Training for specialization as a paramedic is most often provided by employers who select paramedics that have gone through an internal competition. There are very few specialization education programs open to the public currently. Most specializations require the applicant to already be an experienced advanced care paramedic.
Critical care paramedic (CCP) Critical care paramedics' expertise focus on critical and ICU level care, stabilizing and transporting patients from smaller hospitals with less available resources to tertiary care, and regional medical programs in to other hospitals that can provide a higher level of care. CCPs generally work with another CCP, ACP, registered nurse or under the direction of a physician, physician assistant or nurse practitioner. Sometimes ad hoc teams, with multiple practitioners (RTs, emergency physicians, physician assistants, surgeons, etc.) are assembled for certain patients. CCPs are able to provide all of the care that PCPs and ACPs provide. In addition to this they are trained for other skills such as medication infusion pumps, mechanical ventilation and arterial line monitoring. CCPs often work in fixed and rotary wing aircraft when the weather permits and staff are available, but systems such as the
Toronto EMS Critical Care Transport Program work in land ambulances.
ORNGE Transport operates both land and aircraft in Ontario. In British Columbia, CCP's work primarily in aircraft with a dedicated Critical Care Transport crew in several cities for long-distance/high acuity transfers and as regular CCP street crews who may do major trauma calls or, performs medevacs, when necessary. Across the prairies, STARS
Shock Trauma Air Rescue Society uses rotary wing aircraft to reach many in isolated communities and traumatic situations for faster response time than by ground ambulance. In Saskatchewan they also use fixed wing air ambulances. The service, called LIFEGUARD, can respond a greater distance and to more northern communities than STARS. Sask air ambulance service was the first non-military air ambulance service in the world. These air ambulances are crewed by Flight Nurses and CCPs.
Tactical paramedic Tactical paramedics are specialized paramedics who undergo additional training to allow them to perform their usual tasks in a high-risk and dangerous scenarios. Some are trained to handle weapons, rappel from buildings, and other skills needed to work alongside tactical police units. These paramedics are required to wear protective gear but are usually unarmed in civilian environments. Paramedics also exist in the
Canadian Armed Forces. They are trained to the same level as their civilian counterparts, with added knowledge for working in combat environments, in
CBRNE environments, and in prolonged field settings. They can further specialise into ship-borne medicine, dive medicine, aeromedical evacuation, or working in Special Forces environments. All CAF medics are weapons qualified.
Occupational paramedic Occupational paramedic responsibilities may include providing pre-employment screening, medical surveillance services and clinical testing for companies and research institutions. Occupational paramedics may work in a variety of environments including in a clinical setting or in the field including mining sites, oil rigs or other high risk areas. Occupational paramedics may work under the direction of occupational physicians, physician assistants and nurse practitioners. Occupational paramedics may also work collaboratively with registered nurses and registered/licensed practical nurses in the field or may work alone with clinical supports available from electronic means.
Community paramedic One of the more recent roles for paramedics in Canada is the community paramedic. These specialized paramedics work in clinics, hospitals, and in patient's homes. They provide immediate or scheduled primary, urgent and specialized healthcare to vulnerable patient populations by collaborating with other healthcare providers, conducting assessments, treating, and doing/ordering tests. Diagnostics provided by community paramedics include: specimen collection (blood, urine, swabs), electrocardiogram interpretation, vital signs, and facilitate transports for diagnostic imaging. Treatments provided by community paramedics include: fluid rehydration, blood transfusions, urinary catheterization, wound closure & care (tissue adhesive, sutures, dressings), oxygen and nebulizer therapy, medication administration, and coordination of community services. In Saskatchewan, paramedics may become endorsed as community paramedics by the Saskatchewan College of Paramedics upon the completion of an accredited community paramedicine program.
Incident response paramedic Incident response paramedics receive intensive training, including toxicology,
hazmat chemistry,
National Fire Protection Association hazmat awareness and operations certifications, as well as three weeks of
CBRNE training, antidote, medical countermeasures, MCI, and protective equipment training. For day-to-day operations, incident response paramedics respond to hazmat- and toxicology-related incidents. These paramedics may carry a unique range of medications than and more protective equipment, allowing them to better treat poisonings/overdoses and work closely with firefighters and hazmat technicians. == Regulation of the paramedicine profession ==