • Spinal immobilization
  • Treatment of hypoglycemia with oral glucose
  • Emergency child birth
  • Automated external defibrillation

Emergency Medical Responders (EMR)

All services specified under the category of EMA FR, as well as:

  • Cervical collar application and spinal immobilization
  • Patient handling, packaging and transporting skills
  • Blood pressure by auscultation/palpation
  • Glucometer
  • Emergency fracture immobilization
  • Soft tissue injury treatment
  • Administration of semi-automatic or automatic external defibrillator
  • Airway management

Endorsements (with additional training, EMRs may be approved for the following skills):

  • IV maintenance
  • Pulse oximetery
  • Medication administration using PO, SL and inhalation routes:
    • Narcotic antagonist
    • Anti-anginal
    • Analgesic
    • Anti-hypoglycemic
    • Platelet inhibitors
  • Chest auscultation
  • Insertion and maintenance of a nasal airway
  • Use and interpretation of a glucometer

Primary Care Paramedics (PCP)

All services specified for the category of EMR, as well as:

  • Extraglottic airway device
  • Medicine administration using IV, PO, SC, SL, IM, inhalation and nebulization routes:
    1. Narcotic antagonists
    2. Histamine antagonists
    3. Bronchodilation agents
    4. Sympathomimetic agents
    5. Anti-hypoglycemic agents
  • Maintenance of IV lines using infusion pumps and devices

Endorsements (with additional training, PCPs may be approved for the following skills):

  • Initiate peripheral IVs
  • IV isotonic crystalloid administration
  • ET intubation
  • ECG acquisition
  • Initiation and maintenance of non-invasive positive pressure ventilation devices
  • Administration of IV, oral, SL, SQ, inhaled, IM or nebulized anti-emetics, anti-nauseants and vitamins

Community Paramedics (CP)

All services in the category of PCP with IV endorsement, as well as:

  • Community outreach and awareness
  • A range of services to older patients living with chronic conditions such as diabetes, hypertension, heart failure and COPD
  • Fall prevention assessments to keep older patients safer in their homes
  • Scheduled and unscheduled home visits
  • Health promotion and awareness visits in the community

Advanced Care Paramedics (ACP)

All services in the category of PCP, as well as:

  • ECG rhythm interpretation
  • Manual defibrillation
  • Cardioversion
  • Intraosseous placement and infusion
  • External jugular IV lines
  • Surgical airways
  • Chest decompression
  • Gastric tube and suction
  • IV medications and infusion maintenance
  • ETCO2 monitors
  • IV colloid/crystalloid volume expanders
  • Administration of the following using the IV, oral, inhaled, nebulized, ET, IO, IM and rectal routes:
    1. Diuretics
    2. Anti-coagulants
    3. Narcotics
    4. Anti-pyretics
    5. Anti-cholinergics
    6. Sedatives
    7. Anti-convulsants
    8. Anti-emetics
    9. Anti-nauseants
    10. Alkalizers
    11. Antiarrhythmics
    12. Electrolyte calcium
    13. Histamine antagonists

Endorsements (with additional training, ACPs may be approved for the following skills):

  • Provision of transvenous pacing
  • Central line management
  • Management of parenteral feeding lines
  • Chest tube monitoring
  • Mechanical ventilation
  • Urinary catheterization
  • Arterial line management and central venous pressure monitoring
  • Infusion of blood products
  • Point of care testing (capillary, venous, arterial sampling)
  • Collecting of arterial and venous samples
  • Interpret laboratory and radiological data

Paramedic Specialists (PS)

All services in the category of PCP and ACP, as well as:

  • Administration of hydroxocobalamin (cyanide antidote)
  • Solo response unit trained
  • Medical Priority Dispatch System (MPDS) trained
  • Computer Aided Dispatch (CAD) trained
  • Trained in dispatch operations, call taking and radio operations
  • Work in CliniCall supporting Medical Oversight by providing
     paramedic clinical support and referral
  • Technical and clinical advisor training:

    1. Hazardous materials
    2. Personal protective equipment (PPE)
    3. Decontamination
    4. High risk hazards safety
    5. Police events and chemical, biological, radiological, nuclear and explosives (CBRNE) safety

Critical Care Paramedics: adult, neonatal, pediatric and maternal critical sare specialties (CCP*)

All services in the category of ACP,
 as well as:

  • Arterial line placement, management and monitoring
  • Using an incubator for thermoregulation

  • Management of central venous pressure monitoring

  • Esophageal balloon manometry guided mechanical ventilation
  • Interpretation of laboratory and radiological data including x-rays, CT and ultrasound imaging
  • Ultrasound guided diagnostics
  • EEG guided anesthesia planning
  • Administration of drug therapies on the direct orders of employer designated transport advisor
  • Mechanical ventilation
  • Management of chest tubes and drainage systems and gastric tubes

*Note: Infant Transport Team (ITT) Paramedic licenses are no longer being issued by EMALB. The ITT license includes the PCP scope of practice plus many critical care procedures and medications necessary for high acuity neonatal, pediatric, and perinatal inter-facility transport.

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Download the full infographic and explanation: First Responder and Paramedic Credentials in BC (PDF)

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SOURCE: Paramedic Credentials and Levels of Care ( )
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