The British Columbia Ambulance Service (BCAS) is an ambulance service that provides emergency medical response for the province of British Columbia, Canada. BCAS is one of the largest providers of emergency medical services in North America. The fleet consists of 658 ground ambulances operating from 183 stations[1] across the province along with 283 non-transport support vehicles. Additionally, BCAS provides inter-facility patient transfer services in circumstances where a patient needs to be moved between health care facilities for treatment. BCAS also operates a medical evacuation program that utilizes both fixed-wing and rotary aircraft.
BCEHS critical care team on the helicopter pad on the top of Vancouver General Hospital following the offloading of a patient.
Prior to 1974, ambulance services in British Columbia were provided by a mixture of volunteer ambulance brigades, fire departments, funeral homes, and private operators. As a result of recommendations made by the Foulkes Commission's report on health care, titled "Health Security for British Columbians" released in 1973, the Government of British Columbia created the Emergency Health Services Commission (EHSC), which in turn created the BC Ambulance Service on July 4, 1974.[2]
Organization
BCAS is managed by British Columbia Emergency Health Services (BCEHS), which is under the jurisdiction of the Provincial Health Services Authority (PHSA).[3] The operating budget for BCEHS in 2023 was $766 million.[4]
There are 183 ambulance stations in British Columbia, including the transfer fleet.[5][6] As of 2024, the BCAS employs 5040 part-time and full-time paramedics and dispatchers. Dispatch centres are located in Kamloops, Vancouver, and Victoria.[7]
The Emergency Medical Assistants Licensing Board is an independent regulatory body responsible for licensing paramedics.[8]
Air ambulance fleet
BCEHS helicopters based in Vancouver
BCEHS's air ambulance program consists of a fleet of ten fixed-wing aircraft with three each in Vancouver and Kelowna, two in Prince George, and one each in Nanaimo and Fort St. John. Additional aircraft are chartered on an as-needed basis. In addition to its planes, BCEHS operates six dedicated air ambulance helicopters, two based in Vancouver, one in Nanaimo, one in Kamloops, one in Prince George, and one in Prince Rupert. BCEHS also utilizes approximately 35 pre-qualified charter carriers throughout British Columbia.[9]Helijet, an airline based in Richmond, B.C., provides helicopters, pilots, and maintenance crews to their Sikorsky S76 helicopters contracted by BCEHS in Vancouver and Prince Rupert. Helijet has been servicing BCEHS since 1988, expanding to Prince Rupert in 2011. The Sikorsky air ambulances can carry up to 2 stretchers and 4 medical attendants and can travel a maximum distance of 200 miles (320 km), serving a 100 mile radius from their base.[10]
In 2023, BCEHS announced Ascent Helicopters Ltd. was awarded a 10-year, $554.4 million (CAD) contract to provide air ambulance service. Seven Leonardo AW169 helicopters were expected to enter service in the fall of 2024, replacing existing Helijet service.[11]
Licensing and qualifications
Paramedics qualified in British Columbia are broadly grouped as emergency medical assistants (EMAs) and are licensed by the Emergency Medical Assistants Licensing Board (EMALB), an independent government regulatory agency, under one of six categories:[12]
Paramedics from other provinces and countries who request to be licensed in British Columbia will need to apply to the EMALB for equivalency.[13]
All paramedics employed by BC Ambulance are required to obtain a Class 4 driver's licence.[14]
Clinical practice
Paramedics in BC do not work under the license of a physician as they do in other provinces/jurisdictions. They hold their own licenses under the authority of the EMALB. Paramedic practitioners practicing in BC do not use protocols, instead, they utilize BCEHS Clinical Practice Guidelines (CPGs). CPGs are the medical resource documents that guide paramedic practice in the province. CPGs are a combination of best practice and evidence-based medicine designed to better equip paramedics to make informed decisions in the field. They provide valuable information regarding not only what paramedics should do for patients under certain circumstances, but also the decision of when, and if, that care is appropriate is dependent on their ability to decide the best course of action for the patient.[15]
Many paramedics seek additional training to achieve licence endorsements, which authorize them to perform medical interventions/treatments outside of their normal scope of practice. The two most common licence endorsements are for EMRs to utilize narcotic antagonists (otherwise known as Narcan or Naloxone) and a licence level referred to as PCP-IV, which authorizes Primary Care Paramedics to initiate and maintain an IV as well as administer certain medications and crystalloid fluids through an IV line.[16]
Selected PCPs and ACPs are able to administer NA-1 (if endorsed and authorized) after consultation with a transport advisor as part of the FRONTIER stroke trial. If successful, this trial will change stroke management and highlight the essential role of prehospital care in stroke management.[17][18]
Selected ACPs are able to administer TNKase (if endorsed and authorized) after consultation with a transport advisor as part of the Collaborative Heart Attack Management Program (CHAMP) Protocol for ST-Elevation Myocardial Infarction Pre-hospital Reperfusion. If this trial is successful, it can be extended to other areas of the province.[19]
Paramedics have the ability to initiate critical patient bypasses to specialized centres with certain patient presentations and initiate alternate transport destinations to alleviate pressures and patient transport to emergency departments. Some of these include:
Stroke bypass
STEMI bypass
Palliative care (ASTAR Clinical Pathway)
Influenza like illness (ILI Clinical Pathway)
Major trauma bypass
Pediatric and obstetrics bypass
Sobering centres/detox
Emergency Medical Assistant First Responder
Emergency Medical Assistant First Responders (EMA FRs) are licensed Emergency Medical Assistants in British Columbia;[20] however, they are not employed by BCAS.[21] Most EMA FRs work as fire fighters/fire rescue.[22]
Upon completion of an approved EMA FR training program in British Columbia (ranging from 55 to 84 hours),[23] students may apply for licensing with the Emergency Medical Assistants Licensing Board (EMALB).[24] EMA FRs are licensed to provide scene and patient assessments, perform cardiopulmonary resuscitation, insert and maintain airway devices (both oropharyngeal and nasopharyngeal), utilize suction devices, bag-valve-mask devices, and automatic and semi-automatic defibrillators, manage wounds (not requiring tissue puncture or indentation) and fractures, immobilize fractures, and lift/load and extricate/evacuate patients.
EMA FRs may be endorsed to perform spinal motion restriction and emergency childbirth, utilize pulse oximeters, CO-oximeters, and glucometers, perform non-invasive blood pressure measurement, and administer the following medications:
Oral glucose
Epinephrine (by either intramuscular auto-injector or prepared intranasal and sublingual preparations)
EMA FRs may also be endorsed to assist a patient with the administration of a medication.[25]
Emergency Medical Responder
Emergency Medical Responders (EMRs) are licensed to "administer basic life-saving emergency medical care".[26]
Upon completion of an approved EMR training program in British Columbia (~100 hours),[23] students may apply for licensing with the Emergency Medical Assistants Licensing Board (EMALB). EMRs are licensed to provide all Emergency Medical Assistant First Responder (EMA FR) designated services (and endorsements), in addition to occupational first aid, transportation, and soft tissue injury management.
EMRs may be further endorsed to maintain intravenous lines (without medications or blood products), perform chest auscultations, and administer the following medications:
EMR is the lowest level of care employed by BCAS, and most EMRs work at rural ambulance stations on part-time shifts or full-time performing interfacility transfers.[27] Further training is required (e.g. in primary care paramedicine) before transferring to a BCAS station in a larger population centre.
Primary Care Paramedic
Primary Care Paramedics (PCPs) are licensed to administer more advanced pre-hospital care. PCP is the most common level of care in BCAS and handles the majority of pre-hospital patient care presentations and can treat a wide range of patient presentations autonomously. Primary care paramedic programs are 1-year post-secondary programs in the province of British Columbia.[28] Unlike EMA FR or EMR education, PCP programs consist of multiple terms and pre-hospital/health sciences courses in each program, which includes clinical hours and land ambulance placements (preceptorship). Most programs are offered full-time.
In addition to all services provided by EMRs, PCPs are licensed to insert extraglottic airway devices, perform semi-automatic external defibrillation, initiate peripheral IV access, administer isotonic crystalloid solutions, perform ETCO2 monitoring and administer various medications through IV, oral (PO), subcutaneous, sublingual, intramuscular, inhalation, intranasal, intraosseous and nebulization routes. This includes the administration of anti-emetics, corticosteroids, anti-pyretics, procoagulants, anti-histamines, opiate and non-opiate analgesia, anti-nauseants, anti-cholinergics and vitamins.
PCPs can administer the following symptom relief medications:
Acetaminophen (PO/IV)
Acetylsalicylic Acid (PO)
Dexamethasone (PO/IM/IV)
Dextrose D10W (IV)
Dimenhydrinate (IM/IV)
Entonox (INH)
Epinepherine (IM/NEB)
Glucagon (IM/IN)
Glucose 40% (PO)
Hydrocortisone (IM/IV)
Ibuprofen (PO)
Ipratropium Bromide (MDI/NEB/CPAP/BVM)
Ketamine (IN)
Ketorolac (IM/IV)
Methoxyflurane (INH)
Morphine (IM/SC/IV)
Naloxone (IM/IN/IV)
Nitroglycerine (SL)
Ondansetron (PO)
Salbutamol (MDI/NEB/CPAP/BVM)
Tranexamic Acid (IM/IV/infusion)
In addition, PCPs can be endorsed for intraosseous insertion and maintenance, ECG acquisition, administration of non-invasive positive airway pressure ventilation devices, and manual defibrillation. [29]
Community Paramedic
Community Paramedics (CPs) provide non-emergency and scheduled care to patients, often referred to colloquially as "clients," (although CP services are covered by provincial health insurance and come at little to no cost), as part of an integrated healthcare team, usually coordinated with a regional health authority or hospital.[30] Community paramedic classification is neither a licence nor a certification received from an external educational institution. Unlike previously mentioned levels of care, CPs are certified internally, and the services they provide are consistent with their pre-existing licence level. CPs are trained in community outreach and awareness, prevention care services for elderly patients, fall prevention assessments, scheduled and unscheduled home visits, and community public health promotion and education.[16]
Advanced Care Paramedic
Advanced Care Paramedics (ACPs) are trained to handle more complex cases, including serious trauma and cardiac resuscitation.[30] ACPs work in large population centres such as Vancouver, Victoria, Nanaimo, Kamloops, Kelowna, and Prince George.[31][1]
Infant Transport Team
The Infant Transport Team (ITT) are specialized critical care paramedics who are specifically trained in management of perinatal, neonatal and pediatric patients. Formerly, they were primary care paramedics (with many ACP Schedule 2 endorsements) with advanced training to provide emergency medical care to pediatric, neo-natal and high-risk obstetric patients. ITT paramedics work in close collaboration with practitioners at BC Children's & Women's Hospital in Vancouver. The team functions as an extension of the neonatal/pediatric intensive care unit as well as the high risk labour and delivery areas of the hospital. Tertiary level critical care is delivered by the team to the bedside at any location in the province.
They respond as an equally qualified team of two and sometimes take a physician with them for critically ill patients. When dispatched on street calls, these are targeted response ambulances that often assist or intervene when necessary, but can hand a more stable patient off to a layered or co-responding PCP ambulance. The team currently consists of only 25 specially trained paramedics for the entire province.[32]
Critical Care Paramedic
Critical Care Paramedics (CCPs) provide the most sophisticated care, including transporting patients by air and ground. CCPs specialize in the transport of complex critically injured or ill patients to specialized centres.[30]
Paramedic Specialist
Paramedic Specialists are licensed advanced care and critical care paramedics who are trained to handle disasters and mass casualty events.[30]
BC Ambulance has clinical consultation available for paramedics where paramedic specialists are enabled and empowered by the organization and by the medical directors to provide clinical, safety, and operational advice to paramedics. The pre-hospital environment poses many clinical challenges to practising paramedics. When faced with these challenges it may be appropriate to seek clarity with an appropriate senior clinician. Paramedics at all license levels can call CliniCall to speak with a paramedic specialist who will be either an ACP or a CCP.[15]
Paramedic (Secondary) Triage Clinician
Secondary Triage Clinicians are experienced primary care paramedics who conduct follow-up assessments on low acuity patients to determine the most appropriate care plan and response. STCs provide advice via telephone and live video to activate self-care and alternative conveyance pathways for their patients across the province.
Link and Referral Unit Paramedics
Link and Referral Units are specialized primary care paramedic units that assess and transport low acuity patients in place of an emergency ambulance. The LARUs in service are directed to the most appropriate calls by the Low Acuity Patient Navigator and are supported by a Low Acuity Dispatcher.
Wages and benefits
Wages are paid according to license qualification, years of service and supervisory status. Additional service pay is gained at 10, 15, 20, and 25 years of service.
Casual/on-call staff receive $12/hour for on-call shifts until they are called to respond, at which point they receive their full wage.[34][35][36]
Part-time and full-time PCP positions are considered separate internal job postings and are filled according to seniority. Selection for full-time PCP positions is determined by total full-time seniority and then, if there are no more full-time PCP applicants, total part-time seniority.[34] Stations in Vancouver typically have the lowest entry threshold for full-time PCP positions. While this has traditionally meant working for in smaller towns to accumulate at least five years of part-time seniority, the required part-time seniority for accepting a full-time spot in Vancouver is currently approaching zero months.
See also
E-Comm, 9-1-1 call and dispatch centre for Southwestern BC
Emergency medical services (EMS), also known as ambulance services, pre-hospital care or paramedic services, are emergency services that provide urgent pre-hospital treatment and stabilisation for serious illness and injuries and transport to definitive care. They may also be known as a first aid squad, FAST squad, emergency squad, ambulance squad, ambulance corps, life squad or by other initialisms such as EMAS or EMARS.
An emergency medical technician is a medical professional that provides emergency medical services. EMTs are most commonly found serving on ambulances and in fire departments in the US and Canada, as full-time and some part-time departments require their firefighters to at least be EMT certified.
A paramedic is a healthcare professional trained in the medical model, whose main role has historically been to respond to emergency calls for medical help outside of a hospital. Paramedics work as part of the emergency medical services (EMS), most often in ambulances. They also have roles in emergency medicine, primary care, transfer medicine and remote/offshore medicine. The scope of practice of a paramedic varies between countries, but generally includes autonomous decision making around the emergency care of patients.
A certified first responder is a person who has completed a course and received certification in providing pre-hospital care for medical emergencies. Certified individuals should have received much more instruction than someone who is trained in basic first aid and cardiopulmonary resuscitation (CPR) but they are not necessarily a substitute for more advanced emergency medical care rendered by emergency medical technicians and paramedics. First responders typically provide advanced first aid level care, CPR, and automated external defibrillator (AED) usage. The term "certified first responder" is not to be confused with "first responder", which is a generic term referring to the first medically trained responder to arrive on scene and medically trained telecommunication operators who provide pre-arrival medical instructions as trained Emergency Medical Dispatchers (EMD). Many police officers and firefighters are required to receive training as certified first responders. Advanced medical care is typically provided by EMS, although some police officers and firefighters also train to become emergency medical technicians or paramedics.
Advanced Life Support (ALS) is a set of life saving protocols and skills that extend basic life support to further support the circulation and provide an open airway and adequate ventilation (breathing).
A paramedic is a healthcare professional, providing pre-hospital assessment and medical care to people with acute illnesses or injuries. In Canada, the title paramedic generally refers to those who work on land ambulances or air ambulances providing paramedic services. Paramedics are increasingly being utilized in hospitals, emergency rooms, clinics and community health care services by providing care in collaboration with registered nurses, registered/licensed practical nurses and registered respiratory therapists.
Hamilton Paramedic Service is the designated service provider for emergency medical services (ambulance) in the City of Hamilton, Ontario.
Ottawa Paramedic Service is a uniformed municipal public safety agency providing emergency and non-emergency paramedic care to residents and visitors of city of Ottawa, Ontario. It is the sole, licensed, statutory provider and is operated directly by the city. The Service is an independent third service provider. This means that it is part of the Emergency and Protective Services department of the city but functions as an independent and separate agency from other services. The Ottawa Paramedic Service operates in compliance with legislation and licensing standards overseen by the government of Ontario. It also provides routine, non-emergency transports and emergency paramedic coverage for special events. It is the only service provider permitted to service medical emergency calls in the City of Ottawa.
In the United States, emergency medical services (EMS) provide out-of-hospital acute medical care and/or transport to definitive care for those in need. They are regulated at the most basic level by the National Highway Traffic Safety Administration, which sets the minimum standards that all states' EMS providers must meet, and regulated more strictly by individual state governments, which often require higher standards from the services they oversee.
Winnipeg Fire Paramedic Service (WFPS) provides fire and EMS services to the City of Winnipeg, Manitoba. It operates from 27 fire stations, and 3 administration offices across the city.
Emergency medical services in Canada are the responsibility of each Canadian province or territory. The services, including both ambulance and paramedic services, may be provided directly by the province, contracted to a private provider, or delegated to local governments, which may, in turn, create service delivery arrangements with municipal departments, hospitals, or private providers. The approach, and the standards, vary considerably between provinces and territories.
Emergency medical personnel in the United Kingdom are people engaged in the provision of emergency medical services. This includes paramedics, emergency medical technicians and emergency care assistants. 'Paramedic' is a protected title, strictly regulated by the Health and Care Professions Council, although there is tendency for the public to use this term when referring to any member of ambulance staff.
An advanced emergency medical technician (AEMT) is a provider of emergency medical services in the United States. A transition to this level of training from the emergency medical technician-intermediate, which have somewhat less training, began in 2013 and has been implemented by most states. AEMTs are not intended to deliver definitive medical care in most cases, but rather to augment prehospital critical care and provide rapid on-scene treatment. AEMTs are usually employed in ambulance services, working in conjunction with EMTs and paramedics; however they are also commonly found in fire departments and law enforcement agencies as non-transporting first responders. Ambulances operating at the AEMT level of care are commonplace in rural areas, and occasionally found in larger cities as part of a tiered-response system, but are overall much less common than EMT- and paramedic-level ambulances. The AEMT provides a low-cost, high-benefit option to provide advanced-level care when the paramedic level of care is not feasible. The AEMT is authorized to provide limited advanced life support, which is beyond the scope of an EMT.
In the United States, the licensing of prehospital emergency medical providers and oversight of emergency medical services are governed at the state level. Each state is free to add or subtract levels as each state sees fit. Therefore, due to differing needs and system development paths, the levels, education requirements, and scope of practice of prehospital providers varies from state to state. Even though primary management and regulation of prehospital providers is at the state level, the federal government does have a model scope of practice including minimum skills for EMRs, EMTs, Advanced EMTs and Paramedics set through the National Highway Traffic Safety Administration (NHTSA).
Emergency Medical Responders (EMRs) are people who are specially trained to provide out-of-hospital care in medical emergencies, typically before the arrival of an ambulance. Specifically used, an emergency medical responder is an EMS certification level used to describe a level of EMS provider below that of an emergency medical technician and paramedic. However, the EMR is not intended to replace the roles of such providers and their wide range of specialties.
Ambulance Services in Hong Kong are provided by the Hong Kong Fire Services, in co-operation with two other voluntary organisations, the Auxiliary Medical Service and the Hong Kong St. John Ambulance.
Emergency medical services in Australia are provided by state ambulance services, which are a division of each state or territorial government, and by St John Ambulance in both Western Australia and the Northern Territory.
The Queensland Ambulance Service (QAS) is the state emergency ambulance and patient transport provider in Queensland, Australia. QAS is part of the Queensland Government under the Queensland Health portfolio and is one of the largest ambulance services in the world.
The Ambulance Operators Association of Nova Scotia (AOANS) was the provincial association representing ambulance company owners in Nova Scotia. The association's focus was negotiating with the Government of Nova Scotia over funding and private ownership of ambulance services. The AOANS was also contracted by the Government of Nova Scotia to provide a training program for ambulance personnel and an ambulance inspection program. Between 1994 and 1999, after the publication of the Murphy Report, Nova Scotia transitioned to a single ambulance service provider. This resulted in the AOANS members being bought–out and their ambulance services merged into the new system. The AOANS was formally dissolved in 2002.
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