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Paramedic Equivalency Process


The following is an outline of the Advanced Emergency Medical Care Assistant (A-EMCA) Competencies in Ontario. These competencies will be used when assessing candidates requesting equivalency for programs that have not already been validated in this province.

The Advanced Emergency Medical Care Assistant is expected to  :

  • determine and/or ensure the safety of the patient's environment prior to and during patient care;
  • select those elements of the primary assessment and immediate priority management that are to be implemented in patient situations of :
    1. obvious threat of life,
    2. potential for threat of life,
    3. non-compromised/stable condition
    4. Paramedic Equivalency Process
  • differentiate those elements of history that are significant in :
    1. presenting chief complaint or incident,
    2. information from the environment surrounding the patient, e.g. dynamics of injury, medication prescribed or taken, other suggested sources of data,
    3. presenting manifestations of the patient,
    4. type of trauma or pathological condition of the patient,
    5. progression/deterioration of the condition.
  • discriminate those patient situations in which :
    1. a complete secondary assessment (including vital signs) is to be performed,
    2. only priority elements of a priority assessment (including vital signs) are to be selectively performed,
    3. secondary assessments are to be performed during transport,
    4. specific qualitative diagnosed assessments are to be performed
    5. .
  • provide the rationale to support the discrimination used in selecting the priority and/or diagnostic assessments which are performed;
  • interpret the significance of assessment findings pertinent to the :
    1. patient's physical behavioral and physiological manifestations,
    2. potential for deterioration in the patient's status,
    3. obvious manifestations of threat of life,
    4. need for further reassessment.
    implement management priorities, basing the selection on relevance to the :
    1. presenting manifestations of the patient(s),
    2. pathology or trauma involved,
    3. priority management needs of the patient
    4. measures to provide psychological support and therapeutic communication,
    5. patient's age, comprehension ability, coping ability and/or crisis state,
    6. potential for deterioration and/or threat of life,
    7. need for minimal stabilization and immediate transport,
    8. legal implications related to patient care and transport.
  • provide the rationale to support the decision making and judgments used in selecting the priorities in patient management;
  • implement those measures to ensure safe lifting, transferring and transport;
  • report and record the :
    1. chief complaint,
    2. presenting priority assessment findings,
    3. relevant history of the incident or past medical history,
    4. summary of significant changes in status,
    5. response to the provided management.
  • Apply the principles of assessment and management to the triage situation in which multiple patients are involved.

Emergency Health Services Branch recognizes the interpretation, judgement and critical decision-making skills developed during the educational program for an Ontario Advanced EMCA as essential. Therefore, an equivalency candidate must demonstrate that they have had an opportunity to develop such skills either through a similar educational program or through extensive EMS work experience.

To assist candidates in pre-determining their potential for equivalency, the following components are included within the educational program that an Ontario Advanced EMCA completes.

Theory component (800+ hours), including topics such as  :

  • anatomy and physiology
  • pathophysiology
  • disease and trauma processes
  • emergency patient care
  • legal and ethical issues
  • psychology/sociology
  • symptom relief (SR)
  • pharmacology
  • semi-automatic external defibrillation (S-AED)
  • supportive and therapeutic communications
  • crisis intervention

Practical lab and hospital clinical component (300 hours) including areas such as :

  • patient assessment and treatment
  • equipment skills
  • driver improvement
  • intravenous initiation TKO

Land Ambulance Field placement (min. 450 hours) :

  • Receive a satisfactory evaluation from a preceptor crew following 450 hours of land ambulance experience.

Eligible candidates must forward the following documentation to the Emergency Health Services Branch of the Ontario Ministry of Health and Long Term Care. (Administration Fee : $50.00 * All certified cheques/money orders must be made payable to the Minister of Finance).

  1. a letter of evaluation from a Land Ambulance Manager/Supervisor attesting to :
    1. the candidate's competency in delivering pre-hospital patient care,
    2. the number of hours of land ambulance pre-hospital patient care experience
    3. ,
  2. a verified copy of their post secondary educational transcripts,
  3. confirmation of registrations/licenses and/or certificates,
  4. Course outlines, including a breakdown of curriculum hours and learning outcomes.

The candidate's qualifications will be verified and assessed against the standards in Ontario.


The candidates assessed as acceptable will be required to complete a selection of qualifying tests to determine the candidate's knowledge and skills as they pertain to pre-hospital care in Ontario. These tests include  :

  • Ontario Ambulance Legal Test
    This written test is designed to assess the candidate's knowledge of the Ontario Legislative framework as it pertains to the ambulance system. (Administration Fee : $20.00)
  • Symptom Relief Test
    This written test is designed to assess the candidate's knowledge of the Ontario protocols for the delivery of symptom relief drugs. (Nitroglycerin, ASA, Ventolin, Epinephrine and Glucagon). (Administration Fee : $20.00)
  • Semi-Automatic External Defibrillator Test This written test is designed to assess the candidate's knowledge of the Ontario protocols for the delivery of semi-automatic defibrillation. (Administration Fee : $20.00)
  • Patient Care Tests This oral and skills test is designed to assess the candidate's proficiency, based upon Ontario standards, and protocols with :
    • Equipment Practical Test :  various pieces of equipment (stretcher, Sager splint, K.E.D., spinal board, Genesis II ventilator)
    • Symptom Relief Practical Test : skills associated with symptom relief
    • Defibrillation Practical Test   skills associated with defibrillation;
    • Practical Scenario : a practical problem solving scenario. (Administration Fee : $100.00)

English proficiency will be assessed throughout the tests.

Please note  :
All equivalency candidates are offered 3 attempts to complete the testing components. At each re-attempt only the components that are unsuccessful will be retried.

Upon successful completion of the required qualifying tests, the candidate is eligible to write the Advanced Emergency Medical Care Assistant theory exam. (Fee : $250.00)

Note : This exam is conducted twice a year - Winter and Summer.

Upon successful completion of the Advanced EMCA theory exam, the candidate will be issued an Advanced Emergency Medical Care Assistant Certificate.

For further information please email :


For more information
Emergency Health Services Branch
5700 Yonge Street, 6th Floor
Toronto, Ontario
M2M 4K5
Tel : 1-800-461-6431 (Toll-free in Ontario only)
Fax : 416-327-7911
Email :
Call the ministry INFOline at 1-800-268-1154
(Toll-free in Ontario only)
In Toronto, call 416-314-5518
TTY 1-800-387-5559
Hours of operation : 8:30am - 5:00pm.
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