BCPA Position Statement on Healthcare Regulation in BC and the Cayton Report

“It is the duty of a college at all times; To protect the safety of patients, to prevent harm and promote the health and well-being of the public.”

Health Professions in British Columbia are overseen by government within a variety of frameworks.  Currently, the most common framework is professional self-regulation under the BC Health Professions Act.

Paramedicine does not fall under a college based self governance model in BC and instead is overseen by a government appointed licensing board. The Emergency Medical Assistant Licensing Board (EMALB), oversees entry to practice and maintenance of licensure within BC. Paramedics are actually considered Emergency Medical Assistants (EMAs), within provincial legislation.  The title paramedic and its variations is not protected in BC which presents risk to the protection of the public.

The legislation under which BC paramedics are licensed and regulated has not kept up with modern evolutions of medicine. Skills, procedures and authorities in the Act are piecemealed together through a series of schedules that are confusing and fail to reflect current practice. Additionally, education standards have failed to keep pace with the rest of Canada for Paramedics; as a result the primary paramedic employer, BC Emergency Health Services (BCEHS), now bears a significant educational burden bridging knowledge gaps that have become entry to practice knowledge expectations in other canadian jurisdictions.

At the request of the Hon. Health Minister Adrian Dix, Mr. Harry Cayton has released a recent report on the status of regulated health professions in British Columbia.

It is the position of the British Columbia Paramedic Association (BCPA), that paramedics in BC should become a self-regulated health profession within the context of any new approach to regulating health professions. Should health regulatory reform come to pass, the BCPA would request a seat at the table designing the new regulatory structure and process.

Background

The Cayton Report, published April 2019, was commissioned at the request of the provincial health minister to address complaints about current self-regulatory colleges. This report breaks into two sections, each with a specific mandate.

Powerful beneficial ideals are frequently born of adversity. As a result of regulatory difficulties with the College of Dental Surgeons of BC (CDSBC), the Hon. Health Minister Adrian Dix commissioned Harry Cayton to investigate and report upon both the CDSBC and BC’s current health regulatory framework (as defined by the Health Professions Act). Mr. Cayton had the excellent foresight to clearly delineate the report into two sections: the first section being a comprehensive reflection upon the regulatory status of the CDSBC, the second section being a comprehensive reflection upon potential regulatory reform for BC’s health professions.

The first section of Mr. Cayton’s report is clear and does an excellent job of outlining issues found within the CDSBC. It has no direct bearing upon paramedic practice aside from serving as a cautionary tale with respect to the duties and obligations of a regulatory college.

The second section of Mr. Cayton’s report is one of the most relevant pieces of government commissioned literature with respect to paramedic practice from the last decade. It clearly outlines reasoning as to why a profession should be regulated for the protection of the public while laying out a potential new regulatory framework to both enhance protection of the public and reduce regulatory costs.

Section 9.14 of the Cayton report succinctly relays the core principles of health regulation reform:

9.14 The overall objectives of reform of health professional regulation should be:

• To protect the safety of patients, to prevent harm and to promote the health and well-being of the public

• To provide a framework for safe, competent and ethical professional practise

• To have the trust of the public and the confidence of regulated occupations

• To be able to adapt to change and respond to new risks and opportunities

• To be efficient and cost effective in the interests of all citizens

Each of these points deserves specific address with respect to the future of paramedic practice in British Columbia.

“To protect the safety of patients, to prevent harm and to promote the health and well-being of the public”

As part of his recommendations for the enhancement of patient safety, Mr. Cayton proposes amendment of the Health Professions Act to state “It is the duty of a college at all times; To protect the safety of patients, to prevent harm and promote the health and well-being of the public.” This excellent statement of duty would apply to all health professions falling under the Health Professions Act. At present paramedics are separately regulated through the Emergency Medical Assistants Licensing Board (EMALB) under the Emergency Medical Assistants Regulation. As such, any changes to the Health Professions Act will not apply to paramedicine unless amendments to the regulation include the formation of a BC College of Paramedics.

By comparison the EMALB’s statement of purpose is as follows: “The board, under the authority of the Emergency Health Services Act, sets licence terms and conditions. In addition, the board investigates complaints and conducts hearings where necessary.”  The EMALB’s statement of purpose does not include the all important concept of purpose Mr. Cayton proposes for all regulated health professions: “to protect the safety of patients.”

Paramedics know the protection of patient safety must be at the forefront of practice, but a lay member of the public may ask why this concept should be embedded into the regulatory framework. The answer is surprisingly simple. Paramedics on a daily basis perform a tremendous number of controlled medical acts which, if performed incorrectly or inappropriately, have serious potential for patient harm. As healthcare providers performing controlled medical acts, paramedics must have patient safety minded regulation at the forefront of the professional lexicon. Inclusion of paramedicine within proposed changes to the health regulatory framework would ensure patient safety minded governance rose to a place of prime importance within paramedic practice regulation.

“To provide a framework for safe, competent and ethical professional practise”

Regulation governing the practice of paramedicine in BC, the Emergency Medical Assistants Regulation, consists of a 33 page, 5775 word single document. This, as compared to the scope of paramedic practice, miniscule document can not possibly be expected to encompass a framework for safe, competent, and ethical professional practise. By comparison, the allowed scope of practise document alone for BC’s registered nurses is 72 pages in length (professional responsibilities, code of ethics etc., are all separate documents). Current regulatory structure for the practice of paramedicine in British Columbia fails this test. Inclusion of a College of Paramedicine within a restructured health regulatory framework would serve to rectify this healthcare practise inequity.

“To have the trust of the public and the confidence of regulated occupations”

The paramedic profession by and large has the public’s trust, however it has no mechanism to earn the confidence of other regulated health professions. Consistently paramedics rank among the most publicly trusted healthcare workers yet they lack a regulatory college operated by an appropriate blend of subject matter experts and members of the public. The absence of a regulatory college robs the profession of the ability to professionally interact with other regulators for the betterment of patient safety and patient care standards. The formation of a BC College of Paramedics under proposed health profession regulations would alleviate this disparity by creating allowances for interdisciplinary information sharing.

“To be able to adapt to change and respond to new risks and opportunities”

The current paramedic regulatory framework completely fails in this important area. As medical evidence changes, so too does best medical practice for patient safety and best possible care outcomes. The current EMALB structure requires an act of legislation via the provincial health minister to adapt to changing medical evidence. This cumbersome and inefficient structure is neither quick in its ability to respond, nor guaranteed to be directed by appropriate subject matter experts. The formation of a BC College of Paramedics under an updated Health Professions Act would alleviate this impediment to best patient care by Paramedics.

“To be efficient and cost effective in the interests of all citizens”

At present the administrative costs of the EMALB are almost entirely borne by the BC taxpayer. Some degree of cost recovery is achieved through examination fees and licensing fees. Most regulatory college systems of governance impart the cost of operation directly to the regulated practitioner. As Mr. Cayton astutely points out, professional regulation “is a tax on work; a payment for the privilege of working.” What Mr. Cayton is proposing with respect to a health profession regulatory overhaul could include mechanisms for cost sharing amongst regulated health professions. The United Kingdom Health & Care Professions Council (HCPC) for example oversees sixteen separate regulated health professions which all share the regulatory costs associated with their various professions. Paramedicine is one of the sixteen health professions regulated under the UK HCPC. The formation of a similar health council in BC would ideally include Paramedicine.

Conclusion

As a significant stakeholder seeking improvement in paramedic professional regulation, the BC Paramedic Association (BCPA) seeks a seat at the table as health profession regulation is reformed and ideally a BC College of Paramedics is formed. Whether under an overarching health professions council or as a separate regulatory college, the time for more appropriate paramedic practice regulation in BC has come.

The British Columbia Paramedic Association (BCPA), is an independent, non-partisan, not-for-profit, member supported society that represents the profession of Paramedicine in BC.  The BCPA advocates for the best out-of-hospital medical care for patients in British Columbia by establishing professional standards of practice, continuing professional development opportunities/education, creating original research, and providing knowledge translation for paramedic practice in British Columbia. BCPA membership is voluntary and the association is not a labour representative.

Letter of Support for Paramedic Higher Education & Research, BCPA Advisor Dr. Yoon


RE: University Education and Research Programs in Paramedicine


To Whom It May Concern:


I am a Clinical Professor within the Department of Emergency Medicine at the University of British Columbia. As an Emergency Medical Services (EMS) physician, I have been involved in the operations, education, research and promotion of paramedic practice for the last 20 years. It has been my privilege and honour to have worked and to continue to work with numerous talented, dedicated, and inspiring paramedics. I am an enthusiastic supporter of paramedics and a stalwart advocate for advancing paramedicine as a profession. I strongly assert that the need for university level academic programs specific to paramedicine is vitally important to not only the profession, but to the quality of out-of-hospital medical care.


Paramedicine has evolved relatively quickly as a distinct body of knowledge and skills that continue to play a critical role in health care around the globe. University level degree paramedicine programs have been well established in several other countries including Australia, New Zealand, Ireland, South Africa, the United Kingdom, and the United States. Numerous medical schools internationally have recognized EMS as a distinct and major subspecialty of emergency medicine with academic divisions and centres that specialize in out-of-hospital care education and research. Paramedicine is an essential and prominent discipline for virtually all military forces of the world. In this context, the British Columbia Paramedics Association is championing an effort to persuade universities and other organizations to initiate and sustain academic programs specific to paramedicine. We are fortunate to have a critical mass of paramedics who are keenly dedicated and passionate about formalizing paramedicine as an academic discipline. In order to achieve that, university administrations must recognize that our BC paramedics require an organizational vehicle that can establish degree programs, research infrastructure, and an academic milieu that supports excellence in paramedic practice for not only the health care demands of today, but beyond.


We all acknowledge that quality in health care stems from support and achievement in clinical delivery, education, research, innovation and community engagement. We have witnessed paramedic practice in the province move beyond 911 emergency responses and inter-facility patient transfers and into community paramedicine, special operations (including mass gatherings, event medicine and tactical support), disaster management, environmental medicine, HAZMAT management, public health and many other areas of health care. We rely on paramedics to be the front-line providers for mass casualty incidents, pandemics involving substance use and infectious diseases, and time-sensitive life-saving procedures. It is abundantly clear that paramedics are playing a highly prominent and important role in the delivery of health care, but in this province and generally in this country, they are insufficiently supported by our academic institutions.


Paramedics are highly motivated and passionate health care professionals who possess a dedication to life-long learning, inter-disciplinary collaboration, research and clinical excellence. It is long past due for academic institutions and other decision-makers in this province to provide these professionals a formal academic environment to enable them to strengthen and sustain their profession, just like other health professions. Our society takes it for granted that in any person’s moment of medical need, paramedics will be there to use their knowledge and skills to render immediate aid and comfort. I ardently argue that all of us who benefit daily from the security, safety and clinical care that paramedics are always ready to provide us should be doing our best to support paramedicine.
Sincerely,


Philip Yoon, MD, MBA, CCFP(EM), FCFP
Clinical Professor, Department of Emergency Medicine, University of British Columbia
Emergency Physician, Royal Columbian & Eagle Ridge Hospitals, Fraser Health
Reserve Medical Officer, 1 Canadian Field Hospital – Ottawa Detachment, Canadian Armed Forces Medical Director, EMS Physician Online Support, British Columbia Emergency Health Services
Vice-Chair, Emergency Medical Assistants Licensing Board, Ministry of Health, Province of British Columbia

Privilege in Paramedicine

At a glance it may be difficult to see how the life of a Paramedic is one of privilege. Between shift-work, long hours, high stress workspaces, ever changing practice expectations, and remuneration vs. cost of living concerns; being a Paramedic isn’t exactly an occupation that will land you on “Lifestyles of the Rich & Famous.” Statistics regarding work related stress injuries for paramedics are frightening, with suicide data in particular a major cause for concern. Even those of us who retire “healthy” are more likely to suffer from heart disease than the general public. One might ask “What is this Privilege you speak of?”

 

A paramedic’s greatest privilege is trust. Paramedics (alongside firefighters, nurses, and physicians) consistently rank highly as one of the most trusted occupations in Canada. In Australia Paramedics are the most trusted occupation a number of years over. On what may be the worst day of a patient’s entire life; not only do they allow paramedics into their homes, they specifically ask paramedics to lead them through whatever crisis has occurred. Patient’s invite a complete stranger (a paramedic) to take control of their personal crisis out of trust and respect for that strangers occupation alone. This public trust extends through all levels of paramedicine, ranging from the Primary Care Paramedic responding to a simple diabetic call to the Critical Care Paramedic initiating ICU care on behalf of a rural sending facility.

 

With the consistent high degree of trust placed upon paramedics by both the public & other health professionals, it seems unfathomable that paramedics would fail to trust themselves; yet evidence would suggest paramedics do not trust themselves (at least in Canada that is). If paramedics trusted their own judgement as completely as the public seems to, British Columbia would have its own College of Paramedics. A profession that trusts itself has the knowledge, confidence, and maturity to regulate itself for the protection of the public. A profession that trusts itself seeks to build upon the body of knowledge that makes it a unique entity through research and education.

 

It’s time Paramedicine learned to trust itself. It’s time Paramedics extended their profession the same privilege the public has deemed them worthy of.

 

Paramedic Self-Regulation: Its Importance and The Big Picture of The Paramedic Profession

Paramedic Association of Manatoba Self Regulation FAQ

BCPA President’s Message [November 2018]

President’s Message [November 2018]

Welcome to the British Columbia Paramedic Association. After over 44 years of paramedic practice in the province of BC, the time has finally arrived for paramedics to take control of their own profession. Professional Leadership, Clinical Practice Excellence, Higher Education, and Paramedic Research will form the basis of this non-partisan advocacy group. I’m proud to be a member of one of the most passionate, patient focused, professions in healthcare. I’m more proud to play a role in giving paramedics the voice of professional advocacy they have historically been without.

Moving forward members can expect the BCPA to advocate for improved education (for new and existing practitioners), improved clinical practice, paramedic practice research, and a self-regulated professional college. As part of this plan, members can expect to see EMALB approved continuing education material, future symposiums focused on clinical practice, advanced education program development advocacy, and paramedic driven research. None of this can happen without membership support. At this critical start-up phase I implore every member to take on as active a membership role as possible. The BCPA board will be seeking educational content creators, advisory board members in all areas of practice, research coordinators, and governance experts. The success of the association relies on the participation of the membership.

Paramedics spend their entire careers caring for the needs of others. It’s time to continue the exceptional care paramedics provide their patients by caring for the needs of the paramedic profession.

Welcome aboard everyone,

Ed Peters

 

BCPA Organisational Structure and Director Roles

Following the most recent board meeting, the board has finalized the board positions moving forward and adjusted for some of the various expertise of the volunteer directors.

In the very near future we will be releasing application for committee members.  Committees are open to membership that qualify for and hold  “BC Paramedic – Full Membership”.

Organisational Chart

Association President

Executive Director

Vice President & Director, Communications

Registrar & Secretary

Treasurer & Director at Large

Director, Policy & Governance

Director, Research Programs

Director, Education

Director, Clinical Practice

Director, Conferences & International Liaison

 

 

 

 

Development of Active Leadership in Paramedic Practice

What does it mean to be a reluctant leader? Vocabulary.com would describe the word reluctant as “disinclined,” or “unwilling to do something contrary to your custom.” (Vocabulary.com) The same site would define a leader as “a person who rules or guides or inspires others.” (Vocabulary.com, leader) By extension, a reluctant leader is someone who guides or inspires others while being reluctant to do so. As a ten year paramedic the definition of a reluctant leader strikes closer to home than I care to admit.

As paramedics our first samples of true leadership often come minutes to hours after the commencement of our first shift as a licensed/registered paramedic. The safety net of our veteran preceptors has fallen away and we are left to our own madness as thoughts of what our first independent call may be swirl through our fertile imaginations. Will it be a big trauma? Will someone’s mother, father, brother experience a cardiac arrest? Imaginations wander fervently until the phone finally rings or the tones drop. What was your first call?

Every paramedic, no matter their license level, remembers their first independent call. For some it was a simple lift assist; for another it might have been their first opportunity to help bring life into the world. No matter what the call was, it was that paramedic’s first chance to lead another person (the patient) through a trial that exceeded said person’s ability to cope. In that moment a reluctant leader was born. In that moment a paramedic was born.

From the Australasian Journal of Paramedicine, “Three factors: ‘wanting to help people’, ‘exciting career’ and ‘saving lives’, emerged as the most important motivating factors for participants’ to pursue a paramedic career.” (Ross, Hannah, & Van Huizen, 2016) Isn’t it interesting how none of the identified factors included a desire to lead, yet every patient care episode a paramedic participates in involves leading a patient through a trying episode of some variety. Leadership is thrust upon paramedics by the nature of the work. It’s time for paramedics to own the very nature of their role within the healthcare system. It’s time paramedics found comfort in knowing their role is to provide leadership when patients or other health providers have lost control.

How does one transition from the role of reluctant leader to active leader? One definition of active leadership states that, “Active leadership seeks to involve staff in the challenges facing the group and gives them a role in solving those challenges.” (Albers, 2016)  Paramedics can become active leaders by engaging each other as agents of change for their own future. By becoming active leaders, paramedics take ownership of their profession in ways not previously afforded them. Formation of the BC Paramedic Association is one form of active leadership. As active leaders the BCPA will be seek the assistance of all paramedics in facing the challenges before the profession as it continues to grow and develop.

Moving forward the BCPA will ask paramedics to provide Professional Leadership in the areas of Clinical Practice Excellence, Higher Education, and Paramedic Research. Leadership in these areas does not have to come through direct committee involvement. Participation in study data collection, precepting, interdisciplinary communication, and following evidence based standards of practice, are all areas every paramedic can actively display the leadership qualities necessity has breed into the profession.

 

Bibliography

Albers, J. (2016, 02 22). Active vs Passive Leadership. Retrieved 11 07, 2018, from linkedin.com: https://www.linkedin.com/pulse/active-vs-passive-leadership-james-albers

Ross, L., Hannah, J., & Van Huizen, P. (2016). What motivates students to pursue a career in paramedicine. Australasian Journal of Paramedicine, 13(1), 01 to 07.

Vocabulary.com. (n.d.). leader. Retrieved 11 07, 2018, from Vocabulary.com: https://www.vocabulary.com/dictionary/leader

Vocabulary.com. (n.d.). Reluctant. Retrieved 11 07, 2018, from Vocabulary.com: https://www.vocabulary.com/dictionary/reluctant