application for primary care paramedic program...2019/04/15 · application for primary care...

Application for Primary Care Paramedic – April 15, 2019 Page 1 of 18

Application for Primary Care Paramedic Program

HeartSafe EMS Paramedic Training Ltd.

PLEASE READ THIS DOCUMENT CAREFULLY

General Information

Welcome to the HeartSafe EMS Paramedic Training Ltd. Primary Care Paramedic (PCP) Program. Welcome to Your Career in Paramedicine! The HeartSafe EMS PCP Program is an exciting way to enter the expanding field of Paramedicine. Many avenues are open to the Paramedic including Community Paramedic, Industrial Medic and ongoing education in the Paramedicine field.

This program is a rigorous and comprehensive course of study. The academic demands will be considerable and motivation for a Paramedic career is important for success. The student should have unquestioned integrity and be emotionally mature and physically capable of dealing with patients and the demands of an emergency care provider.

This PCP course was designed and written by Mike Billingham of Creative Paramedical Education a retired ACP (Advanced Care Paramedic) and ITT (Infant Transport Team). It meets or exceeds the National Occupational Competency Profile (NOCP) requirements of the Paramedic Association of Canada (PAC).

The HeartSafe PCP program has been approved by BC Emergency Assistant Licensing Branch (EMALB), Province of BC and is registered with the Private Training Institutions Branch (PTIB) # 3876.

The PCP course is offered by: HeartSafe EMS Paramedic Training Ltd. (HeartSafe EMS)

Regulatory Agencies The following regulatory Agencies govern the standards by which the PCP course is presented by HeartSafe. The agencies are Emergency Medical Assistant Licensing Branch, Province of BC, the Paramedic Association of Canada (PAC) and the Private Training Institutions Branch (PTIB). Successful completion of the PCP program means meeting the required standards as established by HeartSafe EMS and the noted regulatory agencies.

http://www.creativeparamedicaleducation.com/




PCP Program components: • Required Anatomy and Physiology (independent) study course (online) which is available free of

charge from HeartSafe EMS and must be completed prior to the start of the classroom portion of the PCP course

• Didactic (classroom) sessions – the full-time course is 15 weeks (full-time M – F 0800 – 1700) • Study time over and above what is done in class is estimated at 2 - 3 hours/night.

• Clinical Placement (as required by the Director of Training) • Work experience (on-Ambulance placement or Preceptorship), which must be completed within

180 days of completion of the classroom portion. Ambulance placement is required so the student can complete the competency assessments (NOCP) as published by PAC at the PCP Level. Completion of a minimum number of Ambulance Preceptorship shifts will be required regardless of the competencies achieved.

Please note the required Clinical and Preceptorship placements may not be available in the immediate area of where the PCP course was held and that students may be required to travel to accept these placements. Any costs associated with these placements are the sole responsibility of the student.

Certification

Graduates will receive Primary Care Paramedic Certification from HeartSafe EMS and are eligible to apply for licensure in BC through the EMA Licensing Branch. Website: www.health.gov.bc.ca/ema at the PCP Level. HeartSafe EMS can assist in obtaining licensure in other provinces, particularly Alberta.

Admission Requirements

Admission to the Primary Care Paramedic Program is contingent on availability of seats in the requested PCP program, completion and submission of all admission criteria (pre-requisites), and applicant ranking as determined by a process of selective admission evaluation (if requested by HeartSafe).

The PCP Application Process consists of two steps 1) Application form submission and prerequisites assessment

2) Completion of required documentation and pre-course requirements

Step 1 - Application Form Submission and Prerequisite Assessment

Applicants must submit the Application for Primary Care Paramedic form. All documents confirming the mandatory prerequisites are met must then be compiled and submitted in person, by mail, email or by fax to:

HeartSafe EMS PO Box 28132

Victoria, BC V9B 6K8 Fax: 250-385-3209

[email protected]

The onus is on each individual applying to the PCP Program to ensure that all required documentation is submitted.

http://www.health.gov.bc.ca/ema




Mandatory Prerequisites:

• Minimum of 19 years of age.

• Resume – to include all previous education, employment history and volunteer positions

• Evidence of High School Graduation. Mature students, 25 years or older, may also be accepted

without proof of high school graduation.

• Current EMR Certificate

o If an applicant does not have a current EMR certificate, he or she can be considered for

enrolment based on a past PCP or ACP certificate and a minimum of 5 years of actual

Ambulance experience.

• Applicants without a current EMR certificate may apply based on having a WorkSafe BC

Occupational First Aid (OFA) 3 certificate (or deemed equivalent) but must accept that applicants

with a current EMR certificate have a preference to being accepted into the course. HeartSafe

EMS may also, at its sole discretion, require an in-person interview for those applicants with an

OFA 3 certificate prior to acceptance into the course

• Current Immunizations (see requirements following)

• Current criminal record check (see requirements following)

• Current Red Cross Basic Life Support (BLS) certificate – formerly the CPR C/AED HCP Certificate

• Two Confidential Letters of Recommendation

Emergency Medical Responder Certificate (or accepted equivalent)

Acceptable credentials are a valid EMR License or EMR Certification completed within three (3) years of PCP course start date. To have other courses reviewed for EMR equivalency please email: [email protected] for information on the review process. The Emergency Medical Responder (EMR) certification course is designed to provide participants with the basic knowledge and skills to be able to manage any medical and trauma related emergency and provides the best preparation for students entering the PCP Program. Candidates should be aware that all candidate assessment testing (if required) is at the EMR level. The EMR course offered by HeartSafe Emergency Medical Solutions Ltd. (HeartSafe EMS Ltd.) includes CPR Level C/AED certification. HeartSafe EMS Ltd runs this course as a 1-week bridging course for students who have successfully completed the OFA Level 3, and as such is not registered with the Private Career Training Institutes Agency (PTIB). More information: https://www.heartsafeems.com/course/ofa-3-to-emr-bridge-course/ Students who have successfully completed their EMR course with HeartSafe EMS Ltd will receive a $250.00 credit towards the PCP tuition once that step in the Registration process has been reached.

https://www.heartsafeems.com/course/ofa-3-to-emr-bridge-course/




Basic Life Support (formerly the CPR C / AED HCP) Certification

Applicants must provide documentation that they successfully obtained current certification. Current certification must be held on the first day of class so it may be necessary for students to update their certification. Please visit Red Cross Basic Life Support for more information on this courses offered by HeartSafe EMS Ltd. This certification is included in the HeartSafe EMS Ltd EMR course.

Canadian Grade 12 Graduation or Equivalent

All applicants must have as a minimum Grade 12 graduation or equivalent. Documentation required.

Mature Students

Mature students will be accepted into the program. A mature student is an individual who does not have BC Grade 12 or Grade 12 equivalence and is at least 25 years of age. All other admission requirements must be met.

Physically able to perform the required tasks of a paramedic Throughout the program, during classroom simulations and while on practice education shifts, you will be performing the physical tasks of a paramedic. To work safely and effectively you will require a healthy level of:

• Aerobic fitness (e.g., climbing stairs with equipment when elevator not accessible)

• Muscular endurance (e.g., performing prolonged CPR on a patient)

• Muscular strength (e.g., lifting and carrying patients)

• Flexibility (e.g., treating patients on the floor or in difficult to reach situations)

A high proportion of job-related injuries to paramedics occur when lifting patients. Physical fitness is critical to maintaining the wellness of paramedics, and fitness must be incorporated into the overall philosophy of the PCP program and the paramedic profession.

While physical fitness involves the physical capability of an individual to perform different tasks, emotional fitness involves psychological factors and the ability to deal with stress. To tolerate the physical and psychological stress associated with pre-hospital care work, you will require a high level of physical and emotional fitness. There is a physical fitness component to the PCP program Applicants must complete the attached Statement of Fitness and submit it with their application. If the Applicant answers yes to any of the questions on the Statement of Fitness, HeartSafe may require the Applicant to have a Medical Doctor complete an additional Statement of Fitness.

https://www.heartsafeems.com/course/basic-life-support/




Criminal Record Check

In accordance with the requirements, to be assigned Preceptoring shifts, outlined by the BC Ambulance Service all students are required to undergo a criminal record search for people working with children and vulnerable adults through their local Police or RCMP. If a relevant record exists, the individual will not be able to participate in clinical practice placements and therefore will not be considered for the program. Relevant information is available through the RCMP website or may be available through your local police website. http://www.rcmp-grc.gc.ca/en/criminal-record-and-vulnerable-sector-checks

Respiratory Fit Testing In order for Candidates to do their on-Ambulance Work Experience, they must complete the respiratory Fit Testing associated with the N95 Particulate Respirator mask. This will be scheduled during the PCP Program. Candidates must be aware that this may require them to be clean-shaven as per the BCEHS requirements.

Immunization

Students are required to submit their completed immunization record to HeartSafe’s Director of Training

who will ensure that strict confidentiality concerning the student’s state of health is maintained.

Students are responsible for maintaining their immunizations while registered in HeartSafe programs.

Those students do not meet or comply with the immunization requirements will not be given clearance

to participate in the clinical or practicum components of the PCP program.

Required Immunization and Testing for PCP Students:

All costs associated with getting, maintaining or acquiring the records of

immunizations is the responsibility of the student.

• Mantoux: (TB test)-a baseline 1-step test or a test in the last 6 months

• Hepatitis B: Series of 3 injections at 0 month, 1 month and 6 months and antibody testing 2-3

months post 3rd injection

• MMR (measles, mumps, rubella): Childhood series and a second injection for measles

• Tetanus/Diphtheria: Booster every 10 years

It is recommended that all students have baseline blood tests* completed before practicum, that test

for:

• Hepatitis B antibody-post vaccine series

• Hepatitis C antibody

• HIV antibody

*These tests are required to be ordered by a physician.

http://www.rcmp-grc.gc.ca/en/criminal-record-and-vulnerable-sector-checks




*Students should have a copy of these test results for their own personal files.

*Only the Hepatitis B antibody results are to be provided to the Director of Training




Two Written References

Applicants must submit two reference letters (confidential recommendation form supplied by HeartSafe EMS) – one professional (e.g. supervisor, teacher, coach, counsellor) and one personal. Letters should highlight the individual’s attributes necessary to work as a paramedic.

BC Class 1, 2, or 4 Driver’s Licence (Restricted or Unrestricted)

BC Emergency Health Services (BCEHS) requires a candidate for employment with BCEHS to hold, at a minimum a Class 4 (restricted) license. Students are encouraged to obtain their Class 4 Driver’s License as soon as possible. This is not a requirement to take the Primary Care Paramedic course.

The non-refundable application fee for the PCP Program is $85.00. Once we have received your program application form, our office will contact you for payment. Payment may be made by cheque, money order, Visa, MasterCard, cash or debit card. Cheques must be made payable to HeartSafe EMS The application fee is non-refundable and your program application will not be considered until the application fee is paid. Any costs associated with the application and selection process are the sole responsibility of the applicant. HeartSafe EMS will not reimburse applicants for any expenses.




Step 2 – Completion of Required Documentation and Pre-course Requirements

Admission Evaluation As noted above HeartSafe may request, at its sole discretion, a personal interview with any prospective PCP course candidate. This interview will consist of a one-on-one interview (in person wherever possible), a written evaluation and practical skills check based on EMR level knowledge and protocols. The candidate will then be notified if they are successful and be granted entry into the PCP program formally.

Prospective students are accepted into the PCP Program at the sole discretion of HeartSafe EMS After acceptance into the PCP Program:

Pre- Course Requirements:

1) Students will receive a HeartSafe EMS Student Contract, which outlines all fees paid to HeartSafe

EMS to sign and return to HeartSafe EMS.

2) Students will receive a PCP Course Outline and applicable HeartSafe EMS Policies.

3) Students will be required to purchase the required course textbook either as an eBook or as a

hard copy.

4) Students will be required to make arrangements to acquire the course uniforms - HeartSafe will

provide the details of three uniform suppliers (not included in the fees paid). Current BCEHS

employees may use their issue uniform (except uniform shirt) in the class.

5) Students will be given access to the online Anatomy and Physiology course – completion

required before the start of the classroom portion of the course.




Fees*

Victoria Courses:

Application Fee (non-refundable) ...................................................................................................$85.00

Program Fees

PCP Course Tuition.............................................................................................................................$7600.00 Currently (August 2016) offering a $1,000.00 Scholarship (PCP Course only) to promote Paramedic training in BC.

PCP Course Textbooks**......................................................................................................................$600.00

Competency Assessment & Fit Testing Fee..........................................................................................$600.00

Uniform Purchase approx. – (Not paid to HeartSafe EMS) ..................................................................$600.00

Additional Fees (if any)

Cost of any prerequisites......................................................................................................................Variable

Criminal Record check, immunization records, etc. (Not paid to HeartSafe)…...................................Variable

Travel for Preceptoring and/or clinical days (Not paid to HeartSafe)…….............................................Variable

Northern BC Courses:

Application Fee (non-refundable) ...................................................................................................$85.00

Program Fees

PCP Course Tuition.............................................................................................................................$8500.00 Currently (August 2016) offering a $1,000.00 Scholarship (PCP Course only) to promote Paramedic training in BC.

PCP Course Textbooks**......................................................................................................................$600.00

Competency Assessment & Fit Testing Fee. ........................................................................................$700.00

Uniform Purchase approx. – (Not paid to HeartSafe EMS) ..................................................................$600.00

Additional Fees (if any)

Cost of any prerequisites......................................................................................................................Variable

Criminal Record check, immunization records, etc. (Not paid to HeartSafe) …..................................Variable

Travel for Preceptoring and/or clinical days (Not paid to HeartSafe) ……............................................Variable

*All course / Licensing/ Application fees etc. are current as of 01 June 2019. Subject to change at any time and without notice by the company/agency as noted above.

**eBook included. Hard copy of course textbook available for an additional $200.00




Program Tuition

The tuition fee includes all program costs associated with the PCP Program including hospital and ambulance placement components but does not include the costs for textbooks, uniforms, equipment, transportation, living expenses or any additional fees associated with applying to the Program.




Refund Policy

1) A student may be entitled to a refund of tuition fees in the event that:

(a) The student provides written notice to the HeartSafe EMS that he or she is

withdrawing from the program; or

(b) If HeartSafe EMS provides written notice to the student advising that the student

has been dismissed from the program.

2) The written notice of withdrawal or dismissal may be delivered in any manner provided that a receipt or other verification is available that indicates the date on which the notice is delivered.

3) The notice of withdrawal or dismissal is deemed to be effective from the date it is

delivered.

4) The refund to which a student is entitled is calculated on the total tuition fees due under the contract. Where total tuition fees have not yet been collected, HeartSafe EMS is not responsible for refunding more than has been collected to date and a student may be required to make up for monies due under the contract.

5) If the HeartSafe EMS has received fees in excess of the amount it is entitled to under

the student contract, the excess amount must be refunded.

6) Refund policy for students:

(a) Refunds before the program of study begins:

1. If written notice of withdrawal is received by the institution 30 days or more before the commencement of the period of instruction specified in the contract and more than 7 days after the contract was made, the institution may retain 10% of total tuition only due under the contract to a maximum of $1000.00

2. If written notice of withdrawal is received by the institution less than 30 days before the commencement of the period of instruction specified in the contract, and more than 7 days after the contract was made, the institution may retain 20% of the total tuition only due under the contract to a maximum of $1300. 00




7) Refunds after the program of study starts:

(a) If written notice of withdrawal is received by HeartSafe EMS or a student is

dismissed and up to and including 10% of the hours of instruction specified in the

contract has elapsed, HeartSafe EMS may retain 30% of the tuition due under the

contract.

(b) If written notice of withdrawal is received by HeartSafe EMS, or a student is

dismissed after more than 10% but before 30% of the hours of instruction

specified in the contract has elapsed, then HeartSafe EMS may retain 50% of the

tuition due under the contract.

(c) If a student withdraws or is dismissed after 30% of the hours of instruction

specified in the contract has elapsed, no refund is required.

8) Where a student did not meet the HeartSafe EMS and/or program specific minimum

requirements for admission through no misrepresentation or fault of their own, then HeartSafe EMS must refund all tuition and fees paid under the contract, less the applicable non-refundable student application or registration fee.

9) Where a student withdraws or is dismissed from their program, they are entitled to 100% refund of any as-yet to be received consumables that have been pre-paid.

10) Where a student withdraws or is dismissed from their program after receiving technical equipment from HeartSafe EMS free of charge:

(a) The student must return the equipment unopened or as issued within 14 calendar

days; and

(b) If the student fails to return the equipment as set out above, then HeartSafe EMS

may deduct the reasonable cost of the equipment from any amount to be

refunded to the student.

11) Refunds owed to students must be paid within 30 days of HeartSafe EMS receiving

written notification of withdrawal and all required supporting documentation, or within 30 days of an HeartSafe EMS’s written notice of dismissal.

12) Where the delivery of the program of study is through home study or distance education, refunds must be based on the percent of the program of study completed at the rates as set out in Section 7 above.




Uniform

Students are expected to be in uniform on the first day of class and everyday thereafter. Once accepted to the program, applicants will receive information about placing orders for uniforms. All students will receive four (4) HeartSafe crests for the uniform shirt and one set (2) of HeartSafe ‘Paramedic Student’ epaulettes. Current BCEHS employees may wear their current issue uniform except for the uniform shirt (navy blue) which must have a HeartSafe crest on both sleeves. A copy of the HeartSafe EMS Uniform policy is available upon request.

Work Experience (Preceptorship)

The PCP Program also requires a minimum of 16 shifts (approximately 192 hours) of on-ambulance work experience (Preceptorship) plus two (2) clinical / in-hospital (if required by the HeartSafe EMS Director of Training) shifts, all of which must be completed within 180 days following completion of the classroom portion. Wherever possible practice education shifts will be scheduled in the same training region as the classroom portion of the program, however students may be expected to travel to other regions where shifts are available.

These Preceptorship and Clinical shifts are in addition to the classroom portion of the PCP Program.

Students must be prepared to accept the financial cost of travel and living expenses associated with attendance at the placement sessions and may be placed throughout the training region. Ambulance stations and hospitals may not be located on routes that are accessible by public transportation. Students are responsible for making the appropriate arrangements to ensure their ability to attend placement sessions at the assigned sites.

Preceptoring shifts on-Ambulance are scheduled at the sole discretion of BC Emergency Health Services (BCEHS) and are subject to availability of trained preceptors and BCEHS scheduling requirements for any given shift / day.

CompTracker (Competency Assessment)

During the program you will be required to use CompTracker, a web-based competency-tracking program. CompTracker enables students, instructors, and preceptors to communicate and track their progress on a daily basis. Students are required to have access to a computer, with Internet access for the duration of the program.

Licensing Fees

Each province has its own licensing regulations and fees and students are encouraged to review requirements for the province in which they wish to practice. In British Columbia, upon completion of the program, you must also successfully complete a formal evaluation conducted by the Emergency




Medical Assistant (EMA) Licensing Board, Province of BC. Please visit their website at www.health.gov.bc.ca/ema for full details and fees. The Licensing exam at the PCP level in BC comprises a written Canadian Organization of Paramedic Regulators (COPR) exam and Objective Structured Clinical Evaluation (OSCE) skill stations. Registration for final licensing exams must be done through EMA Licensing Branch, Province of BC (EMALB). Students must successfully complete the HeartSafe EMS PCP course in all of its requirements before registering for the EMA Licensing final exams. On successful completion of the PCP Course, HeartSafe EMS will forward a copy of the student’s PCP certificate directly to EMA Licensing upon request from the student. All fees payable to EMA Licensing are not included in the fees paid to HeartSafe EMS Paramedic Training Ltd. All fees payable to EMA Licensing are not included in the fees paid to HeartSafe EMS

Administration Fees

NSF Cheques: A $30.00 service fee applies to all cheques returned “NSF”. Transfers and withdrawals are subject to an administrative fee.

WorkSafe BC Coverage

HeartSafe EMS Paramedic Training Ltd provides WorkSafe BC coverage to students while participating in the hospital and ambulance placement. This coverage does not extend to any other components of the program.

Successful Course Completion Requirements

There are numerous evaluation points in the PCP Program. These include written evaluations, practical simulations and practicum evaluation. Each evaluation is designed to ensure students meet the HeartSafe EMS accepted standard of performance. In order to be eligible for the final course written and practical exams you will need to have met the following requirements.

• 100% Attendance of the required course hours.

• 100% Participation in the daily course activities.

• 100% Submission of all the required assignments, case studies, etc.

• Successful completion of the three (3) PCP course written mid-terms with a minimum pass mark of 75%

• Successful completion of the final course practical and written exams requires a minimum pass mark of 75% on both exams.

Failure to meet acceptable standards can result in a student's removal from the program.




PLEASE CONSIDER THE FOLLOWING WHEN SUBMITTING YOUR APPLICATION: 1. Incomplete applications will not be reviewed for acceptance until all of the required documentation is complete and forwarded to HeartSafe EMS 2. All questions must be answered in full and all required documentation must be attached.

Identifying Data

Current Date

*Date of Birth (dd/mmm/yyyy) *Gender: ☐ Male ☐ Female

*Last Name *First Name *Middle Name(s)

*Mailing Address

*City *Province *Country *Postal Code

Evening or Home Phone

( ) Day Phone

( )

Cell Phone

( )

Email

*Do you Identify yourself as an aboriginal person? ☐ Yes ☐ No

If YES, are you ☐ First Nations ☐ Metis ☐ Inuit *Please indicate if you are ☐ Status ☐ Non-Status

*Citizenship Status ☐ Canadian Citizen ☐ Permanent Resident (formerly called Landed Immigrant)

If Permanent Resident, please indicate your country of citizenship

Which course location are you applying for? ☐ Victoria ☐ Other __________________________________________

Start Date you are applying for: ☐ Full-Time ☐ Part Time Month and year

THE APPLICATION FEE FOR THE PCP PROGRAM IS $85.00. THIS FEE IS NON-REFUNDABLE. FEE PAID BY:

Cheque ☐ Visa ☐ MasterCard ☐ AMEX ☐ Cash ☐ Other ☐ Cheque must be payable to HeartSafe EMS Ltd.

Credit Card Number

/

/

/

Expiry Date

/

Cardholder Name: Signature:

Please print clearly

*HeartSafe EMS. respects your privacy. Personal information that you provide is collected pursuant to federal and provincial privacy legislation. It is collected for the purpose of administering admissions, registration, education programs, financial assistance and awards, student support services, graduation, alumni affairs

and advancement, and for the purpose of statistical reporting. It may be disclosed to other educational institutions, federal and provincial government departments, co-sponsoring organizations, and Accreditation Canada for their accreditation process. Personal information is reported to Statistics Canada under

the legal authority of the Statistics Act. If you wish further information, please contact us at [email protected]




Application Checklist

Photocopy of Government issued ID with picture (Driver’s License or Passport preferred) ☐

Copy of prospective student’s resume ☐

Evidence of High School Graduation (photocopy) ☐

EMR Certificate (photocopy), or ☐

WorkSafe BC OFA3 Certificate (photocopy)* ☐

Current or previous EMR, PCP or ACP License (photocopy) ☐

Current criminal record check (requirements as noted above) ☐

Immunization record (photocopy) ☐

Current CPR C / AED Certificate (photocopy) ☐

Copies of the Confidential Letter of Recommendation (x2) ☐

Completed Paramedic Statement of Fitness ☐

* Applicants without a current EMR certificate may apply based on having a WorkSafe BC Occupational First Aid (OFA) 3 certificate (or deemed equivalent) but must accept that applicants with a current EMR certificate have a preference to being accepted into the course. HeartSafe EMS may also, at its sole discretion, require an in-person interview for those applicants with an OFA 3 certificate prior to acceptance into the course

I declare that all statements made in this application are true and correct and I understand that any

misrepresentation of material facts herein may cause forfeiture of my rights to successfully complete the Primary Care Paramedic Program.

X Signature of Applicant Date

X Signature of Parent/Guardian Date

Failure to complete the application in full, and submit all documents required, may result in delays in the processing of your application. Please note we are unable to return any documents.




Statement of Fitness

Answer all the following questions honestly and truthfully regarding any medical conditions. For more information on the statement of fitness please contact HeartSafe EMS

Surname of candidate Given name(s) in full Date of birth (dd/mm/yyyy)

Mailing address City Province Postal code

Disease conditions — is there medical evidence and/or history of:

Insulin-dependent diabetes Yes ☐ No ☐ Respiratory disease Yes ☐ No ☐

Seizure disorder Yes ☐ No ☐ Communicable disease Yes ☐ No ☐

Heart disease Yes ☐ No ☐ Multiple sclerosis Yes ☐ No ☐

Have you experienced any problems in the previous 12 months, related to the overuse and/or addiction to alcohol, recreational or prescription drugs, and/or over-the-counter medications?

Yes ☐ No ☐

Do you have any visual impairment (uncorrected) that would prevent you from assessing a patient’s medical condition?

Yes ☐ No ☐

Have you experienced any psychological or emotional episodes, which could preclude you from performing the duties a Paramedic?

Yes ☐ No ☐

Do you have any hearing impairment (uncorrected) that would prevent you from assessing a patient’s medical condition, and/or verbally communicating with a patient?

Yes ☐ No ☐

Do you have any physical condition that would limit you from carrying out the duties of a Paramedic? These may include lifting patients from awkward situations, lifting a stretcher into the Ambulance or setting up / handling Ambulance equipment.

Yes ☐ No ☐

If the Applicant answers yes to any of the questions on the Statement of Fitness above, HeartSafe may require the Applicant to have a Medical Doctor complete an additional Statement of Fitness.

I have answered all the above questions honestly and truthfully. This is a true reflection of any physical and mental condition that would have a bearing upon my ability to perform the duties of a primary care paramedic.

Signature Date

application for primary care paramedic program...2019/04/15 · application for primary care...

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