Hey /u/MedicBroseph!
Hopefully things are already starting to look up for you. Although not talked about very often, I'd say that the majority of us fall into a rut or a funk at least once during our career. As long as you recognise it and don't let it affect how you do your job, awesome. If it's causing you to dread going to work and you are truly unhappy, time to take a good look at your options. That said, time to answer your questions. Be forewarned about the wall of text as I'm going to be as detailed as possible, starting from the beginning.
In order to be eligible to work as a medic in Ontario, one must graduate from an approved Paramedic programme recognised by the Ministry of Health and Long Term Care. It's two years in length and is taught at Colleges of Applied Arts and Technology, as well as a few private colleges that condense it into one year. The pass rate for "professional" courses is 70% and that of general education classes (english, computers) is 50%. One successful, you graduate with a Diploma in Ambulance and Emergency Care (they never did change the name when it went from a one-year to a two-year course 15 years ago). With that hurdle overcome, you can write the MOH's A-EMCA exam (Advanced-Emergency Medical Care Attendant.....again, a name that hasn't changed since the early 90s) which is a six-hour long multiple choice test. It also has multiple multiple choices and the answers to question 23, 24, 25, 26, 28, and 29 hinge on the answer you gave to question 22. Once passed with a minimum of 70%, the ministry sends you your certificate. The next step is to be hired by a designated delivery agent and then be certified by the base hospital. Only once each of these four conditions are your considered to be a paramedic.
Paramedic services used to be contracted out from the MOH to private providers up until 2000. At that time, the responsibility was downloaded from the province to the Upper Tier Municipalities, such as Sudbury, Ottawa, Toronto. In areas without UTMs, it was given to the counties (such as Simcoe County or Frontenac County. In the northern areas (geographically central, but politically northern) where the population density doesn't warrant county level administration for road maintenance or administration of social and health programmes, the District Social Services Boards bear that responsibility. You can see that they cover vast areas such as the District of Sudbury which excludes the city, the District of Algoma, and the District of Cochrane(https://www.google.ca/maps/place/Cochrane+District,+ON/@50.284,-83.0323699,7z/data=!3m1!4b1!4m2!3m1!1s0x4d6ef2259bf79d4f:0x866c4bc70979f703) to name a few. Three places in the province have opted to contract out to a private company, District of Muskoka, Elgin County, Middlesex-London, and Chatham-Kent. Since the MOH publishes equipment and vehicle standards, what you find in a truck will be identical in Windsor, Toronto, Ottawa, Sudbury, Thunder Bay or Moose Factory. The only difference would be quantities above the minimum required. There are also only two approved ambulance manufacturers for us, Demers Ambulances and Crestline. There are little things such as reds can only flash together and white can only flash together, wig-wags being the only exception. Any deviation and the ministry will order that it be fix. No other colours are allowed. There are basically zero differences between the three private and the public services, wages and benefits included Since 50% of our budget comes from the province, although paid by our respective employers, we are also considered provincial employees and our EMS IDs are provincial. For this reason, we are considered a provincial resource and are not bound by any internal boundaries for response. Even though I work for a municipality, our service's coverage area goes well beyond the city limits. Should an out of town crew be doing a transfer and a call comes in (all dispatch centres are run directly by the MOH except in Toronto and Niagara Falls, and to an extent, Ottawa) and that crew is closest, they respond. Conversely, if we're in North Bay and we're the closest crew, we'll service that call.
What about the fire department? Well, they have never historically had a hand in EMS. In most areas services by career crews, they universally attend for unconscious and VSAs, which makes sense as early defib and CPR provide the best outcomes and are very time sensitive. Plus the extra hands are great. Some places have them respond for seizures, chest pain, or respiratory distress as well. Furthermore, you'll notice that some of the maps above have rural and remote communities. In Ontario, there is no such thing as a volunteer ambulance service. Every square kilometre is serviced by professional, full-time medics.
Now that the operational stuff is covered, onto the career itself. As stated above, fire rarely responds with us. This is great because we're the medical pros and they are not. Just like I wouldn't expect landscapers to start advocating that they should respond to fires since they have PPE, hoses, easy access to water, and are already on the road. Each truck is staffed with a minimum of two PCPs and in areas with ACPs, one of each. I hesitate to use the terms BLS & ALS because much of what PCPs do is considered ALS. When I started working in the mid 2000s, if you just wanted to be considered to write the ACP entrance exam, you needed a minimum of 2000 hours of work in a moderate to high volume service. Most employers subsidised education costs. However today, many PCP graduates are going straight into the ACP programme with little to no experience. This makes EMS the only field that I know of that has 21 year old new employees that have more training, responsibility, pay, and authority than someone whose been doing the job for 20 years. I have an issue with that. New physicians that just completed their residencies don't lead teams or departments. Same with nurses and teachers. We have it backwards. That said, I cannot fault them for doing so because more and more employers want to hire ACPs over PCPs (even though 80% of the province is serviced by PCP only services). Once that additional year (4 months in class doing skills, scenarios, and clinical) and 540 hours on the road, one is eligible to write the MOH's three-hour ACP test. Today, there is very little new knowledge to add in ACP programmes since most of it is already covered in the PCP ones. It's basically all mechanical skills and application. If one wants to progress to Critical Care Paramedic, you either work for Toronto EMS on their critical care transfer truck or for Ornge, the province's air ambulance provider.
Here are some documents that you may find of interest.
Basic Life Support Standards They are horribly out of date as the last revision was in 2006. That's all I'm going to say without going on a tangent. I recommend you read with a drink in hand. Advanced Life Support Standards Unlike the BLS, use your brain with these. PCP prgroamme All PAR courses are essentially identical in all colleges. ACP programme
Hopefully you found this of interest. I'm definitely more than happy to answer any other questions or give you additional information. Best of luck and hope that you can find your way out of this funk! :-)
-highglyder