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 paramedics across canada have various formats for regulation. paramedics in all provinces are regulated by provincial legislation and regulations directly by government, or rather by a designated regulatory college where each paramedic regardless of level has an independent license to practice and is solely responsible for their paramedic practice. these organizations are responsible to the government for the examination and licensing of paramedics, the establishment of standards of practice, the investigation of public complaints against members, and the disciplining of members. they are also required to advise the government on all issues and legislation related to the practice of their members. many canadian paramedics are currently advocating to empower government to work towards becoming a self-regulated health profession. paramedics are forming their own professional regulatory college in much of the same manner as physicians, nurses, respiratory therapists and other health professions. new brunswick paramedic regulation in the province of new brunswick, paramedics are regulated by the paramedic association of new brunswick. nova scotia paramedic regulation in the province of nova scotia, paramedics are regulated by the college of paramedics of nova scotia. saskatchewan paramedic regulation in the province of saskatchewan, paramedics are regulated by the saskatchewan college of paramedics. manitoba paramedic regulation in the province of manitoba, paramedics are regulated by the college of paramedics of manitoba. alberta paramedic regulation in the province of alberta, paramedics and emergency medical responders are regulated by the alberta college of paramedics. ontario paramedic regulation in ontario, paramedics are regulated through two mechanisms in which the ambulance act indirectly regulates paramedicine. the ministry of health (ontario), emergency health services branch, credentials successful graduates of paramedic programs which have completed the provincial paramedic examination as maintained and administered by the ministry. the ministry can also revocate paramedic credentials from currently practising paramedics. the ministry additionally maintains the provincial standards and medical directives expected of all paramedics in ontario. the second mechanism of regulation is by a designated base hospital which grants paramedics the legal authority to practice. paramedics are permitted to perform controlled medical acts by the process of 'delegation'. this means that one physician, known as the medical director, has become familiar with the individual paramedic and then has delegated authority to that paramedic which allows them to perform specific regulated medical act under defined situations. the scope of practice for the paramedic is defined in paramedic protocols established by the ministry of health (ontario) (also referred to as medical directives). these directives specify which skill and the conditions required for the paramedic to act. each directive is signed by the medical director. medical directors are generally emergency medicine specialized physicians who work in a hospital associated with the paramedic service. the relationship between this hospital ('base hospital') is formalized through legal agreements. other physicians in the base hospital who are allowed to give direct orders to paramedics that exceed their protocols (often via telephone) are referred to as delegating physicians. these physicians are usually emergency medicine specialized physicians. in ontario, paramedics are actively advocating for some form of self-regulation to remove the multiple layers and complexities of regulation and paramedic practice. british columbia paramedic regulation in british columbia, the emergency health services act directly regulates paramedicine. this act requires emergency medical assistants (paramedics) working in british columbia to be licensed by the emergency medical assistants licensing board. paramedics hold their own licenses under the authority of the board. the government of british columbia has prioritized the review of paramedics for self-regulation under the health professions act through modernization of the provincial health profession regulatory framework. prince edward island paramedic regulation in prince edward island, paramedics are directly regulated by the emergency health services board, established by the public health act. newfoundland and labrador paramedic regulation in newfoundland and labrador, paramedics are regulated through the newfoundland and labrador paramedicine regulator and must have active medical authorization from the office of the provincial medical director. the office provides paramedics with the ability to perform controlled medical acts while working within the public ambulance program. quebec paramedic regulation in quebec, paramedics are directly regulated by the ministry of health & social services, established by the pre-hospital emergency services act. professional environment in some localities in canada, paramedics may work under the direction of physicians, physician assistants and nurse practitioners in various emergency or related hospital departments. collaborative emergency centres (cecs), collaborative care clinics, and community health centres in rural regions of nova scotia currently utilize this model. in these centres, paramedic and nurses work together as a patient centred team to assess and treat patients without a physician or physician assistant on-site. the paramedic and nurse consult with a provider over the phone for particular patients, and the three disciplines work together to develop a care plan for the patient. this care plan might involve treating the patient that night and then have the patient come back the next day to follow-up with a provider. if the patient needs urgent care that cannot be provided at the cec, the patient can be transferred by ambulance to the closest regional facility. a paramedic working in a cec may be a primary care paramedic or advanced care paramedic. paramedics often work long hours; with a variety of 8-, 10-, 12- and 14-hour shifts. in some areas, however, 24- and even 96-hour shifts are not unusual. salary and benefits are generally commensurate with the level of education and certification, though often less than the salary expectations of police officers and firefighters. this incongruity is often argued as being unfair, especially in light of the relative level of responsibility a paramedic may have for acting decisively and without having direct supervision. however, many paramedics consider their career to offer intangible benefits and reported job satisfaction is generally high. due to the challenging working conditions, paramedics, similarly to other first responders, are at a greatly increased risk to develop post-traumatic stress disorder as compared to the general population. paramedics in canada generally work only as paramedics, but occasionally are cross-trained as firefighters, security contractor, search and rescue or law enforcement officers, and most are paid full or part-time professionals. in the first quarter of 2005, paramedics were granted status federally as a "public safety occupation" which means that paramedics are now eligible for early retirement, as are police officers and fire fighters. many paramedic services provide a full range of paramedic specialty squads including: marine medics, bike medics, first response medics, tactical ert & ccu medics, cbrne medics (chemical, biological, radiological, nuclear and explosive) and usar medics (urban search and rescue - specializing in urban disaster rescue recovery) and finally nohert medics (members of provincial or regional health emergency response teams)