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Paramedic Equivalency Process
Standard PCP Equivalency
Standard ACP Equivalency
AIT Equivalency
Q&A - Equivalency
Education Contacts
Paramedic Courses

Ontario Paramedic Equivalency Process

In order to become employed in Ontario as a paramedic at any level, a person must hold an Advanced Emergency Medical Care Assistant (AEMCA) qualification or hold training and qualifications deemed equivalent by the Director, Emergency Health Services Branch, as identified within Ontario Regulation 257/00 Part III, made under the Ambulance Act.


The Ontario Paramedic Equivalency Process provides an opportunity for paramedics who have not graduated from an Ontario College Paramedic Program to present their experience and qualifications on a case-by-case basis, to determine eligibility to challenge the AEMCA Theory Examination. The Equivalency Process for all applicants involves two phases - validation of educational and work experience, and qualifying evaluations.

The outline below describes the competencies required for AEMCA Equivalency, and the components that are included within the Ontario College Paramedic Program. The candidate's qualifications will be verified and assessed against these standards in Ontario.

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Advanced Emergency Medical Care Assistant (AEMCA) Competencies

The following outline lists the abilities paramedic candidates without Ontario AEMCA credentials (or recognized equivalent credentials) will be judged on while being considered for equivalency. The Advanced Emergency Medical Care Assistant must :

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

The following components are included within the educational program that an Ontario AEMCA completes. Consider them if you are interested in studying to be an Ontario AEMCA or applying for equivalency :

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

Land ambulance field placement (minimum 450 hours) :

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

The outline below describes the competencies required for ACP Equivalency, and the components that are included within the Ontario College ACP Program. The candidate's qualifications will be verified and assessed against these standards in Ontario.

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Advanced Care Paramedic (ACP) Competencies
  1. Weekly student evaluation completed by a clinical supervisor. This should identify learning issues and show student progression.
  2. Minimum 20 successful human intubations (signed off by anesthesia or equivalent). In addition, 2–5 pediatric airway management cases (+/- intubation).
  3. Minimum 20 ED patient assessments reviewed by the clinical supervisor.
  4. Minimum 20 complete patient charts (consistent with field or hospital practice).
  5. Minimum 20 successful IV starts.
  6. Completion of a daily journal (completed by the student)
  7. Completion of a daily clinical skills tracking log
  8. Student feedback on clinical rotation

The clinical skills must match the National Occupational Competency Profiles (NOCP’s). All areas marked as “C” in the NOCP’s must be demonstrated in the clinical environment. This must be signed-off by the clinical supervisor.

As mentioned earlier, the Equivalency Process for all applicants involves two phases - validation of educational and work experience, and qualifying evaluations.

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Phase 1 - Validation of Education and Work Experience

The Emergency Health Services Branch sees the interpretation, judgement and critical decision-making skills developed during Ontario Advanced Emergency Medical Care Assistant (AEMCA) education 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.

Once all required documentation is received, a determination is made on which Equivalency Process the applicant will enter - either AIT Equivalency or Standard Equivalency (both described below) - based upon the documentation provided.

Analysis of the documentation will be conducted and a decision on equivalency status will be provided in writing. The applicant will be advised of the next steps required to complete the Equivalency Process, as applicable.

Therefore, all applicants should carefully review the Required Documents and Qualifications section of the Equivalency Process being completed to ensure that all required documentation is included when submitting an application. Applications with missing documentation may cause a delay in processing.

Applications and documentation submissions should be sent to Education and Patient Care Standards.

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Phase 2 - Qualifying Evaluations

Once a candidate successfully completes Phase 1, they must then complete the qualifying evaluations within twenty-four (24) months to determine their knowledge and skills for pre-hospital care in Ontario. English proficiency will be assessed throughout the tests. Candidates are permitted a maximum of four attempts to complete all testing components. At each re-attempt, only the components that were completed unsuccessfully will be re-administered.

Practical, scenario based evaluations are conducted in "real" time, with the call to be completed as if it were a real situation. The following main categories will be evaluated against applicable standards, i.e. Basic Life Support and Patient Care Standards (BLS), Advanced Life Support and Patient Care Standards (ALS) :

  • Completion of an appropriate scene survey
  • Primary survey, including any critical interventions required as determined by the paramedic during their initial assessment
  • Assessment of patient history
  • Vital signs
  • Secondary survey
  • Patient management - including the use of related equipment where applicable
  • Patient reporting - including hospital update through dispatch and report to hospital receiving staff
  • Transport decision

There are nine dates scheduled for equivalency qualifying testing during the year. Typically, qualifying testing dates are scheduled to precede the AEMCA exam. Equivalency candidates who are successful at Phase 1 and are required to write the AEMCA exam are provided with a list of those scheduled dates for Phase 2.

Candidates eligible for Phase 2 must submit their application along with a certified cheque or money order made payable to the Minister of Finance for the amount of the administrative fees required for the components they will be undertaking.

Application and payment must be received by the Education and Patient Care Standards section of Emergency Health Services Branch no later than two weeks prior to the requested testing date.

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AIT Equivalency

The Emergency Health Services Branch of the Ministry of Health and Long-Term Care (MOHLTC) continues to be an active supporter of paramedic mobility in Canada.  To this end, Ontario has a revised equivalency process for Primary Care Paramedics (PCP) and Advanced Care Paramedics (ACP) licensed/registered in other Canadian provinces and territories.  This revised process meets the most recent updated requirements of the Labour Mobility Provisions (Chapter 7) of the Agreement on Internal Trade (AIT).

The Ministry of Health and Long-Term Care (MOHLTC) AIT Paramedic Equivalency process ensures that paramedics who hold a valid license or certification in good standing from another Canadian province or territory as a PCP or ACP have employment opportunities in Ontario.  Paramedics seeking equivalency in Ontario who do not hold licensure/registration in another province or territory need to enter the MOHLTC Standard Paramedic Equivalency process.

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Standard Equivalency

Paramedics who have completed a paramedic training program from another country or do not meet the AIT Equivalency requirements and want to work as a paramedic in Ontario must undertake the Standard Equivalency Process. Individuals from other disciplines, for example, Registered Nurses or Physicians, who may have experience and qualifications that is equivalent to an Ontario Paramedic graduate can also apply to undertake the Standard Equivalency Process.

Standard Equivalency applicants must successfully complete both Phase 1 and Phase 2 of the Standard Equivalency Process and successfully complete the Ministry of Health and Long-Term Care (MOHLTC) AEMCA Theory Examination. The successful completion of the MOHLTC AEMCA Theory Examination is required to obtain AEMCA certification.

For more information

Emergency Health Services Branch
5700 Yonge Street, 6th Floor
Toronto, Ontario
Canada     M2M 4K5

Tel : 1-800-461-6431 (Toll-free in Ontario only)
Fax : 416-327-7911
Email :

Call the ministry INFOline at 1-866-532-3161
(Toll-free in Ontario only)
TTY 1-800-387-5559
Hours of operation : 8:30am - 5:00pm
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