British Columbia Ambulance Service

Infobox company
company_name = British Columbia Ambulance Service
company_
company_type = Crown Agency
foundation = July 1, 1974
location = British Columbia, Canada
num_employees = 3,200 (2006)
revenue = $252 Million
industry = Emergency Medical Services
homepage = [http://www.health.gov.bc.ca/bcas/index.html BC Ambulance Public Website]

The British Columbia Ambulance Service (BCAS) is the sole ambulance service and provider of pre-hospital emergency care in the province of British Columbia, Canada, and is one of the largest Emergency Medical Services (EMS) services in North America. The BCAS also provides inter-facility patient transfer services in circumstances where a patient needs to be moved between health care facilities. The BCAS has a fleet of over 450 ground ambulances operating from 190 stations across the province. Dispatch centres in Vancouver, Victoria, and Kamloops provide call-taking and ambulance dispatching services to the entire province. In addition, BCAS operates an airevac program that utilizes both fixed-wing and rotary aircraft. As of July 1st, 2007, the BCAS employs 2,064 part-time paramedics and 1,436 full-time paramedics for a total of 3,500 paramedics. There are approximately 315 management and administrative employees in the BCAS.

History

Prior to 1974, ambulance services in British Columbia were generally uncoordinated. Service was provided by a mixture of volunteer ambulance brigades, fire departments, funeral homes, and private operators. As a result of recommendations made by the Foulkes Commission's report on health care, titled "Health Security for British Columbians" and released in 1973, the Government of British Columbia created the Emergency Health Services Commission (EHSC), which in turn, created the BC Ambulance Service on July 4, 1974.

Governance

In British Columbia, responsibility for the provision ambulance services is granted to the Emergency and Health Services Commission (EHSC) under the auspices of the "Emergency and Health Services Act." Under the terms of the Act, the EHSC is considered an agent of the government and as such, holds all responsibility for the provision of ambulance services across the province. The members of the Commission act as a Board of Directors to the BC Ambulance Service. The commission membership consists of health service administrators, medical professionals, and government representatives. The commission meets regularly to provide direction to the BCAS Executive Management Team. The EHSC is also responsible for the operation of HealthLines Services BC (HLSBC). This includes the BC NurseLine telephone triage service (separate from 9-1-1 services), BC BedLine, which assists physicians when it is necessary to transfer a patient to a higher level of care as well as BC HealthGuide, BC HealthFiles, BC HealthGuide OnLine, and Dial-A-Dietitian.

While the EHSC, and consequently the BCAS, are agents of the government and are able to operate independently, in practice they are closely linked to the BC government's [http://www.gov.bc.ca/health/ Ministry of Health] , which provides one-hundred percent funding for operations.

Organization

There are 190 ambulance stations in British Columbia, including three seasonal stations and the Transfer Fleet. Stations may be staffed with part-time paramedics, part-time and full-time paramedics, or only full-time paramedics, depending on where the station is located. Each station is headed up by a Paramedic Chief, who acts as supervisor for the crew at the station. The Paramedic Chief also handles the day-to-day administrative duties required by the station, including payroll management, overseeing station and ambulance maintenance, and crew scheduling.

Each station falls under the responsibility of a District Superintendent. The District Superintendent has responsibility for the operations of all of the stations within a given district. The size of the district, and the number of stations it encompasses, varies depending on factors such as geography, station size, number of paramedics and others.

Each BCAS district is part of a larger region, which is headed by an Executive Director. Each District Superintendent is accountable to the Executive Director for that specific region. In some regions, a Director of Operations assists the Executive Director with day-to-day activities. The District Superintendents are accountable to the Executive Director of the region, who in turn reports to the Chief Operating Officer of the BC Ambulance Service.

*Vancouver Island Region (Headquarters: Victoria, BC)
*Lower Mainland Region (Headquarters: Vancouver, BC)
*Interior Region (Headquarters: Kamloops, BC)
*Northern Region (Headquarters: Prince George, BC)

The BCAS provincial headquarters is located in Victoria, BC. It is staffed by an executive management team, and other support services. The final responsibility for BCAS operations lies with the service's Chief Operating Officer. The Chief Operating Officer is accountable to the Executive Officer, Emergency & Health Services Commission, who in turn reports to the Board of the Emergency & Health Services Commission.

Dispatch Centres

The BCAS operates four dispatch centres located throughout the province. The Victoria Communications Centre is responsible for all ground ambulance dispatching for Vancouver Island and the Gulf Islands; the Vancouver Communications Centre dispatches all ground ambulances in the Lower Mainland (i.e., Metro Vancouver & the Fraser Valley Regional District), the Sunshine Coast, as far east as Boston Bar and as far north as Pemberton; and the Kamloops Communication Centre dispatches crews to the remainder of the province, including the southern interior (Okanagan, Cariboo & Kootenays) and northern BC (Skeena, Northern Interior & Peace Regions, representing west-central, east-central and northern areas of the province, respectively). The fourth dispatch centre, the Provincial Air Ambulance Coordination Centre (PAACC), is located in Victoria and has responsibility for dispatching of all air ambulance resources, whether they are used for scene responses, or for inter-facility transfers.

Each dispatch centre is staffed with a mixture of Emergency Medical Call Takers (EMCT) and Emergency Medical Dispatchers (EMD). The Vancouver Dispatch is the larger of the four Centres where a Dispatch Supervisor provides line supervisory support to dispatch centre staff, with a Dispatch Director and Dispatch Superintendents who manage the dispatch centre. Other Centres have a Charge Dispatcher in the role of Supervisor and Superintendent(s) managing the Centre. Training for EMCTs and EMDs is provided in-house by the BC Ambulance Service.

The BC Ambulance Service utilizes the Advanced Medical Priority Dispatch System (AMPDS) to triage calls.

To report a medical emergency, dial 9-1-1, the emergency telephone number in British Columbia. When dialed from a land line or mobile phone (excluding satellite phone and VoIP service), your phone number and address will be provided to the EMCT and EMD. In the case of cellular phones, only your phone number will be made available, although GPS technology will soon make it possible to locate the nearest cell site and possibly your exact co-ordinates.

Within the Metro Vancouver region, BCAS utilizes the E-Comm Wide-Area Radio Network for one-stop communication between police and fire agencies.

Deployment

The current system designates a given station (or 'Operator') as either Metropolitan, Urban, Rural or Remote. A Remote-designated station typically has a call-volume of less than 500 calls per year and is staffed entirely by part-time EMR and PCP-qualified paramedics; Rural-designated stations usually have a range between 500 to 2000 calls per year and may have a full-time or part-time Paramedic Chief and might also have a full-time shift pattern for four full-time paramedics during daytime hours. Urban-designated stations generally have call volumes greater than 2000 calls per year and may range up to and over 10,000 calls. A 'Post' is a station or group of stations that are grouped together based on operational needs. The basic difference between Urban and Metro is that metropolitan posts consist of groups of neighbouring urban posts, each of which has a very high call volume; for example, every station in Vancouver Post is designated Metro. When a post incorporates more than one station, it functions as a unit for the purposes of irregularly-scheduled paramedic deployment (including part-time paramedics attached to the post).

In larger Urban and Metro-designated posts, including stations in Metro Vancouver, the Fraser Valley Regional District (i.e., Abbotsford and Chilliwack), Victoria, Nanaimo, Kelowna, Kamloops and Prince George, ground ambulance service is provided by a mix of PCP and ACP-qualified paramedics. In smaller Urban-designated posts (such as Cranbrook, Nelson, Prince Rupert, Terrace, Fort St John, Vernon, Salmon Arm, Penticton, Campbell River, Port Alberni, Squamish, Whistler, Powell River, Sechelt, Williams Lake and Quesnel) there is a core of four to eight full-time, regularly scheduled paramedics at the PCP level but there is also a heavy reliance on part-time, irregularly scheduled paramedics who are also trained to the PCP qualification. These auxiliary staff traditionally rely on paged call-outs and need not stay at the station but should remain in relatively close proximity in case of a call.

The first step toward a Metro designation (from Urban) requires a population base of 70,000 to 80,000 people. This will maintain a call-volume around 10,000 calls per year and will warrant the addition of Advanced Life Support (ALS) resources to the station (e.g., Chilliwack). The next step would be to split the calls between two separate stations serving a single community (e.g., Kelowna, Kamloops, Prince George & Nanaimo). Finally, as in the case of Abbotsford, when the call volume for the two stations combined reaches in excess of 20,000 calls, the station is re-designated as a Metro Post. When there are enough Metro Posts in a given region, they are reorganized into a larger comprehensive post like Metro Vancouver or Greater Victoria. This will likely be the case for the Fraser Valley Regional District; that is, Abbotsford, Chilliwack, Mission, Agassiz and Hope may well become a 'Fraser Valley Post'; Kelowna and Nanaimo may not be far behind.

Air Ambulance

The BCAS is responsible for the delivery of air ambulance services throughout the province of British Columbia. There are four dedicated air ambulance bases in BC, located in Richmond, Kelowna, and Prince George at their respective airports (YVR, YLW, & YXS) while the Infant Transport Team (ITT) is based out of BC Children's Hospital in Vancouver. ITT paramedics handle all of the high-risk infant, child, and maternity transports that take place in BC. The ITT is unique in North America, as the first team to use paramedics to perform transports of these critical patients.

The BC Ambulance Service air ambulance fleet consists of six fixed-wing aircraft, five Beechcraft Super King Air 350 turboprops and one Bombardier Learjet 31 jet. Additional aircraft are chartered on an as-needed basis. The BCAS also operates three dedicated air ambulance helicopters. Two Sikorsky S-76 helicopters are based in Vancouver, with a Bell 222 helicopter based in Prince Rupert. In addition, patient transfers are routinely performed by BLS crews in charter aircraft (e.g., Beechcraft King Air 100 turboprops).

Licensing & Qualifications

Paramedics qualified in British Columbia are broadly referred to as "Emergency Medical Assistants" and are licensed by the Emergency Medical Assistants (EMA) Licensing Board ( [http://admin.moh.hnet.bc.ca/emaintra/ EMALB] ), a government agency, under one of five categories:

*Emergency Medical Responder (EMR)
*Primary Care Paramedic (PCP)
*Advanced Care Paramedic (ACP)
*Critical Care Paramedic (CCP)
*Infant Transport Team Paramedic (ITT)

EMR and PCP are Basic Life Support (BLS) qualifications while ACP is an Advanced Life Support (ALS) qualification; ITT and CCP include additional ALS endorsements. BCAS protocols are universal protocols which a qualified practitioner may employ at any time, up to his or her license qualification, within the provincial borders, given that the required equipment is at hand.

Since BC EMAs are not governed by a college of paramedics, the EMALB controls all aspects of licensing including evaluations, scope of practice and fees. There is a new [http://admin.moh.hnet.bc.ca/emaintra/policy/feeschedule.html fee schedule] (effective April 15, 2007). Written exams now cost $50.00 per attempt and practical exams at the EMR and PCP qualifications cost $400.00; practical exams for ACP qualification cost $500.00. There is also a licensing renewal fee of $50.00, due every five years. There is no cost for licensing at the ITT or CCP levels although so-qualified paramedics are still subject to the 5-year license renewal fee. Legislation exists to allow CCP licensure; however, there are currently no CCP-qualified paramedics in BC.

Emergency Medical Responder

An EMR licensee is qualified to deliver a limited number of medications, under the class of 'symptom relief', including "ASA", "Nitrous Oxide", "Nitroglycerin SL" 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 Entonox.

Primary Care Paramedic

The vast majority of Paramedics in BCpractice at this level.

In addition to the EMR protocols, PCP licensees have protocols for Shortness of Breath (SOB), Anaphylaxis, Narcotic Overdose, an expanded Diabetic Emergencies and a catch-all for patients with a decreased level of consciousness Not Yet Diagnosed (NYD) that combines the Diabetic/Hypoglycemic and Narcotic OD protocols. PCP-qualified paramedics may also be endorsed for intravenous cannulation (PCP-IV) and will have an additional protocol for Hypovolemia as well as enhancements to the anaphylaxis, diabetic, narcotic OD and NYD protocols. Additional PCP-level medications include "Salbutamol" (Ventolin), "Naloxone HCL" (Narcan), "Glucagon", "Epinepherine HCL" (Adrenaline), "Diphenhydramine" (Benadryl), "Thiamine" (Betaxin), "Dextrose 10%" (D₁₀W) and "Normal Saline".

Infant Transport Team

ITT paramedics are specifically trained for intensive perinatal, neonatal and pediatric care. They respond as a paired paramedic/paramedic crew to most calls and occasionally 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 consists currently of only 22 specially trained paramedics for the entire province.

In addition to the PCP protocols 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 Transport Advisor.

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, Venous Pressure Monitoring, Arterial & Central Line Monitoring, Chest Tube Management, Blood Product Infusion, IV Infusion Devices, 'IV with Medication' Maintenance, Mechanical Ventilation (using the LTV 1200 and BMD CrossVent), Foreign Body Removal with Laryngoscope and ET/IO/Rectal 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 are the only team trained in the province to transport pediatric and adult ECMO (Extracorporeal Membrane Oxygenation) patients.

Note that, 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 and Out-of-Scope Medications by orders.

Advanced Care Paramedic

Though there are relatively few ACP designated ambulances compared to PCP designated, the majority of the population is covered by ACP ambulances. 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. 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.

ACP paramedics have protocols to administer all PCP and ITT medications plus "Adenosine", "Calcium Chloride", "Dextrose 50%", "Dimenhydrinate" (Gravol), "Furosemide" (Lasix), "Heparin", "Ipratropium Bromide" (Atrovent), "Lidocaine", "Morphine Sulphate" and "Procainamide" (Pronestyl). Their additional skills include Cardioversion, Combitube, ETT - CO₂ Monitors, External Jugular Vein Cannulation, External Pacing, IV Colloid/Crytalloid Volume Expanders, Nasopharangeal Airways, Needle Thoracentesis and Surgical or Needle Cricothyrotomy.

Critical Care Paramedic

CCP crews are all paired paramedic crews in British Columbia, except for a trial program in Trail, which can best be described as a mixed success.

ACP-qualified paramedics can take further training consisting of a large portion of the CCRN program through BCIT, followed by an intensive hospital-based program through St. Pauls' Hospital. Following this there is a residency, and finally a CCP license. Formerly, an ACP could take a shorter course and receive an endorsement that was similar to CCP.

CCP's skills follow the NOCP guidelines as endorsed by the Paramedic Association of Canada. In addition to standard ACP protocols, CCP can perform skills and procedures as well as virtually any medication following their assessment and consult with the Critical Care Transport Advisor (CCTA). CCTA's are essential to both the air-evacuation and ground critical care transport programs. Some of their additional skills include Bladder Catheterization, 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, Transvenous Pacing, 12-Lead ECG, Venous Pressure Monitoring, Arterial & Central Line Monitoring, arterial line placement, adult intraosseous placement, Chest Tube Management, Blood Product Infusion, Mechanical Ventilation.

CCP's have standard operating guidelines for common critical patients; SIRS/Sepsis, RSI, Chest decompression, Ventilation strategies using the LTV 1000 and 1200, ACS or coronary care, etc. When operating beyond their ACP licence however, at some point the CCTA must be contacted.

Strictly speaking, the only skill not performed by CCP paramedics is Incubator usage, though if an ITT crew is available and close to a critical neonate or maternity, the best care scenario would have the ITT respond.

Training

EMR training is available through a variety of instructional agencies throughout the province. EMR courses that are approved by the [http://www.healthservices.gov.bc.ca/ema/ EMA Licensing Board] include those offered by the [http://www.jibc.bc.ca/paramedic/ Paramedic Academy] of the [http://www.jibc.bc.ca Justice Institute of BC] , the [http://www.firstaid.ca/ Academy of Emergency Training] , [http://www.firstaidtraining.com/ EMP Canada] , [http://www.lifesupportbc.com/ Life Support British Columbia] , [http://first-aid-training.com/ First Aid Certified Training Systems] and [http://www.mala.bc.ca/ Malaspina University College Centre for Continuing Studies] .

Primary Care Paramedic training is offered by both the Paramedic Academy and the Academy of Emergency Training. Advanced Care Paramedic training is only available through the Paramedic Academy. All ITT and CCP training is conducted 'in-house' by the BCAS through the Clinical Education Division in conjunction with BC Women's, Children's, Vancouver general, St. Paul's hospitals and the British Columbia Institute of Technology (BCIT).

The EMA Licensing Board maintains a [http://www.healthservices.gov.bc.ca/ema/trainingagencies/index.html list] of the approved training courses available to potential students. Those students who do not complete one of the approved courses will not be permitted to apply for a licensing examination.

Wages and Shifts

Shifts

There are two different part-time shifts, and four main full time shifts used at BC Ambulance stations. The part-time shifts are called Kilo and Foxtrot, while the four main full time shifts are Alpha, Bravo, Charlie, and Echo.

An Alpha shift is a 24 hour/day shift pattern, broken up into two 12-hour shifts, or a 10 hour then 14 hour shift, depending on the station. Both Bravo and Charlie shifts are 11 hours long, with Bravo starting in the morning (eg: 0700-1800), and Charlie starting in the afternoon (eg: 1300-0000). An Echo shift is 10 hours long, and can start at any time during the day depending on the area's needs. Neither Bravo, Charlie or Echo patterns are 24 hour/day shifts. Employees working a full time shift are paid their full time wage regardless of how many calls they do.

The part-time shifts have their advantages and disadvantages. The main disadvantage is that your pay is entirely dependent on the amount of calls you receive, as you are paid per call out. It is not uncommon for paramedics at stations with lower call volumes to have to have a second job. However, at stations that have a Kilo shift in a busy station, which is not very common, paramedics can sometimes make more money in a shift than a full time employee working the same number of hours. While working a Kilo shift, you receive what is called Pager Pay. As of 2008, pager pay is $2/hour, and has been for a number of years. You are not expected to perform any duties or even be at the station (although you should be within 5-10 minutes travel time) during a Kilo shift, while receiving pager pay. For locals hired as paramedics, this type of shift works quite well, as they can stay home during their shift. For non-locals who have to commute, this can be quite problematic if it is a station with low call volume. In the event you get paged to a call, you get a minimum of 4 hours pay, regardless of whether you are actually out for 4 hours or not, and should your call go over 4 hours, you are paid by the minute. In a very busy station, the few that actually have a Kilo shift, where you could get called out multiple times per day, you can make a great deal of money per day without even necessarily having done all those hours of actual work. However, in the event that you do not get called out, you only make $2/hour as pager pay.

A Foxtrot shift is a compromise between a full time shift and a Kilo shift. You are paid $10/hour to be at the station and have a response time of less than 90 seconds. Again, you are not expected to perform any duties while receiving what is called Standby Pay. Should a call come in, you are considered "activated" for 3 hours. You receive 3 hours pay, regardless of the number of calls you do in that time frame. After that three hours, you return to your Standby Pay until another call comes in.

In the past, the majority of paramedics in the smaller communities were locals, who normally had other jobs and performed paramedic duties so they could serve their community. Now, the number of locals has decreased significantly and small communities have to rely on non-locals to staff the ambulance stations. The low call volume of those stations, now paired with the cost of commuting makes it quite commonplace for paramedics to require more than one job to support themselves for the first two years of working for BC Ambulance, until they get enough seniority to transfer to a station that is busier. The retention rate of newly hired paramedics after one year is not very impressive.

Wages

The starting wage for an EMR is $18.41/hour, a PCP starts at $19.27/hour or $20.17/hour with IV endorsement, and full time ACP starts at $31.00/hour. For the first 6 years of employment, part time employees are given paid 17% in lieu of benefits on top of their wage. Only after being employed for six years are part time employees given some medical and dental benefits. The only scheduled wage increase is after five years of service, you receive a $5/hour raise. For part time employees working a kilo of foxtrot shift, you only receive this wage when you get called out. Otherwise you only make the pager or standby pay. If there is a vacancy in a full time shift that you as a part time employee are asked to fill, you will be paid your full time wage for the entire shift.

Labour Relations

Ambulance paramedics, emergency medical call-takers, and emergency medical dispatchers are members of the [http://www.apbc.ca Ambulance Paramedics of British Columbia (APBC), Local 873] of the [http://cupe.ca/ Canadian Union of Public Employees] (CUPE). Provincial headquarters and administrative staff are members of the [http://www.bcgeu.bc.ca/ British Columbia Government Employees Union] (BCGEU).

[http://www.health.gov.bc.ca/bcas/careers/start/ Hiring Process]

Hiring Process

The basic requirements to become employed by the BCAS as of August 15, 2007 are:

* A valid EMR, PCP, ITT, ACP or CCP license issued by the Emergency Medical Assistants Licensing Board;
* A valid Class 1, 2 or 4 BC Driver's License. If Class 4, then 'unrestricted' is preferred.
* Proof of a 'safe and competent' driving history as demonstrated by a Driver's Licence Abstract;
* A CPR Level 'C' (or HCP) certificate, valid within one year, also known as "BCLS";
* Legal entitlement to work in Canada;
* At least 19 years of age;
* Grade 12 Graduation diploma or equivalent;
* Satisfactory Criminal Record Search and [http://www.pssg.gov.bc.ca/criminal-records-review/ Criminal Record Review Act] Search;
* Fit to safely perform the duties of a paramedic as measured through a medical and physical pre-employment assessment;
* Be of good character;
* Be available on a regular basis for ambulance duty.

At this time, EMR-qualified staff are only permitted to work in remote and rural stations and must upgrade to PCP if they wish to further their career with the BCAS, including lateral transfers to an Urban or Metro-designated station on a part-time basis or application for a full-time posting. The exceptions to this rule include applications to one of the Dispatch Centres or to the Metro Vancouver Transfer Fleet, both of which require only an EMR qualification; these are internal applications for current BCAS employees only.

If the above requirements are not able to be fully met, the applicant can still contact a paramedic chief in their local community for further information on applying. For example, in cases of extreme staff shortages, an attendant may be hired as a "Driver Only" if he or she holds only a Level 3 Occupational First Aid (OFA 3) Certificate [http://www2.worksafebc.com/Topics/FirstAid/Certificates-BC.asp?ReportID=33597&_Type=Certificates-Accepted-in-B.C.&_Title=OFA-Level-3-and-Equivalencies or equivalent] (OFA 3 is not a prerequisite for an EMR license but it is the current industry standard in BC for remote or high-risk workplaces).

With the abolishment of mandatory retirement, paramedics may work past the age of 65 as part-time employees. Once they retire from full-time service, they must be off work for a period of one month after which they may reapply to become employed by the BCAS in a part-time capacity; it is the pension corporation that requires a formal severance of employment prior to the pension benefits being activated. The details of this process have yet to be fully fleshed out.

On average, it takes approximately 3 to 6 months before an applicant is granted an interview. The interview consists of a behavioural interview with a panel of two to three paramedic chiefs (and may include a Regional Superintendent or HR personnel) and is approximately 1 hour long. It may be held at a regional Human Resources office or at a given ambulance station where the applicant is under consideration. The interview follows the STAR (Situation, Task, Action, Result) format. If the applicant has not yet completed a PCP program, there will also be a written exam based on OFA 3 knowledge of first aid and anatomy. After an applicant completes the interview he or she will not find out the results for another 1-3 months. If unsuccessful at the interview stage, the applicant may be told he or she cannot re-apply for a period of 6 months.

If the applicant passes the interview, they are entered into the hiring pool and ranked according to their score on the written exam and interview. From this point, the prospective employee may be contacted by a paramedic chief that is hiring. After passing the interview stage, a physical fitness assessment, a medical assessment and two criminal record checks will be conducted. Assuming all goes well, the applicant is then hired into the service at a specific ambulance station, called a 'primary operator'. Once issued an employee number, they are deemed eligible to work and the employee enters into a six-month probationary period. If the applicant is hired as underqualified (i.e., hired without a Class 4 driver's license or other specific training), conditions of probation may be imposed such that the person must obtain certain qualifications before their probation is up or they may be released from the service. During probation, a paramedic may not move to another station (called a lateral transfer) or work at any other BCAS station (often called working at a 'secondary operator'). The probationary period may be extended at the discretion of the Executive Director; this requires both the signature of the Paramedic Chief and the District Superintendent, as well as notification to the individual prior to the extension.

Full time vs. Part Time

All employees hired start as part time employees. You will generally start at a Remote or Rural-designated station until you have passed your 6 month probation period and have enough seniority to transfer to another station. Sometimes it can take up to a year and a half before another position becomes available for you to fill. As a part time employee, you work as much or as little as you like, with a minimum commitment of being available to work eight shifts per month at your home station. This can be advantageous as it allows you to schedule what days you like to work, or if you want to go on vacation without worrying about asking for time off. To become a full-time employee, you have three options. The first option is to continue working as a part time employee in the field, until you attain sufficient seniority (currently around 4.5 years), in order to transfer directly to Vancouver Post (Emergency or Transfer fleet). Secondly, you could or apply to transfer into Dispatch after completing your initial probation. The last option is to gain your ACP qualification and bid on a full-time position in one of the major centres.

Getting hired in Vancouver as a PCP is the more common route taken to be hired as a full time employee. Once you are hired as a full time employee in Vancouver, you can also apply for a full time position elsewhere, however you will be competing for that position with every other full time employee who has applied. Full time positions are awarded based on the number of years worked as a full time employee. This means that it could be at least 2-3 years working in Vancouver before you have enough seniority to leave. Generally, this is a good thing as it gives new full-time paramedics ample opportunity to practice and hone their skills.

Rank & Qualification Insignia

The BC Ambulance Service is a paramilitary 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. BCAS qualification insignia has not yet caught up to the new license levels of EMR/PCP/ACP/CCP and as such, current collar insignia is out of date. Past insignia had paramedics qualified at the EMA 1 or EMA 2 levels provided bronze and silver circles, respectively, forming the BCAS logo, along with a bar below denoting the EMA 1 (now EMR) or EMA 2 (now PCP) qualification. EMA 3 - Advanced Life Support (now ACP) and EMA 3 - Infant Transport Team paramedics were recognized with gold cauducei, with either "ALS" or "Neonatology" imprinted upon them. Emergency Medical Dispatchers (EMDs) and Emergency Medical Call Takers (EMCTs) presently wear gold and silver shields, respectively.

For rank insignia, field paramedics and dispatchers wear a blank epaulette holder. Paramedics and dispatchers who hold the position of Paramedic Chief, Dispatch Officer or Charge Dispatcher, wear a black epaulette with three gold stripes. District Supervisors, Dispatch Supervisors, Provincial Special Program Managers/Advisors wear the same coloured epaulette, with four gold stripes. Ranks above District Supervisor are management positions and are distinguished by a shoulder flash that is navy blue, with a navy blue trim, as well as a varying number of pips on their epaulette. District and Platoon Superintendents wear an epaulette with three pips, Directors of Operations wear one pip and one crown and the Executive Director of a region will wear two pips plus a crown. Shoulder flashes for field staff are royal blue with yellow trim, and include the British Columbia Coat of Arms, with the words "Ambulance" above, and "British Columbia" below, in white. Shoulder flashes for management personnel are navy blue with a navy blue trim. The layout of the shoulder flash is the same for both. Each station and dispatch centre has a staff member designated as its Occupational Safety & Health representative. These paramedics and dispatchers are identified with a navy 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.

ee also

*E-Comm, 9-1-1 call and dispatch centre for Southwestern BC

References

[http://www.health.gov.bc.ca/bcas/ BC Ambulance Service Official Site]

[http://www.apbc.ca Ambulance Paramedics of BC, CUPE Local 873 Official Site]

[http://www.bcparamedicsatwork.com British Columbia Paramedics at Work - a photo/video chronicle of British Columbia's Paramedics on the job]