British Columbia Ambulance Service

As of July 2018 [3]

BCAS operates a variety of ground vehicles for ground transport. Most ambulances operated by BCAS are Type III ambulances with some Type I ambulances being used in remote communities. Some Type II ambulances based on the Mercedes-Benz Sprinter chassis are in use following their acquisition during the 2010 Winter Olympics. SUV's are also used as response units by some Advanced Care Paramedics. These response units carry their Advanced Life Support equipment and medications in the SUV and then transport the patient in a Basic Life Support ambulance. Critical Care Paramedics also have ground ambulances available for when aircraft is grounded or when responding to an area where it is not possible to land a helicopter. BCAS operates a number of other support vehicles to respond to HAZMAT, mass casualty, and public events. These vehicles include pickup trucks, gators, bicycles, and retired Type III ambulances. BCAS supervisors drive SUV's, Dodge Chargers, or Mini- Vans.

Ambulances are marked on the side to indicate what kind of paramedics are operating the ambulance:

Marking On The Ambulance	Qualifications Of Staff Operating The Ambulance		Vehicle Type
EMERGENCY PARAMEDIC	Emergency Medical Responder/Primary Care Paramedic		Type III Ground Ambulance
COMMUNITY PARAMEDICINE	Primary Care Paramedic		Community Paramedic Unit
ADVANCED LIFE SUPPORT UNIT EMERGENCY PARAMEDIC	Advanced Care Paramedic		Type III Ground Ambulance
PARAMEDIC SPECIALIST	Advanced Care Paramedic / Critical Care Paramedic		Paramedic Response Unit
INFANT TRANSPORT PARAMEDIC	Infant Transport Team paramedic
CRITICAL CARE PARAMEDIC	Critical Care Paramedic
CRITICAL CARE TRANSPORT	Critical Care Paramedic
CRITICAL CARE FLIGHT PARAMEDIC	Critical Care Paramedic
TRANSFER AMBULANCE	Emergency Medical Responder/Primary Care Paramedic
BC AMBULANCE SERVICE SUPERVISOR	Unit Chief / District Supervisor		Paramedic Response Unit

BCEHS helicopters based in Vancouver

The BCAS is responsible for the delivery of air ambulance services throughout the province of British Columbia. Critical care paramedics are deployed from bases in Prince George, Richmond, Kelowna and Kamloops, Nanaimo, Langley and Vancouver. Each team is composed of two CCPs who transport all Adult patients and some pediatric patients. The infant transport team (ITT) based out of BC Children's Hospital in Vancouver handles the critical care infant, child, and maternity transports. The ITT have completed advanced training and provide emergency medical care to pediatric, neo-natal and high-risk obstetric patients.

The BC Ambulance Service air ambulance fleet consists of six fixed-wing aircraft, five Beechcraft Super King Air 350 turboprops and one Cessna Citation Encore jet. Additional aircraft are chartered on an as-needed basis. The BCAS also operates four dedicated air ambulance helicopters, two based in Vancouver and one based in both Prince Rupert and Kamloops. BCAS also utilizes approximately 40 pre-qualified charter carriers throughout British Columbia.[4]

An emergency medical responder (EMR) licensee is qualified to deliver a limited number of medications, under the class of 'symptom relief', including ASA, nitrous oxide, nitroglycerin, naloxone, and oral glucose. They are also qualified in the use of an automated external defibrillator (AED) and may monitor an existing IV line. Their protocols include cardiac arrest, cardiac chest pain, diabetic emergencies, and management of pain using nitrous oxide. The "Schedule 2" endorsements appear as "symptom relief" and "iv maint".

The vast majority of paramedics in BC are primary care paramedic.[6]

In addition to the EMR guidelines, PCP licensees have increased treatment guidelines. PCP-qualified paramedics may also be endorsed for CPAP, intravenous cannulation (PCP-IV) and will have an additional guidelines for hypovolemia as well as enhancements to the anaphylaxis, diabetic, opioid OD guidelines. Additional PCP-level medications include salbutamol, glucagon, epinephrine, diphenhydramine, thiamine , dextrose 10% (D₁₀W), tranexamic acid, and normal saline.

BCAS Medical Leadership has introduced 'Treatment Guidelines', which is a more generalized framework within which paramedics can operate with more flexibility and clinical decision making.

Infant transport team (ITT) paramedics are specifically trained for critical care of perinatal, neonatal and pediatric patients. They respond as an equally qualified team of two and sometimes take a physician with them for critically ill patients. When dispatched on street calls these are targeted response ambulances that often assist or intervene when necessary, but can hand a more stable patient off to a layered or co-responding PCP ambulance. The team currently consists of only 26 specially trained paramedics for the entire province.

In addition to the PCP guidelines and medications, they may also administer Acetaminophen, Adenosine, Atropine Sulphate, Calcium Chloride, Dextrose 50%, Dimenhydrinate (Gravol), Hemabate, Indomethacin, Lorazepam, Magnesium Sulphate, Midazolam (Versed), Morphine Sulphate, Ondansetron, Oxytocin, Sodium Bicarbonate and Out-of-Scope medications with orders from a CCTA. ITT paramedics have their own unique set of prehospital treatment guidelines that mirror ACP guidelines in the areas of pediatrics, having the ability to treat respiratory/cardiac arrest and disrhythmias. The ITT practitioner also has adult ACLS guidelines and intubation in the event they encounter an adult cardiac arrest.

Their additional training and skills include the use and monitoring of Incubators, Endotracheal (ET) Intubation, Intraosseous (IO) Access, nasogastric (NG) tube insertion and suctioning, manual defibrillation, cardioversion, chest decompression, Venous pressure monitoring, Arterial & Central Line Monitoring, Chest Tube Management, transthoracic pacing, Blood Product Infusion, IV Infusion Devices, 'IV with Medication' Maintenance, Mechanical Ventilation (using the LTV 1000 and 1200 and BMD CrossVent), Foreign body removal with laryngoscope, ET/IO/PR drug administration, Central & Parenteral Line Management, Venous & Arterial blood sample collection, point of collection analysis of ABG's and chemistry using the I-Stat, Lab & X-ray interpretation.

The ITT paramedics also transport pediatric and adult ECMO (extracorporeal membrane oxygenation) patients with a perfusionist from BC Children's.

While there are some areas of overlap between ACP and ITT, the additional ITT 'Airevac' class of skills that are not included in the standard ACP skill-set are Venous Pressure Monitoring, Arterial & Central Line Monitoring, Chest Tube Management, Blood Product Infusion, Mechanical Ventilation, nitric oxide delivery systems and Out-of-Scope Medications by orders.

Although there are relatively few advanced care paramedic (ACP)-staffed ambulances compared to PCP, the majority of the population is covered by ALS service. These are targeted response units with two ACP-qualified paramedics. They are able to defer transport of a more stable patient to a layered or co-responding PCP ambulance. This ensures that most patients have access to ACP but that the resource is not tied up on a call they are not needed on. It also ensures that ACP-qualified paramedics treat a "critical mass" of the most acutely ill patients, thereby maintaining their high skill level.

ACP paramedics have protocols to administer all PCP plus Adenosine, Calcium Chloride, Dextrose 50%, Dimenhydrinate (Benedryl), Ipratropium Bromide (Atrovent), Lidocaine, Morphine Sulphate, Midazolam (Versed), Ketamine, Fentanyl, and Amiodarone (Cordarone). Their additional skills include synchronized cardioversion, airway isolation devices, endotracheal intubation, end-tidal CO₂ monitoring, external jugular vein cannulation, transcutaneous pacing, IV colloid/crytalloid volume expanders, nasopharangeal airways, needle thoracentesis and surgical or needle cricothyrotomy.

Critical care paramedic (CCPs) are paired in British Columbia.

To become qualified at this level, experienced ACP paramedics take further training consisting of a portion of the CCRN program through BCIT, followed by an intensive hospital-based program through St. Paul's Hospital. Next, there is a work experience portion, and finally, CCP licensure. Formerly, an ACP could take a much shorter course and receive a "Full Schedule 2" endorsement.

CCP's have standard operating guidelines for common critical patients; SIRS/Sepsis, RSI, Chest decompression, Ventilation strategies using the LTV 1000 and 1200, ACS and coronary care, etc. CCP paramedics sometimes take an intensivist with them, but consult with Critical Care Transport advisors.

CCP qualifications follow the NOCP guidelines as endorsed by the Paramedic Association of Canada. In addition to standard ACP protocols, the CCP can perform Schedule 2 ACP skills and procedures as well as administer virtually any medication following assessment and consult with the Critical Care Transport Advisor (CCTA). CCTAs are essential to both the air-evacuation and ground critical care transport programs.

BC Ambulance Service Ranks & Qualifications

The BC Ambulance Service is a uniformed organization and as such, has a similar rank structure to most police or fire departments. The medical qualifications of a uniformed member are denoted with collar insignia, commonly known as 'collar dogs', while rank is denoted using epaulettes. Excluded management and administrative employees in regional offices and provincial headquarters do not wear uniforms.

Current qualifications designated by collar dogs include EMR, PCP, ACP, ITT, EMCT and EMD. The EMR and PCP levels are shown on bronze and silver circles, respectively, forming the BCAS logo, along with a circumform bar below, denoting the EMR or PCP qualification. ACP and ITT (Infant Transport Team) paramedics are recognized with gold caducei, with either "ALS" or "Neonatology" imprinted upon them. CCP (Critical Care Paramedics) have a gold coloured shield with blue star of life and CCP on it. Within the Communication Centres, EMD (Emergency Medical Dispatcher) and EMCT (Emergency Medical Call Taker) are designated by gold and silver shields, respectively.

For rank insignia, Paramedics and dispatchers who hold the position of Unit Chief or Charge Dispatcher wear a black epaulette with three gold stripes. District Supervisors and Dispatch Supervisors wear the same coloured epaulette with four gold stripes while Dispatch Officers wear two gold stripes. Ranks above District Supervisor are management positions and are distinguished by a varying number of pips on their epaulette. District and Platoon Superintendents wear an epaulette with three pips, Managers wear one pip and one crown, Directors wear two pips and one crown and the Executive Director of a region will wear three pips plus a crown. Each station and dispatch centre has a staff member designated as its Occupational Safety & Health (OSH) representative. These paramedics and dispatchers are identified with a black epaulette with a single royal blue bar. Staff who are designated as OSH representatives hold no supervisory authority, but are available to assist staff with safe work practices. BC Ambulance instructional staff wear a black epalette with the word "INSTRUCTOR" embroidered in gold, facing laterally.

Shoulder flashes for field staff are navy blue with a navy blue trim, and include the British Columbia Coat of Arms, with the words "Ambulance" above, and "British Columbia" below, both in white.

• Service Bars - issued one for every five years service with BCAS or combined time with another bona fide EMS agency.
• Line of Duty Death Pin - worn only in the event of a BCAS line-of-duty death or during Paramedic Appreciation Week, the first seven days of July.
• 25, 30 and 40-year Service Pins - issued after the designated years of service, full- and part-time inclusive.
• Union Pins - permitted one on a uniform at any given time.
• Stork Pin - awarded when a crew performs a pre-hospital delivery of a baby. All license levels eligible.
• Q-Pin- A pin awarded after a crew member, a unit chief or someone of the public notices a member performing with outstanding quality.