Land Ambulance Certification Standards

Version 1.4

Comes into force August 2, 2022

Emergency Health Regulatory and Accountability Branch  
Ministry of Health

To all users of this publication:

The information contained in this standard has been carefully compiled and is believed to be accurate at date of publication.

For further information on the Land Ambulance Certification Standards, please contact:

Emergency Health Regulatory and Accountability Branch 
Ministry of Health
590 Rossland Road East
Whitby, ON L1N 9G5
Tel: 905-665-8086

Document control

Commonly used abbreviations

Section 1 – Application to operate a land ambulance service

Application form

A person who wishes to be certified to operate a land ambulance service in the Province of Ontario must complete and submit the application form and associated fee prescribed by the Certifying Authority. In accordance with O. Reg. 257/00 s. 2(2) made under the Ambulance Act (the Act), such application must be submitted at least 120 days before the day the applicant intends to begin providing ambulance service. Application forms may be requested by contacting the Inspections and Certifications unit, Emergency Health Regulatory and Accountability Branch (EHRAB), Ministry of Health (MOH).

The completed application form, including a certified cheque or money order payable to the Minister of Finance in the amount of $40.00, must be submitted to:

Inspections & Certifications
Emergency Health Regulatory and Accountability Branch
590 Rossland Road East
Whitby ON L1N 9G5
Attention: Chair, New Operator Certification Panel
Tel: 905-665-8086

Certification process

Upon receipt of the application and fee, a detailed package of information entitled, the New Operator Certification Package will be provided to the applicant within seven business days. The package will set out the specific criteria and requirements that an applicant will need to meet in order to demonstrate their readiness to be certified to provide land ambulance service in Ontario.

The New Operator Certification process includes two phases as described below:

Phase one:

The applicant will submit documentation that outlines how the applicant intends to fulfill the legislated requirements as set out in the Ambulance Act, O. Reg. 257/00 and applicable standards. The required documentation will be submitted in the prescribed format and will include an administrative fee of $460, to cover the convening of the New Operator Certification Panel. The required documentation and administrative fee are defined in the New Operator Certification Package, as may be amended from time to time.

The submitted documentation will demonstrate the applicant’s ability to provide ambulance service and the provision of patient care, quality assurance and administrative preparedness. Within 20 business days of receipt of the submitted documentation, the Certifying Authority will provide a written evaluation to the applicant containing an assessment of the applicant’s compliance or ability to comply with the criteria.

• If the submitted documentation meets the requirements of the certification criteria, the applicant will proceed to Phase Two, the New Operator Certification Panel interview. The Certifying Authority will establish a mutually agreeable date and time (within 15 business days) for the operational evaluation interview to be conducted by the New Operator Certification Panel.
• If the submitted documentation fails to meet the requirement of the certification criteria, the applicant will be contacted and provided a summation of areas identified to be lacking the necessary supporting documentation. Applicants will be provided a deadline for submission of the additional supporting documentation.

Phase two:

Upon successful completion of Phase One, the applicant will be required to attend the New Operator Certification Panel interview. The Panel may require the applicant to clarify components of the documentation submission and/or answer any questions from the panel. The applicant will also be required to respond to verbal scenarios designed to demonstrate the preparation, planning and operational readiness to provide land ambulance service.

Certification

Upon successful completion of the certification process, a recommendation will be put forth to the Certifying Authority for certification as a land ambulance service operator in Ontario, for a term of one year. Within 180 days of receiving the Certificate to Operate a land ambulance service, the operator will be subject to an Ambulance Service Review. Successful completion of the Ambulance Service Review will result in the issuance of a three year Certificate to Operate.

Section 2 – Recertification process

Recertification process

1. Each certified operator of a land ambulance service will be notified by Inspections and Certifications that an Ambulance Service Review will be conducted on the service at a time that is not less than 90 days following the date of notification.
2. An Ambulance Service Review site visit will be completed by the Ambulance Service Review Team to determine the provider's compliance with the legislation and standards.
3. The operator of the land ambulance service will be provided with a written report by Inspections and Certifications, within 60 days from the last day of the site visit. The report will include observations noted during the service review where improvements are required in order to comply with legislation and standards.
4. Where the Ambulance Service Review determines that the applicant/operator has met the requirements for certification, the Manager, Inspections and Certifications will make a recommendation to the Certifying Authority regarding the observations of the review team.
5. Where the Ambulance Service Review determines that the applicant/operator has not met the requirements for certification, the applicant/operator will be given opportunity to address the observations noted by the review team. A Supplemental Ambulance Service Review will be conducted to re-evaluate compliance with legislation and standards.
6. Where the Certifying Authority accepts the recommendation from the Manager, Inspections and Certifications, that the operator has met the requirements for certification, the Certifying Authority will issue a certificate to the provider that has a term of three years.

Failure to recertify

1. Where the review team determines that the operator has not met the criteria for recertification, the Certifying Authority will notify the Director, EHRAB.
2. Where the operator has not met the criteria for recertification, the applicant/ operator will undergo a Supplemental Visit within 180 days post initial service review.
3. The Director may make an order under s. 11(1)(b) of the Act, where the operator will be required to comply with the order to meet certification compliance.
4. In accordance with s. 11(3) of the Act, if an operator fails to successfully complete the certification process in the time specified, the Certifying Authority shall, by order, revoke the operator’s certificate.

Director’s Order

1. Where the Director finds that an operator is found to be operating in a manner that contravenes the Ambulance Act or any regulation or standard as set out under the Act, the Director, EHRAB, may make an order under s. 11(1)(b) of the Act, that the certified operator must complete the certification process within the time frame specified in the order. The Director, EHRAB, will advise the Certifying Authority within five business days of the order and of the specified timeframe for the operator to comply with the order.
2. The certification criteria and process information package, that the operator will be required to comply with, will be sent to the operator within seven business days of being notified of the order by the Director, EHRAB.
3. Within 20 business days of being notified of the order, the Certifying Authority will establish a timeframe when the certified operator will be evaluated for compliance with the certification criteria.
4. Where the Certifying Authority determines that the operator has met the criteria for certification, the Certifying Authority will issue a certificate that has a term of one year.
5. The Certifying Authority will inform the Director regarding compliance of the operator with the order and, where a certificate is issued, the date on which the certificate expires will be identified.
6. An operator who receives a one-year certificate subsequent to an order made under the Act s. 11(1)(b) will receive an Ambulance Service Review within 180 days of the date the certificate is issued under this provision.

Section 3 – Operational certification criteria

In addition to the requirements of Section 1 and Section 2, a person seeking to be certified or recertified to operate a land ambulance service shall provide the Certifying Authority with documentation to demonstrate that:

1.0 Operational requirements

1. Each applicant/operator shall ensure the continuity of ambulance service operations within their geographical area, in accordance with the Ambulance Act, its regulations and standards as those documents may be amended from time to time.
2. The applicant/operator's service shall participate in an Ambulance Service Review, every three years or as mandated by a Director’s Order, to evaluate the applicant/operator’s compliance with the Ambulance Act, its regulations and standards, in order to renew their Certificate to Operate.
3. Each applicant/operator shall provide access to all ambulance service accommodations, ambulances, emergency response vehicles, and all equipment and supplies used in the applicant/operator's service.
4. Each applicant/operator shall receive written approval from the Director, EHRAB, prior to engaging in clinical research trials as per the Research Trail Standard in the ALS PCS.
5. Each applicant/operator shall receive written approval from the Director, EHRAB, prior to engaging in new patient care models.

2.0 Staffing/deployment plans

1. Each applicant/operator shall ensure that land ambulance and emergency response vehicles are staffed and operated, in accordance with the Patient Care and Transportation Standards published by the Ministry as may be amended from time to time.
2. Each applicant/operator has provided a deployment plan to their local MOH Field Office, that ensures the proper provision of land ambulance services in their geographical area, in accordance with the needs of the citizens within their geographical area.
3. The applicant/operator shall only permit the transport of a patient as defined in the Act, to a health care facility with an Emergency Department or Urgent Care Centre, in an ambulance response vehicle.

3.0 Response time performance plans

1. The Upper Tier Municipality (UTM)/Delivery Agent will establish and maintain a Response Time Performance Plan consistent with O. Reg. 257/00 Part VIII, as may be amended from time to time.
2. The response time standard as set under paragraph (a), will be reported to the Director, EHRAB, not less than one month prior to commencing the provision of service and subsequently, no later than October 31^st in each year for the subsequent calendar year.
3. The applicant/operator ensures that all reporting requirements as set out in Regulation 257/00, regarding the Response Time Performance Plan established under paragraph (a) is reported to the Director, EHRAB.

4.0 Base Hospital agreement

1. A valid agreement is in effect between the applicant/operator and the designated Regional Base Hospital Program, for each area in which the applicant/operator proposes to provide land ambulance service.
2. The Regional Base Hospital Program agreement shall include, but is not limited to:
   1. Providing medical direction and training to all paramedics/EMAs.
   2. Monitoring quality of patient care provided by paramedics/EMAs.
   3. Delegation of controlled medical acts to paramedics/EMAs.

5.0 Identification cards

1. Each paramedic/EMA employed by the applicant/operator is assigned a unique identification number issued by the Director, EHRAB.
2. The unique identification number referenced in clause (a) shall appear on a photo identification card as well as the service number that conforms to Schedule 1 of this standard.
3. The service specific photo identification card shall be carried on the paramedic/EMA at all times, while on-duty.
4. In the event that a paramedic/EMA employed by the applicant/operator separates from the service or is terminated, the operator of the land ambulance service shall recover and return the photo identification card to the Ministry.

6.0 Communication service

1. Each employee of the applicant/operator who is required to drive an ambulance as part of their employment, shall transport each patient to a facility or other destination as directed by an Ambulance Communications Officer, in accordance with the Patient Care and Transportation Standards published by the Ministry as may be amended from time to time.
2. In the absence of a direction given under paragraph (a) the driver of an ambulance shall in an emergency situation, transport a patient to the closest, most appropriate, health care facility that is able to meet the health care needs of the patient in accordance with the Patient Care and Transportation Standards published by the Ministry as may be amended from time to time.
3. No paramedic/EMA of the applicant/operator's service shall refuse or disregard the direction of an Ambulance Communications Officer with regards to any request for ambulance service.
4. The communication service that normally directs the movement of the land ambulances and emergency response vehicles in the applicant/operator's service will be kept informed by the employees, of the applicant/operator at all times, as to the availability and location of each employee, land ambulance and emergency response vehicle.
5. The presence and movement of each land ambulance and emergency response vehicle in the applicant/operator’s service is reported promptly by each applicable employee of the applicant/operator to the communication service in whose geographical area the ambulance or emergency response vehicle is physically located.
6. The driver of a land ambulance or emergency response vehicle, who is an employee or agent of the land ambulance operator, who is directly or indirectly involved in a collision or other event that prevents the vehicle from providing service will immediately notify the communication service which directs the movements of the land ambulance or emergency response vehicle.

7.0 Patient Care/continued medical education

1. As a condition of employment, each employee in the applicant/operator’s service, who is required to provide patient care, provides such patient care in accordance with the current Basic Life Support Patient Care Standards (BLS PCS) and the Advanced Life Support Patient Care Standards (ALS PCS) published by the Ministry, as may be amended from time to time.
2. Each paramedic/EMA employed in the applicant/operator's service will receive the opportunity to obtain continuing medical education to maintain competence in patient care, patient care equipment and communication equipment as required for the proper provision of service, in accordance with the standards referred to in paragraph (a).
3. Each paramedic/EMA employed in the applicant/operator’s service required to complete consolidation in accordance with the Certification Standard of the Advanced Life Support Patient Care Standards, published by the Ministry as may be amended from time to time, is provided the opportunity to complete the consolidation.
4. Each paramedic/EMA employed in the applicant/operator's service will receive the opportunity to complete the continuing medical education hours per year, for their level of certification and other requirements as set out in accordance with the Certification Standard of the Advanced Life Support Patient Care Standards, published by the Ministry as may be amended from time to time.
5. Each newly hired paramedic/EMA employed in the applicant/operator’s ambulance service, has undergone an evaluation of their patient care skills, as well as received education and training as required to correct any noted deficiencies, to ensure patient care is provided in accordance with the Basic Life Support Patient Care Standards and the Advanced Life Support Patient Care, published by the Ministry, as may be amended from time to time.
6. Each paramedic/EMA employed in the applicant/operator's ambulance service will receive the opportunity to complete remediation as may be necessary to correct a deficiency in a patient care skill as identified by the operator or Base Hospital Medical Director in accordance with the Certification Standard of the Advanced Life Support Patient Care Standards, published by the Ministry as may be amended from time to time.
7. Each paramedic/EMA employed in the applicant/operator’s ambulance service shall be provided education and training on new, updated, or amended legislation and standards.

8.0 Paramedic/EMA qualifications

1. An applicant/operator shall ensure that a personnel record is maintained for each paramedic/EMA employed by the applicant/operator, that demonstrates the paramedic/ EMA holds the qualifications as set out in O. Reg. 257/00, Part III.
2. Each paramedic/EMA employed in the applicant/operator’s service is immunized and free from communicable diseases, in accordance with the Ambulance Service Communicable Disease Standards published by the Ministry, as may be amended from time to time.
3. Each paramedic/EMA employed in the applicant/operator’s service shall receive the annual influenza training and immunization in accordance with the Patient Care and Transportation Standards published by the Ministry as may be amended from time to time.
4. Each applicant/operator shall, by the date set out in the Patient Care and Transportation Standards published by the Ministry as may be amended from time to time, report the requested influenza data to their local Senior Field Manager, Emergency Health Program Management and Delivery Branch.

9.0 Documentation

1. Ambulance Call Reports and Incident Reports are completed, distributed and secured from unauthorized access with respect to each call, incident, complaint, investigation, and collision relating to the applicant/operator's service, and/or employees, in accordance with the Ontario Ambulance Documentation Standards and the Ambulance Call Report Completion Manual, published by the Ministry as may be amended from time to time.
2. If an applicant/operator utilizes an electronic version of the Ambulance Call Reports (eACR), and Incident Reports, the operator shall ensure that the eACR and Incident Report includes all components as specified within the Ontario Ambulance Documentation Standards, and the Ambulance Call Report Completion Manual, published by the Ministry as may be amended from time to time.

10.0 Equipment and supplies

1. Each vehicle used as a land ambulance or emergency response vehicle in the applicant/operator's service shall contain at a minimum, the patient care equipment and supplies as set out in the Provincial Equipment Standards for Ontario Ambulance Services published by the Ministry as may be amended from time to time.
2. Each applicant/operator shall ensure that all patient care, conveyance and accessory equipment used in the applicant/operator’s service shall be maintained according to the original equipment manufacturer’s specifications.
3. Each applicant/operator and every paramedic/EMA employed by the applicant/operator shall ensure that all patient care, conveyance, and accessory equipment is maintained in a clean and sanitary condition and in proper working order.
4. Each applicant/operator and every paramedic/EMA employed by the applicant/operator service shall ensure that medications and controlled medications are secured in a manner that prevents unauthorized access to them and are stored according to manufacturer’s specifications, service policy and legislation.

11.0 Vehicles

1. Only ambulances and emergency response vehicles that comply with the applicable version, at time of manufacture, of the Ontario Provincial Land Ambulance and Emergency Response Vehicle Standards published by the Ministry as may be amended from time to time, shall be used in the applicant/operator's ambulance service.
2. Each addition or modification made to a land ambulance and/or emergency response vehicle used in the applicant/operator's service shall comply with the current version of the Ontario Provincial Land Ambulance and Emergency Response Vehicle Standards at the time of the modification as published by the Ministry as may be amended from time to time.
3. Each land ambulance and emergency response vehicle used in the applicant/operator's service is identified by and has displayed in an obvious, highly visible location on the front and rear exterior of the vehicle, a unique identification number that has been assigned by the Director, EHRAB.
4. Each land ambulance and/or emergency response vehicle used in the applicant/operator's service shall be maintained in a clean and sanitary condition, in a safe operating condition according to manufacturer’s specifications, and in proper working order.

12.0 Quality assurance

1. Each applicant/operator shall have a quality assurance program/process intended to ensure compliance with all applicable legislation and standards. Ambulance service applicants/operators shall have a quality assurance program in place to oversee care provided by paramedics under the standards.
2. Each paramedic/EMA employed in the applicant/operator’s service will receive an annual evaluation of their patient care and documentation, to ensure patient care and documentation of the care provided, is compliant with the standards. Completed annual evaluations will be maintained on the employee’s file and a copy provided to the employee.

Section 4 – Schedule 1

Identification card criteria

1. An ambulance service identification card shall be a minimum of 8.5 centimeters long and 5.3 centimeters wide with a white background color, and shall contain:
   1. The employee’s unique identification number issued by the Director under this standard;
   2. The ambulance service’s unique identification number issued by the Director, EHRAB shall be present in the top right-hand corner;
   3. The surname and initials of the paramedic/EMA; The word ‘AMBULANCE’ in letters using a font of at least 0.5 centimeters with a length of 3.2 centimeters, and will be in letters that have a high contrast with the background color of the card;
   4. A color photograph measuring a minimum 3.0 centimeters long and 2.3 centimeters wide featuring a head shot of the employee on the left-hand side of the card;
   5. An expiry date;
   6. Security measures that will prevent duplication of the card;
   7. An expiry date;
   8. Security measures that will prevent duplication of the card; Security measures that will prevent tampering with the information or photograph contained on the card.
2. Ambulance service identification cards issued by the Emergency Health Regulatory and Accountability Branch are and remain the property of the Ministry. Upon release from employment, it is the responsibility of the applicant/operator who made the application for the Identification Card to retrieve and surrender the card to the Emergency Health Regulatory and Accountability Branch.