Thank you, Mr. Chair.
My name is Pierre Poirier, and I am the executive director for the Paramedic Association of Canada.
Thank you for the opportunity to speak today.
I have a few notes, and hopefully I'll be brief, in recognizing the time of day.
In some ways the short answer to the question regarding the best practices and the federal barriers is that the federal government continue to be engaged in the development of professional scopes of practice. The paramedic best practice probably already does exist in many locations within Canada, and that's also international recognition, and the federal government should continue to support curriculum development in alignment with those scopes of practice.
Just a bit of history, there are about 40,000 paramedics in the country. We're arguably the third-largest health care group in the country, following nurses and physicians. Our nomenclature is related to three classes of paramedics: primary care, advanced care, and critical care. The education related to that is at the diploma level. It's two years to be at primary care, probably a third year to be at advanced care, and subsequent training to that for critical care.
We're throughout the country. A bit of our history includes the contemporary history, probably transitioning in the 1970s in Calgary away from ambulance drivers, where enhanced training started to be provided. In Toronto there were advanced care paramedics starting in the 1980s. In the 1990s you saw many other provinces come on board with recognition of education. The key element to the transition for paramedics in this country, and our contribution to health care delivery, was the support in 1997 from Human Resources and Skills Development Canada—I'm not sure what the title was at that time—of the development of a national profile for paramedics. That was a key contribution from the federal government that helped create a national view of what a paramedic was. There were over 50-odd different titles for what we did at the time. Right now we recognize that there are essentially three for the profession. Different jurisdictions across the country have different titles, but essentially they are all trained to be three specific titles.
Our scope of practice is varied across the country, and that's a result of our health care framework in recognition of the province's authority over health care to a large degree. Paramedics, in terms of their scope, do incredible things in terms of the ability to save a life. All of the interventions are about that. What we're seeing today is the development of a community paramedic and our ability to, I wouldn't say intervene, but contribute to health care in many different ways that are not necessarily in the critical or the emergency situations.
I was thinking about this in a broader context, and my apologies for that. In some respects the Canada Health Act doesn't recognize paramedics. It doesn't recognize us in terms of our environment. When you talk about ensured health services, that limits us to hospitals and physician services and doesn't include what we do outside of that. I think there's an opportunity there to look at the broader scope of how we view the health act and how the federal government could be engaged in what paramedics do.
I think we're at a transition time where, when we look at health care delivery models, another dollar added isn't necessarily of equal value in terms of what it was previously. To look at it in a different sense, I think there should be a recognition of interprofessional collaboration and unexclusive scopes of practice, particularly opening up scopes of practice and reducing the ability to have exclusivity in areas of treatment. A good example of that recently is in Alberta with the Health Professions Act, where it was recognized that colleges would apply for the ability to make use of restricted activities. Everything that wasn't a restricted activity was open to the health care system and for different colleges to provide that service. Colleges could, by themselves, build the argument to access these restricted activities. That's really opened up the realm of how health care can be delivered. That's an important piece for us to look at. I think there's an opportunity for national leadership from the federal government on this issue of looking at scopes of practice in a much more open way.
Recently there was documentation with respect to the “Optimizing Scopes of Practice” document, which talks specifically about not having exclusive scopes and not having siloed regulation or siloed concepts at how we look at health care.
Another area where the federal government could take a leadership role would be looking at how we combine what is current practice or how professions practise, how paramedics practise, and how we can integrate that into the system and recognize those as different skills, and all those skills and abilities are attributed to a specific area, and that there's a way of accrediting that outside of the college realm in terms of delivery of service. I think Dr. Turnbull in that document “Optimizing Scopes of Practice” has a very good point about how we should look at health care in a very different way.
I mentioned that in many respects Canada has demonstrated a leadership role with respect to alternate service delivery. The development of community care paramedicine over the last five to 10 years or so has really contributed to a positive delivery and access for patients. I can list a few of those initiatives.
I think this committee may have heard previously about the aging at home strategy in Deep River, Ontario, whereby paramedics are providing blood glucose checks; teaching prevention education with respect to slips, trips, and falls; and doing blood pressures. These are not restrictive activities in terms of medically delegated acts. It's basically helping or assisting people to age at home and keeping them healthy in that environment. That's one of the areas.
Paramedics were also very much engaged in H1N1, providing vaccines. There's a long-term case study that's been going on in Brier Island in Nova Scotia with respect to paramedics providing service to the local community. It's not always emergency care. It's oftentimes the more basic levels of care and I think those are very important.
Recently, the Ontario government provided $6 million to community paramedicine, which is a great investment. I think what we're starting to see is the return on investment for the communities and also for different levels of government on how this is a very positive thing.
Another important note, and I come back to the Canada Health Act, was in terms of cost being restrictive or preventing access. Recently, CBC's Marketplace talked about the cost of—and I hate to say it—an ambulance ride in terms of the care that a paramedic provides as being, I would say, outrageous, but also preventing or restricting access. Across this country you'll pay around $50 in Ontario, $140 in New Brunswick, and upwards of $250 to $300 easily in Saskatchewan or Manitoba for an ambulance, and this is a problem. I think there should be some leadership that could be demonstrated from the federal government in assisting with the concept of it being something that restricts access for patients.
In all, I'd like to thank the group for your time and for the ability to present before you today.