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Ontario’s Paramedics

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Critical Care - CCTU

The Critical Care Transport Unit or CCTU as it's commonly referred to, is a program staffed by TPA (Toronto Paramedic Association) member Paramedics employed by Toronto Paramedic Services.

Founded in 1998 as a Paramedic/Paramedic crew configured Team, the CCTU program has developed into a successful and sought after resource. When time is critical and your patient is critical, they are the team to call. The 14-member team brings knowledge, skill, experience, and compassion to the patient care arena bridging the gap between initial care and definitive care.

The team specializes in the care of Adults, Paediatrics, High Risk Obstetrics, Intra-aortic balloon pump, and shared care ECMO/ECLS (Extracorporeal Life support).

Their extensive skill set compliments their scope of practice which includes but is not limited to: Mechanical ventilation, Invasive line Monitoring, Transvenous Pacing, RSI, Lab Value analysis, Chest imaging interpretation. Ct-Head imaging interpretation, Chest Tube management, hemodynamic management, intraosseous insertion, etc.

A range of drugs/pharmacology in excess of 100 are also part of their scope. Administration can be via any desired route, inhalation, bolus or infusion. The drug classes are inclusive of but not limited to: Antiarrhythmics, nitrates, anti hypertensives, sedatives, pain control, anti-nausea, antibiotics, inotropes, tocolytics, bronchodilators, paralytics, steroids, as well as blood and blood products.

With special funding from the Provincial government the team although based in Toronto is a regional asset.

Completing approx. 1300 to 1400 calls per year the team makes a significant contribution to the spectrum of care for some of the sickest and most injured patients in the Regional Health Care System.

Operating from a Base in the north end of Toronto provides the team excellent multi-highway access. This access enables rapid response times. The team provides 24/7 coverage to stakeholder hospitals in metropolitan Toronto and the surrounding area.

The team is primarily dedicated to Critical Care calls, however they do respond to 911 calls as well when the situation warrants.

The 14 member team each hold dual Paramedic certifications to enable their practice as both a Critical Care Paramedic (certified by ORNGE) and as an Advanced Care Paramedic (certified by Sunnybrook Base Hospital).

Annual CME's, clinical time, self study, and re-certification keeps them current and capable in all their areas of responsibility. The Paramedics practice is enabled by a set of Medical Directives. They can also access an established group of Emergency, ICU and OBS physicians associated with their program for direct Medical Delegation.Main 7


The team provides care to paediatric patients from 28 days old or as low as 5 kgs up to their transition into adults.

No child is too sick or injured for this team to provide care and transport.

Annually the team sees approx. 200 critically ill or injured paediatric patients. The presenting problems range from complex medical issues, Sepsis, Resp problems, Metabolic derangements, cardiac issues, seizures, trauma, overdose, drownings, etc.

The team is called into Stakeholder hospital E/R's, ICU's, Operating Rooms, and Paediatric units to provide Critical care and Transport to definitive care. Many times in assessing and preparing the child for transport they initiate or continue further resuscitation and stabilization.

The two main receiving children's tertiary care hospitals that the Team transports to are The Hospital for Sick Children in Toronto and McMaster Children's Hospital in Hamilton. The Team utilizes a skill set, medical equipment and a range of pharmacology to appropriately manage their paediatric population of patients. The Paramedics practice in this area is enabled by a set of Medical Directives. They also have access to an established group of Emergency and ICU peadatricians associated with their program for direct Medical Delegation. Like other areas of their practice they participate in CME's, self-study, in hospital clinical shifts, and recertification's specific to Paediatrics.

The team's goals are quality patient care, and safe transports with a low threshold for adverse events consistent with that of all other specialized paediatric transport teams around the globe.

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ECMO/ECLS (Extracorporeal Membrane Oxygenation/Extracorporeal Life Support) Care and Transport is an emerging specialty requirement within our large Regional jurisdiction. 24 hours a day 7 days a week any of our on-duty CCTU Paramedic crews can form the Adult Joint ECMO/ECLS care and transport team. This Joint 5 member team consists of 2 Critical Care Paramedics, and from Toronto General Hospital (UHN) 1 Intensivist, 1 surgeon, and 1 Perfusionist.

The team assembles and responds in a CCTU ambulance to hospitals in the region that request this level of care for one of their inpatients. Within those hospitals the team could encounter that patient in the ER, OR, ICU or the CCU.

The target patient types either have a Respiratory or Cardiac pathology that is refractory to standard conventional treatments available at the hospital they are in.

The team roles have evolved and are well defined. The Intensivist Leads the team, the surgeon places the ECMO/ECLS lines, the Perfusionist runs the ECMO/ECLS machine. The Critical Care Paramedics are responsible for the overall logistics of the call, all the pharmacological infusions, bolus drugs, blood products, mechanical ventilation, and all the invasive and non-invasive monitoring cardiac, respiratory and hemodynamic. As well, the paramedics complete the patient care documentation.

Due to the dynamic nature of this type of call the Critical Care Paramedics are enabled by a very broad range of medical directives to optimize time and care within the shared care join team model.

Once the patient is successfully on ECMO/ECLS and is stable the team transports them from the referring hospital to the Medical Surgical ICU at Toronto General Hospital (UHN).

The Critical Care Paramedics have received formal education in ECMO/ECLS by the team of Intensivist and Perfusionist they work with out of Toronto General Hospital (UHN).

As the existence of this team and its capability becomes more known, the ECMO/ECLS call volume has steadily increased year over year since 2013.

The is responsible for promoting the practice of Paramedicine and ensuring the highest level of care for our patients. We are leaders in the advancement of Paramedicine and achieve our objectives through public awareness, research and education. We lobby for self-regulation under the Regulated Health Professions Act. We also assist in fund-raising for community-based charities. The is a proud chapter of the Ontario Paramedic Association and the Paramedic Association of Canada. The () is not a labour union.

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