 In the 1990s, semi-automatic Defibrillators and Symptom relief medications administration became the norm for paramedic Scope of practice.Due primarily to local grassroots efforts (Action Paramedic led by the ACT Foundation), political pressure and a research program called the Ontario Prehospital Advanced Life Support Studies (OPALS) Ottawa was the first center in Ontario to be selected to introduce fully trained Advanced Care Paramedics (ACP) as part of a Ministry of Health province-wide project.As we know them today ACPs have been in Ottawa since 1995.