framework to begin the creation and assessment of the requirements for ontario's ambulance response system. the act contained basic information to begin regulating ambulance services such as definitions of terms and levels of authority. this act would effect all forms of ambulance services in ontario regardless of ownership. the ontario hospital services commission was created within the provincial government to oversee the transition of ambulance services into a standardized system. these changes were spearheaded by dr. norman mcnally-who has been named "the father of ems in ontario". on july 1, 1968, all ontario ambulance services became part of the ontario hospital services commission (ministry of health and long term care). persons insured with o.h.s.c are entitled to use an ambulance will only be required to pay 25% of the scheduled rates. this transition as a whole was positive for the workforce of attendants. a transition that demanded better equipment, pay, standards of care and ensured proper ambulances would be used to transport patients instead of homemade vehicles. these changes came at the expense of the hiscoe and magladry families who spent all their time and money to provide ambulance care. by the end of the transition phase in 1974 ottawa ambulance service was purchased by the newly formed ambulance services branch of the ministry of health and all the employees became crown agents. by 1975 the ambulance act was updated to contain the new standardized criteria for employment with a service as well as the service and its equipment. ottawa ambulance service continued to operate from 1975 to 1984 when the service name was changed to "ottawa-carleton regional ambulance service". this name remained the same until 2001. in 1984 changes occurred in the periphery of ottawa. areas such as orleans, kanata, osgoode, richmond and barrhaven expanded quickly and required better ambulance coverage. bases and contracts were drawn up creating the following five privately owned ambulance services that also responded to ottawa: rockland orleans ambulance service: orleans base opened in november 1984 (was briefly owned by ottawa) and was owned by bernard thivierge. arnprior-kanata ambulance service: kanata base opened in november 1984 and was owned by doug powell. carleton place-richmond ambulance service: richmond base opened in 1981 due to local pressure for better coverage. this service was owned by mr. alan barker of carleton place. st. lawrence and district ambulance service: this service owned or operated the barrhaven post (1984) and nepean post (1984). although once the hunt club bridge became operational, the nepean post was closed and sldas took over the queensway carleton hospital ambulance base. this service was run by mr. ron dalgleish until july 21, 1997, when it was sold to rural metro who ran the service until 2001. osgoode and district ambulance service: this service was opened in april 1988 under a contract with st lawrence and district ambulance service. rural metro owned this service for a period of a few months until it went to tender again. then the service was owned by eastern medical services (created and owned by doug powell, jim mcisaac and michel chretien) until 2001. ottawa ems the ottawa ems-smu came into existence on january 1, 2001, when six separate agencies providing ambulance and paramedic care to the then regional municipality of ottawa-carleton were amalgamated into one service. st. lawrence & district ambulance services in nepean, ontario (sldas), ottawa carleton regional ambulance service in ottawa (ocras), rockland/orleans in orleans, ontario (roas), carleton place/richmond in richmond, ontario, kanata/arnprior ambulance in kanata, ontario, and eastern medical in osgoode, ontario, all became the ottawa paramedic service. in 2003 the city also assumed control of the communications centre which was, at that time, run by a third party for the government of ontario. an ottawa paramedic service ambulance parked on queen street, during the 2007 remembrance day ceremonies in ottawa. in front of the ambulance is a st. john's ambulance van. in the 1980s better ambulances and equipment became the ministry of health and long-term care's priority. in the 1990s, semi-automatic defibrillators and symptom relief medications administration became the norm for paramedic scope of practice. due primarily to local grassroots efforts (action paramedic led by the act foundation), political pressure and a research program called the ontario prehospital advanced life support studies (opals) ottawa was the first center in ontario to be selected to introduce fully trained advanced care paramedics (acp) as part of a ministry of health province-wide project. as we know them today acps have been in ottawa since 1995. various advanced life support (als) response programs had been developed and implemented with much less success over the past 40 years throughout ontario. until 2001, ottawa had never had a single agency provide comprehensive acp paramedic treatment in the community. prior to then it was typically several services operating under a single communications radio network offering only primary care paramedic (pcp) level of treatment and response. the ottawa paramedic service is part of a larger city department comprising ottawa by-law services, corporate security and emergency management and ottawa fire services. like many other models the paramedic service and fire service are sister agencies within a single department, distinct but culturally separate. a single department overseen by a general manager with a paramedic chief and a fire chief each with their mandate serving residents and the community. service the service is a structured hierarchy with a clearly defined rank system conforming to a national and provincial paramedic visual identity. the paramedic chief is the most senior leader in the service and is responsible for the overall effective operation of the ottawa paramedic service. the office of the chief is the most senior administrative body within the branch. under this office the service is organized into four broad functional groups called divisions. all divisions report to the chief. each division is further divided into sections of operational work areas. sections may be divided into teams, units or in the case of larger sections, such as in the operations division, platoons. divisions are led by a deputy chief, sections by commanders and units, teams or platoons are led by superintendents. the chief, deputy chiefs, commanders and superintendents together are the formal leadership team of the service. the service executive team (the executive) is composed of the service's most senior staff including the chief and the divisional deputies. the senior management team (smt) comprises the executive and all command staff (the commanders). commanders can be responsible for 6 to 10 superintendents and overall up to 120 staff in total. superintendents are the front line supervisors of the service and, depending on their role, can be responsible for from 6 to 24 personnel each. operations division - led by a paramedic deputy chief the division is divided into four sections (alpha, bravo, charlie and delta) which are led by a commander with five platoons, each led by superintendents communications division - is divided into two sections, each led by a commander including communications operations (medical dispatch) and performance management technical services division - led by a paramedic deputy chief the division is divided into three sections, each led by a commander including logistics, quality assurance and the training and development section special operations division - led by a paramedic deputy chief along with two commanders is responsible for: paramedic bike unit, paramedic tactical unit, usar , public support unit, the paramedic marine unit, the ottawa medical venturer unit (medvent) and is also responsible for contingency, special event and emergency planning as well as community medicine personnel 1 chief 4 deputy chiefs 12 commanders 40 superintendents (operations, clinical training, logistics, communications, professional standards, quality review and public information) 70 communications officers 8 administrative support personnel (including quality assurance/improvement clerks, program performance analysts, administrative assistants and other non-uniformed personnel) 44 equipment and supply technicians 1 biomedical engineer 12 public education officers 440 advanced and primary care paramedics (sub-specialties of marine, tactical, usar, cbrne as well as others) fleet a paramedic outside the treatment and rehabilitation unit, during the remembrance day ceremonies in ottawa 86 paramedic units (type iii) - demers ambulances mystère mx160a (on ford e-series chassis), all equipped with stryker power load 4 special response units (ford f series/demers type 1) 1 neonatal transfer unit (type iii with stryker power load) 1 bariatric patient vehicle (modified type iii) 7 supervisor response vehicles (ford explorer police interceptors) 18 paramedic response units (ford taurus and ford explorer police interceptors) 2 off road rescue units (4x4 asap units) 1 treatment and rehabilitation unit (nova bus lfs) 2 multi patient units 2 emergency shelter trailers 2 multi-casualty incident (disaster supplies) trailers facilities headquarters campus - located at 2495 don reid drive in ottawa (the first leed-certified building in the city) the campus - is divided into two distinct areas with separate buildings. one 30,000-square-foot (2,800 m2) building houses the paramedic communications centre (2475 don reid), the ministry of health field office and the regional paramedic program for eastern ontario (rppeo, the base hospital). the second building is the administrative and operational centre for all paramedic service operations. this building serves as the 100,000-square-foot (9,300 m2) single start station for all urban paramedic operations in the city paramedic posts - 16 strategically located throughout the city for paramedic personnel to have down time between calls combined services facilities - 8 facilities located in sub-urban and rural areas. the emergency and protective services (eps) combined services buildings house part-time fire service personnel and full-time paramedics. these combined service paramedic posts were report to work locations outside of the urban core and are shared with other city staff such as police and fire. they are now used the same as paramedic posts with indoor facilities. level of care note: the paramedic service is the only licensed agency in ottawa that employs and responds certified paramedics. no other agency employs or responds with paramedics in any capacity in the city. (with the exception of ornge) advanced and primary care paramedicine ottawa paramedics utilize special emergency bypass protocols as well as critical interventions not normally associated with acp or pcp level of care. close to 2000 public access defibrillators (pad) are located throughout the city in certain buildings such as a pools, hockey rinks and other public facilities as well as in all marked police cars and some fire vehicles. police officers and fire service personnel have basic first aid training and also provide fully automatic defibrillation under a first responder program. both services may be asked to respond to certain call types at the request of the paramedic service. all defibrillators and training for the pad program as well as for first responders are provided by, maintained and administered by the ottawa paramedic service, community medicine program research the ottawa paramedic service has a research committee comprising front-line personnel leading, evaluating and directing what research the service will enter into and recommend with whom the service will partner in research the ottawa paramedic service is an agency in paramedic and emergency medical research participating in research programs and studies including: resuscitation outcomes consortium ottawa c-spine study paramedic stemi bypass paramedics assessing elders at risk of independence loss (peril) and many others