 Advanced Care Paramedics were not introduced until 1984, when Toronto trained its first group internally, before the process spread across the country.By 2010 the Ontario system involved a two-year community college based program, including both hospital and field clinical components, prior to designation as a Primary Care Paramedic, although it is starting to head towards a university degree-based program.The province of Ontario announced that by September 2021, the entry level primary care paramedic post-secondary program would be enhanced from a two year diploma to a three year advanced diploma in primary care paramedicine.