# Advanced Care Paramedic ( ACP )



## mariomike (4 May 2013)

This is how it works in Toronto.

To apply for a job as an ACP, all candidates must have a minimum of three years seniority with T-EMS as a PCP. ( ACP jobs are closed to external applicants. )

They are then required to write the selection exam. 

Those who pass are ranked based on departmental seniority ( Senior Qualified Process ) to determine their eligibility to enter the ACP training program.

This explains how the Regional Advanced Care Paramedic Training Program works for out of town services:
http://www.temsregionaled.ca/index.html


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## Hunter (17 Jun 2013)

On the website it states that the program was accorded a 6-year CMA accreditation in 2006.  Has this accreditation been renewed?


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## Civvymedic (17 Jun 2013)

There are also other Ontario colleges that offer the ACP program. Durham college and Georgian college to name 2. I teach at Georgian and think we have an excellent program, but of course I have some bias.


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## mariomike (17 Jun 2013)

Hunter said:
			
		

> On the website it states that the program was accorded a 6-year CMA accreditation in 2006.  Has this accreditation been renewed?



Looks like it has.

Toronto EMS, Christopher J. Rubes Centre for EMS Studies - Advanced Care Paramedic (Internal), Toronto

http://www.toronto.ca
Status: 6-Year Accreditation. Expiry date: 2015/09/30 


Partner/delivery sites:
 Delivery site - Toronto, Toronto 


Toronto EMS, Christopher J. Rubes Centre for EMS Studies - Advanced Care Paramedic (Regional), Toronto

http://www.toronto.ca
Status: 6-Year Accreditation. Expiry date: 2015/09/30 


Partner/delivery sites:
 Delivery site - Brantford, Brantford 
 Delivery site - Oakville, Oakville 
http://www.cma.ca/index.php/ci_id/50602/la_id/1.htm#PARA-ON



			
				Civvymedic said:
			
		

> I teach at Georgian and think we have an excellent program, but of course I have some bias.



No doubt you have an excellent program, but how much does it cost? Is it on your own time?

The T-EMS ACP program is on Departmental time and expense while on full salary. 

This is the only way to become a Level 3 ( ACP ) in Toronto. Your salary and tuition is paid for by the City.
http://www.temseducation.com/moodle/pluginfile.php/5432/mod_resource/content/1/Level%20III%20Training%20Opportunity%20May%201%202013.pdf


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## Civvymedic (17 Jun 2013)

Unfortunately not everyone can work in Toronto and have ACP fully covered. There is a big EMS world outside of Toronto. No offense. 

Some of our students are from outside the Province, others are paying for it on there own and work for services in Ontario. Others have had employers pay for the course, such as Simcoe. We have a great mix of students.

The program is 3 semesters, full time. The cost is about 18 k. After graduation as you know an ACP in Ontario can expect to earn a very good living. 

Everyone is a working Paramedic and some courses are taught live on line.


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## mariomike (17 Jun 2013)

Civvymedic said:
			
		

> After graduation as you know an ACP in Ontario can expect to earn a very good living.



I would be among the first to say that they are worth every penny, and more.


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## pbi (31 Jul 2013)

mariomike said:
			
		

> I would be among the first to say that they are worth every penny, and more.



We have come a very, very long way since the days in Ontario when ambulances were run by funeral homes and taxi companies!


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## mariomike (31 Jul 2013)

pbi said:
			
		

> We have come a very, very long way since the days in Ontario when ambulances were run by funeral homes and taxi companies!



I never heard of a taxi company operating an ambulance service in Ontario, but many funeral homes did. The first ambulances were modifications of funeral car ( and mortuary stretcher ) designs of the time. Funeral Directors had education and experience in the natural sciences. Possibly, second only to that of the local physician.

The City of Toronto has owned and operated ( as an independent Department ) the emergency ambulance service since 1933.

When I hired on in 1972, basic training was still only 160 hours at the Metro Toronto Department of Emergency Services school. 

By 1975 basic training had increased to 1,400 hours. 

There is additional training for the Emergency Task Force, Public Safety Unit, CBRN, Emergency Support Unit, Heavy Urban SAR, Multi-Patient Unit, Critical Care Unit, Community Program, and the Marine Unit. 

In 1984, Toronto’s first Advanced Care Paramedics hit the streets, armed with an additional 1000 hours of training.

Since 2002, the PCP entry level diploma program is two years long.

The University of Toronto is now offering a four-year degree in Paramedicine.


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## pbi (1 Aug 2013)

mariomike said:
			
		

> I never heard of a taxi company operating an ambulance service in Ontario...



In the early 1970s, the taxi company in Petawawa village at one point operated an ambulance. I guess this might have made some sense if you consider that they had radio communications, they knew the road system pretty well, and somebody was awake late at night. Their medical training might have left something to be desired.



			
				mariomike said:
			
		

> The first ambulances were modifications of funeral car ( and mortuary stretcher ) designs of the time. Funeral Directors had education and experience in the natural sciences. Possibly, second only to that of the local physician.



Where I grew up (the Township of Toronto, now Mississauga) the two ambulances in our area were both run by funeral homes. Funeral homes also commonly rented oxygen for home use, and hospital beds. At first glance this seemed very nice of them, but in fact I think it got their foot in the door for business:

"_Hello, Funeral Home?...Grandad won't be needing the oxygen and the bed anymore_"

"_Oh, really? That's too bad. Anything else we can help you with?_"

I think the Province started to clean up the situation in the laet '60s or early '70s when they moved to a provincial ambulance service model (except, I think, for Toronto EMS)


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## mariomike (1 Aug 2013)

pbi said:
			
		

> I think the Province started to clean up the situation in the laet '60s or early '70s when they moved to a provincial ambulance service model (except, I think, for Toronto EMS)



In Ontario, prior to 1968 when ambulance service came under the provincial health insurance plan, things were indeed bad. Especially in less populated areas.  

But, after 1968, few jurisdictions in North America had standards as high as Ontario. The Ontario Hospital Services Commission ( OHSC ) owned and supplied the ( blue and white ) ambulances and equipment to licensed ambulance services. The were hooked into a province-wide communications network. The province issued all licenses, set the standards for vehicles, equipment and training. Grade 12 minimum became mandatory to be hired. 160 hours of mandatory training came into effect in 1968 for every ambulance attendant in Ontario. At the time, that was significant. 

Metro Toronto remained the only municipality to operate its own emergency service. The province provided funding, but Metro took responsibility for the quality of the service.  The ambulances were cream coloured modular "coffee wagon" style with the Metro emblem. The warning system, uniform and other things were different. The debate over which level of government - Metro or the province - maintained the highest standards was long standing - even 45 years ago. 

Metro operated independently under Commissioner Pollard. The rest of the province served under Dr. McNally, Director of the provincial Emergency Health Services Division.



			
				pbi said:
			
		

> Where I grew up (the Township of Toronto, now Mississauga) the two ambulances in our area were both run by funeral homes.


 
I remember working highway accidents with crews from Fleuty ( Cooksville ), Skinner and Middlebrook ( Port Credit )  and Lee ( Streetsville  ) in the early 1970's.  

There was a story in the Star on 5 July, 1973 comparing the provincial and Metro ambulance systems "differences of opinion and philosophies."

"While McNally would like to see ambulance attendants become 'truly paramedical personnel' with intensive training, Pollard says, "It's the most unrealistic thing I've ever seen in my life to increase the specialization ( of medical training ) to an abnormally high degree...where does it stop? How much do we pay these highly trained people? It really all comes down to dollars and cents."

Cheers


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## pbi (2 Aug 2013)

mariomike said:
			
		

> But, after 1968, few jurisdictions in North America had standards as high as Ontario. The Ontario Hospital Services Commission ( OHSC ) owned and supplied the ( blue and white ) ambulances and equipment to licensed ambulance services.



Like this old IH Travelall: this (in a blue and white scheme) was very common in a lot of places outside T.O.:
http://www.youtube.com/watch?v=kNxnJRUBFwQ&feature=player_detailpage



> I remember working highway accidents with crews from Fleuty ( Cooksville ), Skinner and Middlebrook ( Port Credit )  and Lee ( Streetsville  ) in the early 1970's.



Fleuty's and Lee's were the two I remember. Skinner's never had an ambulance, as far as I can recall (maybe you saw their pickup wagon?). Long after Mississauga was created, the only two ambulances running were Fleuty's and Lee's.

Just west of where I lived, in Trafalgar (now Oakville) was Alexander's Ambulance, which was unique in that it was a stand-alone ambulance firm. They operated several Cadillacs and Superior Criterions, like this one:
http://www.northlandpcs.com/images/museum/Miller_Meteor_Criterion_Ambulance_930.jpg

I remember the controversy over bringing in the paramedic model versus the "ambulance attendant" model. If I recall correctly some doctors were strongly opposed to the idea that a non-doctor could be allowed to administer the protocols that are now common for paramedics and probably even EMTs.

I wonder how many people died in those days who would be alive today?

Cheers


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## mariomike (2 Aug 2013)

pbi said:
			
		

> Like this old IH Travelall: this (in a blue and white scheme) was very common in a lot of places outside T.O.:
> http://www.youtube.com/watch?v=kNxnJRUBFwQ&feature=player_detailpage



I remember seeing them running 183's ( emergency transfers ) from Anyhospital, Ontario into downtown hospitals such as Sick Kids etc. 
The only colour I recall was the official OHSC blue and white. 

Also, the OHSC yard was on Horner Ave. in south Etobicoke ( probably still is? ), so we got to see a lot of their smashed up wrecks getting ready for the scrap yard. 
It was a sad sight, because the limousine style ambulances ( Superior, Miller-Meteor, Cotner-Bevington ) were beautiful. Too many of us, they were works of art.
( I don't mean the truck types like the International Travel-alls, Ford Econolines and GMC Suburbans etc. I doubt if anyone missed them. I am referring to the Cadillac / Oldsmobiles etc. )

Remember too that back then those types of light trucks and vans were not yet popular as personal vehicles. They were built for tradesmen etc. so niceties like padded dashboards, air-conditioning and power steering etc. were not included. 



			
				pbi said:
			
		

> Fleuty's and Lee's were the two I remember. Skinner's never had an ambulance, as far as I can recall (maybe you saw their pickup wagon?). Long after Mississauga was created, the only two ambulances running were Fleuty's and Lee's.



Skinner and Middlebrook definitely had a licensed ambulance. I remember their Pontiac Bonneville at accident scenes on the QEW and at Queensway Hospital ER.  
It was replaced by a regulation OHSC blue and white Ford.  

Something to remember about the funeral homes "back in the day" was that many operated "combination cars" ( Hearse, ambulance and first-call, all-in-one. ) 
However, the Skinner and Middlebrook Bonneville ambulance was definitely an ambulance only, not a combination car. 



			
				pbi said:
			
		

> Just west of where I lived, in Trafalgar (now Oakville) was Alexander's Ambulance, which was unique in that it was a stand-alone ambulance firm. They operated several Cadillacs and Superior Criterions, like this one:
> http://www.northlandpcs.com/images/museum/Miller_Meteor_Criterion_Ambulance_930.jpg



Not sure if I specifically remember Alexander's Ambulance, but I saw lots of Cadillacs, Oldsmobiles etc. coming into the city from out of town.  

Emergency operations in Toronto would have destroyed them.

Incidentally, when the Ontario Ambulance Act was passed in 1966*, it was expressly forbidden to transport a dead body along side a viable patient in the same ambulance. 
This did not serve the Funeral Homes well as a Home would make $ 25.00 to retrieve a deceased body but only $5.00 for transportation to a hospital of a viable person.
It was obvious to see who would have transport priority from accident scenes!

( We transported many D.O.A.s back then to the old morgue on Lombard St., but never with a living patient. At least, not intentionally.   )

T-EMS has a 1954 Packard for parades etc. Here it is parked outside the City Archives on Spadina Ave.
http://www.flickr.com/photos/rfzappala/4650668086/

I got to drive it a few times. Something a bit creepy about it is that, in the patient compartment, it has two manequins. One dressed as the attendant, the other as a stretcher patient with wearing an oxygen mask. You get some looks from people!

* This was the year that "Accidental Death and Disability: the Neglected Disease of Modern Society" commonly known as "the White Paper" was published in the U.S. This is generally considered to be the beginning of paramedicine in North America. 



			
				pbi said:
			
		

> I remember the controversy over bringing in the paramedic model versus the "ambulance attendant" model. If I recall correctly some doctors were strongly opposed to the idea that a non-doctor could be allowed to administer the protocols that are now common for paramedics and probably even EMTs.
> 
> I wonder how many people died in those days who would be alive today?
> 
> Cheers



Doctor McNally ( the provincial director ) was in favour of it, but Commisioner Pollard ( Metro ) was less than enthusiastic about paramedic training because of the cost.

Not so well known now, but Doctor McNally did encounter resistance from the medical profession.

"Sadly Dr. McNally failed to consider the opinions of his colleagues Province wide.
As the first Advanced Ambulance man arrived in his small town service and presented his papers announcing his new skills to the Hospital administrators, the home town Physicians refused to allow it.

As the 2nd. Class of advanced Ambulance men studied and performed, Dr. McNally began receiving pressure from the most powerful political lobbyists.

The College of Physicians and Surgeons would not have any part in this delivery of medical skills by non-physicians.

Dr. McNally fought with all his political connections; however as the 3rd. Class of advanced Ambulance men celebrated their graduation Dr. McNally agreed to stop the course and agreed that No advanced Ambulance man would be allowed to used his advanced skills in the province of Ontario.

Enabling legislation was never passed, and so none of the graduates were ever permitted to practice their skills. Seen as too expensive, the program was replaced in 1971 by the Ambulance and Emergency Care Program at Humber College, Toronto."

From "The History of Ontario EMS" by Brent Goodwin ACP

The attached photo is the type of ambulance I worked in my early days. 

The photo was taken at the scene of a construction accident on July 8, 1975 at the base of the not yet completed CN Tower.

Interesting to note the Royal York Hotel ( directly over the open patient compartment door ) and compare it to the skyline of today!

Cheers.


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## pbi (3 Aug 2013)

OK: you have me on Skinner and Middlebrook's ambulance. I honestly never knew that.  

For a while, back in the days of Township of Toronto (prior to 1967 when Mississauga was formed), the TTFD operated two Mercury station wagons, one red and one white, which ran as chief's cars but were equipped as ambulances. They were very nice looking vehicles, with  big tail fins and big chrome siren-light "bullets" mounted on the roofs. I'm not sure why the TTFD did this, but I think that the TFD also did the same thing then.

I remember the old Toronto cream-coloured "box ambulances" very well. When I was in Grade 6 I did a school project on fire trucks, and my Dad took me to the TFD station on Lansdowne Ave. There was a city EMS ambulance quartered next door, and the crew was kind enough to show us around.


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## mariomike (3 Aug 2013)

pbi said:
			
		

> I remember the old Toronto cream-coloured "box ambulances" very well. When I was in Grade 6 I did a school project on fire trucks, and my Dad took me to the TFD station on Lansdowne Ave. There was a city EMS ambulance quartered next door, and the crew was kind enough to show us around.



That was the old #5 ( ambulance ) station. "The Parkdale Express". The fire side of the house had a different number.  

You would have been much smaller then, but even so, do you remember how tiny the crew quarters were? There was only one couch, and many battles for it.   

Didn't matter anyway, because you were never in for more than a few minutes at a time back then.   

Most of the Boroughs had station wagons at major fire scenes that could carry an injured firefighter, because ambulances did not routinely stand by at fires back then. 

They were not licensed ambulances and did not respond to calls. They just stood by at fires because they knew from experience how long it could take for an ambulance to arrive on scene.


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## pbi (4 Aug 2013)

mariomike said:
			
		

> That was the old #5 ( ambulance ) station. "The Parkdale Express". The fire side of the house had a different number.


Actually I think it was TFD Station 5. My girlfriend (much later...!) lived in Parkdale, in that station's first due area, and I'm pretty sure it was Station 5.



			
				mariomike said:
			
		

> Most of the Boroughs had station wagons at major fire scenes that could carry an injured firefighter, because ambulances did not routinely stand by at fires back then. They were not licensed ambulances and did not respond to calls. They just stood by at fires because they knew from experience how long it could take for an ambulance to arrive on scene.



If I remember correctly, I think this was the explanation that a firefighter gave me. Must have been difficult to provide any care to the patient in the back of one of those station wagons with the low roof line.


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## mariomike (4 Aug 2013)

pbi said:
			
		

> Actually I think it was TFD Station 5. My girlfriend (much later...!) lived in Parkdale, in that station's first due area, and I'm pretty sure it was Station 5.



The ambulance side of the house was 5 Station. 

The TFD side was 15 Station.
http://www.tfspics.com/Toronto-Fire-Stations/Toronto-Fire-Stations/11223463_mTMhdC#!i=821374670&k=tRRXQxt&lb=1&s=A  

Cheers


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## pbi (6 Aug 2013)

I must have the wrong station. The one I visited was built before 1972(it was in the late 60's when I visited), and the ambulance station was an addition to the structure, not a standalone.

I think it may have been this one on Dufferin: http://www.tfspics.com/Toronto-Fire-Stations/Toronto-Fire-Stations/11223463_mTMhdC#!i=819438208&k=nxTZJgS&lb=1&s=A. This was built early enough.


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## mariomike (6 Aug 2013)

pbi said:
			
		

> I must have the wrong station. The one I visited was built before 1972(it was in the late 60's when I visited), and the ambulance station was an addition to the structure, not a standalone.
> 
> I think it may have been this one on Dufferin: http://www.tfspics.com/Toronto-Fire-Stations/Toronto-Fire-Stations/11223463_mTMhdC#!i=819438208&k=nxTZJgS&lb=1&s=A. This was built early enough.



That's on Dufferin south of Dupont ( across from the Galleria ). Similar to the one in Parkdale. The fire side was 14 Station, and the ambulance side ( that single bay on the right side ) was the old 6 Station. 

The ambulance in Parkdale was later moved to a nice "purpose built" EMS station ( 37 ) at Dufferin and Queen. 6 Station also was relocated to a very nice "purpose-built" EMS quarters ( 33 Station ) at Dovercourt and Bloor.

All T-EMS stations were renumbered in 1976 and the TFS stations were renumbered in 1998.

Cheers


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