The regulatory landscape for paramedics who work in more than one province has always been a bit tricky to navigate, but the events of the past year have highlighted the need to make more information available on this important topic.

As you know, if you are an EMR, PCP or ACP working in any province in Canada, you are required to hold a valid practice permit or license issued by that province’s regulatory body. There are essentially two types of regulatory bodies for paramedics in Canada: government agencies and self-regulating colleges. Currently, BC, ON, QB, PEI and NL are government agency regulators, whereas AB, SK, MB, NB and NS have self-regulating colleges. While the structure of these organizations differs, the primary reason they both exist is to ensure that registered practitioners are providing safe, competent care to the citizens living in each province.

Both types of organizations have policies and processes for issuing practice permits and/or licenses to practitioners who are qualified to provide patient care. Both organizations are also responsible for enforcing conduct rules on people who practice without the proper practice permit/license, and they have a duty to enforce them. If a paramedic practitioner is found working in a province without proper registration, there can be serious implications ranging from suspensions and steep fines to possible criminal charges. Regulators are also required to share conduct information about practitioners with other Canadian jurisdictions, which can result in the practitioner’s inability to become registered again anywhere in Canada.

So, how do provinces allow for interprovincial transports and repatriations? Does the practitioner need to be registered in each province, even if they are only going to be in one of the provinces briefly to drop off or pick up a patient?

Typically, many provinces have provisions to allow a registered practitioner from one jurisdiction to provide care during an interprovincial transfer, and in some circumstances, grant up to 72 hours for the provision of this care. There are also interprovincial aid agreements in place to further address this, which allows registered practitioners from one jurisdiction to practice in another province and provide aid in the event of a mass casualty incident or a natural disaster.

Interprovincial transfers are arranged between the doctor at the sending facility, the doctor at the receiving facility and the dispatch agencies within each province. Once confirmation is obtained that the doctor in the receiving facility is willing and able to take the patient, the dispatch agencies coordinate  and arrange the most appropriate transport unit. All of this takes place behind the scenes and for the most part the paramedic plays no role in it.

When the paramedic(s) receive the call to transport the patient, the paramedic does not need to notify the regulatory body in the other province, as it will have been arranged for by the dispatch agencies. Most paramedics have a clear understanding of this process, but for the new members of the profession, it is a good reminder.

For mass casualty incidents, for example, a large bus crash on the SK/AB border, there are interprovincial mutual aid agreements that are in place and allow for paramedics to provide care, that are for typically up to the 72-hour maximum mentioned previously. In the event of a significant natural disaster, however, one that might require interprovincial aid that exceeds 72 hours, that would be when the regulatory bodies get involved and could, in Alberta’s case, grant a courtesy permit that would allow an out-of-province paramedic practitioner the ability to work in Alberta for a predetermined period of time.

Any exceptions aside, the most common situation where unregistered practitioners work outside their home jurisdiction occurs within industry. Many worksites, such as oil and gas exploration or pipeline construction, are mobile and can often cross provincial borders. If you are working in such an environment where there is an expectation to provide ongoing care in a province other than the one you are registered in, even it is only in another province by a couple kilometers, you must gain a valid practice permit/license from that province’s regulatory body. Failure to do so will most likely result in substantial repercussions.

For information on registration in Alberta: