As an integral part of the provision of land ambulance services, upper tier municipalities and designated deliver agents are responsible, either directly or through selected operators, for ensuring that patient care and transport are carried out in accordance with applicable legislation, standards and procedures. They are also responsible for the supervision of staff, maintenance of vehicles and equipment and the provision of a quality assurance program.

While the municipal sector assumed land ambulance service delivery responsibilities in 2001, Part II of the Ambulance Act (the Act) sets out the responsibilities of the province, through the Emergency Health Services Branch, in the administration and enforcement of the legislation governing ambulance service provision:

• establish standards for the management, operation and use of ambulance services;
• ensure compliance with those standards;
• the certification of ambulance services;
• the credentialing of paramedics;
• the designation of Base Hospitals to support paramedic service delivery;
• the inspection of ambulance service operations; and
• the investigation of complaints

Certification of Ambulance Services

Emergency Health Services Branch has the responsibility to conduct the certification process of candidate ambulance service operators to ensure operator compliance with the Land and Air Ambulance Certification Standards.

The Inspection, Certification and Regulatory Compliance Unit is responsible for ensuring that ambulance services comply with all provisions of the Act, regulations and standards.

Only land and air ambulance services that have been certified by the Inspection, Certification and Regulatory Compliance Unit can operate an ambulance service in Ontario.

The certification process for ambulance operators includes:

• Reviewing documentary evidence to determine if a service meets the planning and administrative components of the criteria for certification;
• Providing the applicant with a written evaluation, assessing ability to comply with the certification criteria;
• Conducting operational evaluation interviews that measure the applicant's preparations for dealing with the day-to-day operational issues of a land or air ambulance service.
• Providing the Director, Emergency Health Services Branch with the result of the evaluation process. If successful, the EHSB issues a certificate.
• Land ambulance service operators undergo the formal certification process every three years. Unannounced inspections are also routinely conducted.

Credentialing of Paramedics

The Ministry of Health and Long-Term Care establishes the criteria that must be met in order to be a paramedic in Ontario.

The Education section of this web site provides detailed information on the qualification/ credentialing process and the requirements to become a paramedic or ambulance communications officer in Ontario. It also provides information on recognizing the qualifications of paramedics from other provinces and territories under the provincial Agreement on Internal Trade (AIT), as well as those applying for Ontario recognition of their skills from outside Canada.

Base Hospitals

The ministry's Base Hospital Program provides essential support services to the ambulance system.

Base Hospitals provide paramedic oversight in the performing of controlled medical acts, the medical direction and quality monitoring of patient care provided by paramedics, and continuing medical education.

Fully funded for approved costs by the ministry, Base Hospital programs are located in host hospitals that sign a performance agreement with the ministry. The terms of the agreement provide the Base Hospital with clear, measurable indicators regarding the delegation, training and medical quality assurance to be provided to paramedics, and the patient care practices to be reviewed.

Base Hospitals also advise the ministry on matters related to ambulance-based pre-hospital patient care standards and delivery through the Emergency Health Services Branch Medical Advisory Committee, and participate in specified emergency medical services research activities.

The following is a list of all provincial Base Hospitals:

• The Ottawa Hospital (East)
• Lakeridge Health Corporation (Central East)
• Health Sciences North (Northeast)
• Thunder Bay Regional Health Sciences Centre (Northwest)
• London Health Sciences Centre (Southwest)
• Hamilton Health Sciences Corporation (Central West)
• Sunnybrook Health Sciences Centre (Sunnybrook Centre for Prehospital Medicine) (GTA)
• Ornge (for air ambulance flight medics)

Inspections

Inspectors are appointed to their position within the Inspection, Certification and Regulatory Compliance (ICRC) unit by the Director of EHSB under authority of Section 18 of the Act.

Inspectors visit ambulance service operators to ensure compliance with legislation and standards. Inspections can be routine (scheduled) or unscheduled, in-depth or of specific focus. While it is customary for senior ambulance service administrators to be available during core weekday hours, inspectors have authority under the Act to visit an ambulance service at any time.

Summary of ICRC Visits

Scheduled inspections ensure that all facets of a service are consistent with legislation and standards. Unscheduled inspections provide an additional opportunity to monitor service delivery and to help operators identify delivery deficiencies, and assist in making service delivery consistent with legislation, regulations and standards. Follow-up inspections are made to determine if inspection findings have been addressed..

In cases of gross inadequacies, where a service is not meeting its legislated requirements for operation, a Director's Order may be issued under the authority of Section 11 of the Act. This Order mandates that the operator will rectify all areas of weakness or deficiency found within a prescribed timeframe. If a follow-up visit shows that the deficiencies under the Order have not been addressed, the matter may be forwarded to Investigation Services for further enforcement.

Investigations

Investigators are appointed to Investigation Services by the Director, Emergency Health Services Branch under authority of Section 18 of the Act. Investigation Services members are Provincial Offences Officers with respect to the Act, its regulations and standards, and are appointed as Commissioners for the Taking of Affidavits.

Purpose of an Investigation

EHSB conducts investigations to determine if there were any contraventions of the Act, its regulations or the standards.

What does an Investigation NOT do?

EHSB does not conduct investigations into matters covered under any other provincial or federal legislation. EHSB does not conduct investigations to determine the cause of injury or death, or the actions of other allied agencies (e.g., fire, police).

Complaint Process

Any citizen may inform Investigation Services of any incident related to land or air ambulance services or ambulance communications services in Ontario, where they have reason to believe that the activities of paramedics, ambulance communications officers or other ambulance or communication service staff may be in contravention of the Act, regulations or standards.

Complaints may be sent via email to websitecontact.moh@ontario.ca, or in writing to:

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

Investigation Services is responsible for:

• conducting investigations
• dealing with complaints
• ministry representation at inquests
• recommending to the Director to proceed with Director's Orders towards ambulance services, dispatch centres, paramedics and/or Ambulance Communications Officers
• gathering evidence and preparing Crown Briefs for the Provincial Offences Prosecutor to proceed with charges under the Ambulance Act

In addition, Investigation Services may be requested to work with the OPP and/or municipal police services to assist in the preparation of Crown Briefs for the Crown Attorney in advance of criminal charges.

Investigation Process

Investigations are conducted to determine if there have been any contraventions of the Act, its regulations or standards through the collection and evaluation of evidence. Evidence is gather ed by various means, including:

• taking statements
• recording observations
• conducting searches
• making seizures

Complaint Sources

Prior to conducting field work, documents and records pertaining to the issue being investigated are obtained and reviewed by the investigator assigned to the case. Once reviewed, the investigator conducts preliminary research of relevant legislation and standards and compares the reports and documents to legislated requirements. The investigator reviews the qualifications held by ambulance service and communications service personnel involved in the event to ensure that the required qualifications for their positions are held.

The investigator will contact the complainant to clarify their concerns. In many instances, a complaint can be resolved at this stage of the investigation.

If further information is required the investigator will arrange to conduct interviews with witnesses who may have relevant information that can assist in determining what occurred during the event. Parties include:

• The patient and/or family
• Emergency Medical Attendants / Paramedics
• Ambulance Communications Officers
• Dispatch centre management
• Ambulance service management
• Hospital staff
• Police or fire personnel who were witnesses to the event
• Bystanders to an event
• Municipal officials

Ambulance service operators are required to make employees available to the investigator. Any employee, emergency medical attendant / paramedic / communications officer contacted for information and/or statements are advised that the investigator is gathering facts.

Investigation Services does not normally undertake investigations of conduct which might involve a criminal offence. However, should it be discovered during the normal course of an investigation that an employee may have committed such an offence Investigation Services will refer its findings to local police.

An investigation may be undertaken at the same time that a Coroner's investigation or an investigation by the police or other law enforcement agency is being conducted. In consultation with the Coroner, Crown Attorney, police or other agency, it may be appropriate for the ministry to defer its investigation if such activity might interfere with an investigation by the police, Coroner or other agency.

Investigation Conclusion

In many circumstances, operational and procedural changes resulting from investigation findings have precluded the recurrence of similar situations and, as a result, improved the delivery of service to the public.

A copy of the investigation report or findings are provided to the service operator and, if required, to the presiding Coroner. Investigation reports will be released to the patient or estate executor, or to a patient's family member upon explicit direction from the patient/executor.

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 : ehs.websitecontact@sdsx.moh.gov.on.ca

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