Training

Class 4A licence: the licence to drive an ambulance in Quebec

Class 4A allows you to drive an ambulance. Conditions, medical report, 30-question knowledge test and SAAQ fees.

October 10, 2026 · Lire en français

Training

To drive an ambulance in Quebec, a paramedic needs Class 4A on their driver's licence. It is added to a Class 5 licence after a medical report, a vision test and a 30-question theory exam at the SAAQ. This text applies to women and men alike.

What Class 4A lets you drive

Section 28.4 of the Regulation respecting licences fits in one line: Class 4A authorizes driving an emergency vehicle. The Société de l'assurance automobile du Québec (SAAQ), Quebec's driver licensing and auto insurance board, lists them on its page for this class:

an ambulance
a police car
a fire department vehicle
any other road vehicle recognized as an emergency vehicle by the SAAQ under the criteria set by regulation

Under section 29 of the same regulation, a Class 4A licence also includes Classes 4B, 5, 6D and 8. The holder can therefore drive a minibus or a bus with 24 passengers or fewer, a car, a moped and a farm tractor. The holder of a Class 1, 2 or 3 licence already has Class 4A.

Requirements to get it

The Regulation respecting licences, up to date as of June 1, 2026, sets out three paths. All of them require a medical report and a pass on the SAAQ vision test.

Your situation	Emergency vehicle driving course	Section
Class 5 driver's licence for 24 months or more	Not required	43, paragraph 2
Class 5 driver's licence for less than 24 months	Required	43, paragraph 3
Class 5 probationary licence	Required	25

Source: Règlement sur les permis, chapter C-24.2, r. 34, sections 25 and 43. The 24 months include time on a probationary licence.

The recognized course is the one given by the École nationale de police du Québec, Urgences-santé, the Institut de protection contre les incendies du Québec or the École nationale des pompiers du Québec, or an equivalent course. Sections 25 and 43 set no minimum age and no maximum number of demerit points for Class 4A. The employer can set one: see below.

The medical report and the vision test

This is the first step, says the SAAQ. There are two ways to do it:

download the form Rapport sur l'état de santé - Permis de conduire, write "Ajout de classe" at the top, then have it filled out by a physician or a specialized nurse practitioner, including the "Troubles visuels" section
take the vision test at an SAAQ service centre, pick up the form there, then have it filled out by a physician or a specialized nurse practitioner

The form goes back to the SAAQ through SAAQclic, by mail or at a service outlet. The SAAQ then informs you of its decision.

The theory exam and its cost

The exam has 30 questions on specialized driving techniques and takes about 1 hour. You need at least 22 correct answers. You book the appointment in SAAQclic.

The SAAQ page provides for no road test. Passing the theory exam gives you the Class 4A licence. After a failure, you must wait at least 7 days before retaking it, and the exam fee is charged again.

Fee	Amount
Theory exam	$13.50
Adding a class to the licence	$18.50
Total	$32.00

Source: SAAQ, page "Permis de conduire véhicule d'urgence (classe 4A)", last modified March 3, 2026, consulted October 10, 2026. The total is our own calculation. The fees of the professional who fills out the medical report are not included.

On exam day, bring your licence and, if required, the certificate showing you passed the course. Credit cards are not accepted at service outlets.

Periodic medical exams

Medical follow-up continues after you get the licence. According to the SAAQ page "État de santé et permis de conduire", modified April 2, 2026, the holder of a Class 1, 2, 3, 4A or 4B licence provides a medical report at ages 45, 55, 60 and 65, then every 2 years. The report must be sent before the deadline in the SAAQ's letter. A late report can lead to a licence suspension.

How it differs from Classes 4B and 4C

Class 4B authorizes driving a minibus and a bus fitted for 24 passengers or fewer, under section 28.5. It requires 12 months of Class 5 rather than 24, a medical report and the vision test, under section 42. It does not allow you to drive an ambulance.

Class 4C no longer exists. The Regulation respecting licences repealed it through chapter 18 of the statutes of 2019, and the SAAQ no longer lists it among its licence classes.

The 4A licence and the paramedic job

Three public bodies say when you need to have it.

The Cégep de Sherbrooke, in its 2027-2028 program sheet for Pre-Hospital Emergency Care (181.A1), asks students to commit to holding a Class 4A driver's licence before the end of the 5^th semester
Québec.ca, on its page on the Programme national d'intégration clinique updated March 24, 2025, lists the Class 4A driver's licence among the documents to gather for registration in the national workforce registry of primary care paramedics
Urgences-santé, on its careers page, requires a valid driver's licence with Class 4A and an SAAQ driving record, issued within the last three months, showing no more than six demerit points

Each cégep sets its own deadline: check yours. The full path is in our article Becoming a paramedic. Employers are covered in Paramedic jobs.

This text summarizes a regulation and official pages. It is not legal advice.

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Frequently asked questions

What is Class 4A?

It is the driver's licence class for emergency vehicles, defined in section 28.4 of the Regulation respecting licences. It covers ambulances, police cars and fire department vehicles. It also includes Classes 4B, 5, 6D and 8.

What does 4A on a licence mean?

The 4A mention shows that the SAAQ authorizes you to drive an emergency vehicle. It also puts you among the drivers subject to medical follow-up: a report at ages 45, 55, 60 and 65, then every 2 years. The holder of a Class 1, 2 or 3 licence has Class 4A with no further steps, under section 29 of the regulation.

What is 4B on a driver's licence?

Class 4B authorizes driving a minibus and a bus fitted for 24 passengers or fewer. You get it after 12 months of Class 5, with a medical report and a vision test. The holder of a Class 4A licence already has it.

How do I get Class 4?

The regulation has no plain Class 4: there is 4A and 4B. For 4A, the SAAQ has you complete the medical report and the vision test first, then the theory exam, booked in SAAQclic. It costs $13.50 for the exam and $18.50 to add the class.

What licence do you need to drive an ambulance?

You need a driver's licence with Class 4A, the emergency vehicle class under section 28.4 of the Regulation respecting licences. A Class 1, 2 or 3 licence also works, since it includes Class 4A. The employer can ask for more: Urgences-santé requires an SAAQ driving record, issued within the last three months, showing no more than six demerit points.

What are the requirements for a Class 4 driver's licence?

For Class 4A, section 43 of the Regulation respecting licences requires a medical report, a pass on the SAAQ vision test and a Class 5 driver's licence. With 24 months or more of Class 5, the emergency vehicle driving course is not required. With less than 24 months or a probationary licence, it is. For Class 4B, section 42 requires 12 months of Class 5, a medical report and the vision test.

Can you drive an ambulance without a diploma?

The licence requires no diploma: sections 25 and 43 of the Regulation respecting licences require Class 5, a medical report, the vision test and, in two cases out of three, the emergency vehicle driving course. The job does require one. Section 63 of the Act respecting pre-hospital emergency services (chapter S-6.2) requires, to act as a paramedic, the recognized initial college training and a pass on its exam, or training or professional recognition accepted by the national medical director. It also requires registration in the national workforce registry and the status card. The path is in our article Becoming a paramedic.