Until the beginning of 1998 the Ministry of Health and Long-Term Care fully funded and directed the operations of all land ambulance services in Ontario.

Beginning January 1, 1998, the province commenced the process of transferring the responsibility for the proper provision of land ambulance services to upper tier municipalities and designated delivery agents. By January 1, 2001, the transition was completed to the upper-tier municipalities and delivery agents. The ministry also provides financial assistance to the municipalities and delivery agents by providing a cost-sharing grant to fund one-half of the approved cost of land ambulance service. Additionally, the ministry sets standards for the delivery of land ambulance services and monitors and ensures compliance with those standards.

In the spring of 2000 amendments to the Ambulance Act and Regulations governing the provision of ambulance services came into effect. The historic licensing system for ambulance service operators that has been in place for over three decades was replaced by a periodic, quality based, certification scheme. A certificate to operate an air or land ambulance service is required before a person can commence to provide such a service. Persons seeking to operate an ambulance service who are not currently certified, can challenge a process that may lead to issuance of a certificate to operate an ambulance service for a period of one year. Current operators are required to complete prescribed certification process at least once in each three-year period. Both new and established operators are required to meet all of the quality requirements set out in the legislation and standards. Operators must complete the required certification process prior to the expiry of their existing certificate.

For more information related to land and air ambulance certification standards please visit the library at www.ambulance-transition.com.

Monitoring and ensuring the quality of patient care and service delivery is a vital element of any ambulance system. In Ontario the function of monitoring the appropriateness and quality of patient care is provided by a series of designated base hospital programs. The medical director of each base hospital program is responsible for certifying and delegating to each paramedic the authority to perform controlled medical acts. The base hospital medical director and other qualified emergency medical physicians monitor the quality of care provided by paramedics. These physicians also are available to provide paramedics with advice and direction concerning challenging or unusual emergency medical situation. Base hospital physicians also provide feedback to paramedics and provide and participate in continuing medical quality assurance and patient care competency maintenance activities for paramedics.

The Emergency Health Services Branch, Ministry of Health and Long-Term Care, may grant reciprocity/equivalency for paramedic training in pre-hospital care obtained outside the province through the Ontario Paramedic Equivalency Challenge Process. An equivalency candidate must demonstrate that they have had an opportunity to develop skills similar to the Ontario Advanced Emergency Medical Attendant (A-EMCA), either through a comparable educational program or through extensive EMS work experience.

Ambulance service in Ontario is a seamless program that responds to requests for service and transports patients cross municipal boundaries without reference to residence or other demographic factors. Central Ambulance Communications Centres (CACCs) facilitate this seamless approach by coordinating, directing and deploying the movement of all ambulances and emergency response vehicles within large geographic areas. Computer-assisted wide area central dispatching helps the dispatcher in assigning the closest available and most appropriate ambulance to each emergency. Emerging technologies such as Automatic Vehicle Location (AVL) and Global Positioning Systems (GPS) also assists CACC communications staff by identifying the location of the closest vehicle for response and helping the dispatcher direct the ambulance to the call scene.

A close working relationship between dispatch and ambulance services is required to move seriously ill and injured persons from one health care facility to another for treatment. The CACC computer aided dispatch system assists the dispatcher in managing this growing demand for medically essential ambulance transports between health care facilities while maintaining the necessary ambulance resources to respond to emergency calls.

Interactive computer technology enables a dispatcher in the CACC to link together physicians, paramedics, other providers of emergency health services and public safety agencies. The computer aided dispatch system also allows the dispatcher to track the status of emergency departments and the availability of health care specialists and beds at most of the advanced care hospitals and health care facilities in the province. The system also allows for the linking of land and air ambulance service to ensure a smooth integration of these two vital programs.

One of the core responsibilities of the Ministry of Health and Long-Term Care is to monitor and ensure compliance of ambulance service providers with the legislated standards. This is accomplished in a number of ways. Day-to-day monitoring of service delivery occurs through the CACCs. Ministry staff routinely visit municipalities, designated delivery agents and service providers to address program delivery and standards issues.

In addition the ministry conducts regular quality assurance reviews of air & land ambulance services, base hospitals and CACCs. These reviews are peer-orientated operational reviews that measure the success of each program provider in meeting the requirements for service delivery. This review program combines some characteristics of an accreditation process with those of an inspection and a compliance review program. This peer orientated review program serves as a basis for determining if a service operator is meeting the criteria for certification under the Ambulance Act and Regulations.

Supporting the land ambulance system, the provincial air ambulance program provides service to persons located in areas of the province that are remote or where land ambulance response times are great. Air ambulances also transport emergency and medically essential non-emergency patients to and from medical facilities when necessary.

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