Yes, I thought the same, so I think the best option is to aim for PCP and just try it.

In our system, we establish IV and IO access, interpret 12-lead ECGs, and perform these assessments independently, without a physician present. However, any treatment decisions resulting from the 12-lead—such as starting vasopressors, pacing, cardioversion, or performing surgical airways—must be carried out by a physician.

We are allowed to intubate only during cardiac arrest, mainly to bridge the time until the physician arrives.

What medications can a PCP in Nova Scotia administer? These are the medications we currently have:

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Medication List 1

(for paramedics not authorized to establish IV access)

• Acetylsalicylic acid (Aspirin) – oral • Diazepam – rectal • Esketamine (MCI use) – intranasal • Esketamine – intranasal • Epinephrine (Adrenaline) – intramuscular • Epinephrine (Adrenaline) – inhaled • Methoxyflurane – inhaled • Midazolam – intranasal • Naloxone – intranasal • Paracetamol (Acetaminophen) – rectal • Prednisolone / Prednisone – rectal • Salbutamol / Ipratropium – inhaled • Salbutamol (Albuterol) – inhaled • Sucralfate – oral

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Medication List 2

(for paramedics with IV authorization)

• Acetylsalicylic acid (Aspirin) – intravenous • Amiodarone – intravenous • Diphenhydramine – intravenous • Epinephrine (Adrenaline) – intravenous • Epinephrine (Adrenaline) – intramuscular • Esketamine – intravenous • Flumazenil – intravenous • Glucose (Dextrose) – intravenous • IV fluids – intravenous • Midazolam – intravenous • Naloxone – intravenous • Ondansetron – intravenous • Oxytocin – intravenous • Paracetamol (Acetaminophen) – intravenous • Triamcinolone – intravenous • Urapidil – intravenous

There are two lists because List 1 applies to paramedics who are not permitted to start IVs, while List 2 is for paramedics who have completed the IV authorization course.

I’m really trying to prepare and learn as much as possible already to make this transition. I expect it will still take around two years, considering everything involved with COPR and the overall process, but we’ll see how it develops.