AF FES EMS Playbook - March 2021.pdf

Air Force Fire & Emergency Services Emergency Medical Services

Playbook

March 2021

Air Force Civil Engineer Center Fire & Emergency Services Division

Tyndall Air Force Base, Florida

Summary of Changes

This “Air Force Fire and Emergency Services Emergency Medical Services Playbook” dated March 2021, replaces the “Air Force Fire and Emergency Services Emergency Medical Services Playbook”, dated September 2020.

A vertical bar next to paragraphs identify information changed from previous versions. Specifically, this revision includes the following significant updates:

National Registry Emergency Medical Responder Legal Considerations

TABLE OF CONTENTS

Chapter 1 INTRODUCTION 5

1.1 Purpose 5

1.2 Scope 5

1.3 Program 5

1.4 Points of Contact 5

Chapter 2 AIR FORCE POLICY, PROTOCOLS AND SCOPE OF PRACTICE 6

2.1 Air Force Policy 6

2.2 Air Force Emergency Medical Services Protocols 6

2.3 Scope of Practice 7

Chapter 3 AIR FORCE FIRE & EMERGENCY SERVICES EMERGENCY MEDICAL

SERVICES ROLES & RESPONSIBILITIES 8

3.1 Air Force State Emergency Medical Services Office 8

3.2 Lead Licensing Agent 8

3.3 Program Directors 8

3.4 Training Officers 8

3.5 Medical Directors 8

3.6 AF F&ES EMS Instructor Trainers 8

3.7 AF F&ES EMS Instructors 9

3.8 Candidates 9

Chapter 4 AIR FORCE FIRE & EMERGENCY SERVICES EMERGENCY MEDICAL

SERVICES SHAREPOINT PAGE 10

4.1 Purpose 10

4.2 Contents 10

4.3 User Agreement 11

Chapter 5 MEMORANDUM OF UNDERSTANDING (MOU) 12

5.1 General Information 12

5.2 Contents 12

5.3 Review & Edits 12

Chapter 6 NATIONAL REGISTRY EDUCATION PROGRAMS & CERTIFICATION 13

6.1 General Information 13

6.2 National Registry of Emergency Medical Technicians 13

6.3 Education Programs 13

6.3.1 National Registry Emergency Medical Responder (NREMR) 13

6.3.2 National Registry Emergency Medical Technician (NREMT) 13

Chapter 7 NATIONAL REGISTRY RECERTIFICATION 15

7.1 Recertification Guidance 15

7.2 National Registry Emergency Medical Responder (NREMR) 15

7.3 National Registry Emergency Medical Technician (NREMT) 15

7.4 National Registry Paramedic (NRP) 17

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Chapter 8 PROGRAM AND AGENCY ACCOUNTS 19

8.1 General Information 19

8.2 National Registry Program Account 19

8.3 National Registry Agency Account 20

Chapter 9 EMERGENCY MEDICAL SERVICES PROGRAM COURSES 23

9.1 General Information 23

9.2 NREMR Initial Course Requirements 23

9.3 NREMR Refresher Course Requirements 24

9.4 NREMT Initial Course Requirements 26

9.5 NREMT Refresher Course Requirements 27

9.6 AF F&ES EMS Instructor Course 27

Chapter 10 SPECIAL CONSIDERATIONS & CIRCUMSTANCES 29

10.1 General Information 29

10.2 How-to Transfer from State Level License to National Registry Certification 29

10.3 Active/Inactive Certification Status 29

10.4 National Registry Extension Requests 30

10.5 Lapse & Re-Entry Procedures 30

10.6 Annual Re-Certification Review 31

10.7 Legal Considerations 31

10.8 Audits 33

Appendix 1 REFERENCES, ACRONYMS, AND EMS LINKS 34

CHAPTER 1

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INTRODUCTION

1.1. Purpose. The Air Force Fire & Emergency Services (AF F&ES) Emergency Medical Services (EMS) playbook serves as the primary resource in providing an understanding of the intent, capability, and operations to effectively implement and manage an effective AF F&ES EMS program. This document outlines tasks, procedures, and execution of the AF F&ES EMS Program in accordance with Air Force Instruction (AFI) 32-2001, Fire and Emergency Services Program and AFI 44-102, Medical Care Management. EMS includes responding to emergency medical incidents for early intervention.

1.2. Scope. This playbook applies to all AF F&ES personnel trained to provide EMS care and allows firefighters to understand EMS roles & responsibilities. To build a foundational understanding of the operations and execution of the EMS program, it is important to understand EMS.

1.2.1. EMS consists of a team of professionals who are responsible for responding to emergency medical incidents to provide early intervention and care to the sick and injured.

1.2.2. The vision of EMS of the future will be community based health management that is fully integrated with the overall health care system. It will have the ability to identify and modify illness and injury risks, provide acute illness and injury care and follow-up, and contribute to treatment of chronic conditions and community health monitoring. This new entity will be developed from redistribution of existing health care resources and it will be integrated with other health care providers and public health and safety agencies. It will improve community health and result in a more appropriate use of acute health care resources. EMS will remain the public’s emergency medical safety net.

1.3. Program. The AF Fire Chief (AF/A4CX) is responsible for developing policy. The Air Force Installation Mission Support Center (AFIMSC) advocates for resources that enable AF F&ES Flights to protect people, property and the environment through preventative measures or direct intervention. The Air Force Civil Engineer Center, Fire & Emergency Services Division (AFCEC/CXF), is designated as the lead agency responsible for implementation and execution, as well as the approval authority of the AF F&ES EMS Program.

1.4. Points of Contact: Installation level AF F&ES EMS Program Directors and AF F&ES Training Officers should contact AFCEC/CXF for any AF F&ES EMS Program issues. The information in this document should answer most questions and resolve most issues. However, AFCEC/CXF can be reached by one of the following:

Mr. Fred Terryn Mr. John Hearn Program Manager Program Manager

DSN: (312) 523-6460 DSN: (312) 523-6108

Commercial (850) 283-6460 Commercial (850) 283-6108 Frederic.terryn.1@us.af.mil John.hearn.9@us.af.mil:

AFCEC Reach Back Center afcec.rbc@us.af.mil

CHAPTER 2

AIR FORCE POLICY, PROTOCOLS, AND SCOPE OF PRACTICE

2.1. Air Force Policy.

2.1.1. AFI 44-102, Medical Care Management provides guidance for the general delivery of patient care and management of clinical services throughout the Air Force Medical Service (AFMS) and F&ES. The Air Force Surgeon General (AF/SG) directs medical services on the installation.

2.1.2. AFI 32-2001, Fire and Emergency Services Program. States the Emergency Medical Services program includes responding to emergency medical incidents for early intervention. The purpose of this program is to establish minimum standards and a uniform approach toward rendering EMS through shared F&ES and Medical Treatment Facilities (MTFs) delivery at Air Force installations worldwide.

2.1.3. All levels of service will be determined at the installation level and specifics contained in the installation’s Memorandum of Understanding (MoU). The minimum level of training for all F&ES personnel is National Registry Emergency Medical Responder (NREMR). Installation Fire Chiefs (IFCs) must maintain 8 National Registry Emergency Medical Technicians (Non-Transport) per fire station.

Additional Emergency Medical Technician (Non-Transport) requirements or a higher level of care will be based on a community risk assessment and critical task analysis to meet their specific mission requirements.

2.2. Air Force EMS Protocols. Medical protocols in the pre-hospital setting are established to ensure safe, efficient and effective interventions during the pre-hospital phase of patient care. The EMS professional’s safety, coupled with the patient’s best interests, should be the final determinants for all decisions. All EMS personnel will adhere to the Air Force EMS Protocols and understand the reason for their use. EMS personnel will not perform any step or steps in the protocols if they have not been trained to perform the procedure or treatment required.

2.2.1. The goals of EMS professionals are:

• To establish standards for appropriate patient care

• To relieve pain and suffering, improve patient outcomes and do no harm

• To provide quality pre-hospital care; the direct result of comprehensive education, accurate patient assessment, good judgment, and continuous quality improvement

• To maintain competency and high standards; vital components in providing quality pre-hospital emergency medical care to the patients who rely on our services

2.2.2. The current Air Force EMS Protocols can be found on the AFCEC EMS SharePoint page, https://portal.afcec.hedc.af.mil/CX/F&ES/EMS/SitePages/Home.aspx.

2.2.3. Re-certification candidates must complete an assessment of current protocols when completing their biannual renewal. This assessment is administered by the AF F&ES EMS Program Director of the candidates NREMT Agency.

https://portal.afcec.hedc.af.mil/CX/fes/EMS/SitePages/Home.aspx

2.3. Scope of Practice. The National EMS Scope of Practice Model is a continuation of the commitment of the National Highway Traffic Safety Administration (NHTSA) and the Health Resources and Services Administration (HRSA) to the implementation of the EMS Agenda for the Future. It is part of an integrated, interdependent system, first proposed in the EMS Education Agenda for the Future: A Systems Approach which endeavors to maximize efficiency, consistency of instructional quality, and student competence.

The National EMS Scope of Practice Model supports a system of EMS personnel licensure that is common in other allied health professions and is a guide for States in developing their Scope of Practice legislation, rules, and regulation. States following the National EMS Scope of Practice Model as closely as possible will increase the consistency of the nomenclature and competencies of EMS personnel nationwide, facilitate reciprocity, improve professional mobility and enhance the name recognition and public understanding of EMS.

The National EMS Scope of Practice Model defines and describes four levels of EMS licensure:

Emergency Medical Responder (EMR), Emergency Medical Technician (EMT), Advanced EMT (AEMT), and Paramedic. Each level represents a unique role, set of skills, and knowledge base. National EMS Education Standards will be developed for each level. When used in conjunction with the National EMS Core Content, National EMS Certification, and National EMS Education Program Accreditation, the National EMS Scope of Practice Model and the National EMS Education Standards create a strong and interdependent system that will provide the foundation to assure the competency of out-of-hospital emergency medical personnel throughout the United States.

CHAPTER 3

AIR FORCE FIRE & EMERGENCY SERVICES EMERGENCY MEDICAL SERVICES

ROLES & RESPONSIBILITIES

3.1. Air Force State EMS Office. The AF State EMS Office has administrative oversight over all affiliated National Registry of Emergency Medical Technicians (NREMT) program and agency accounts.

The Office is responsible for developing the minimum State curriculum standards for the NREMT Instructor courses, NREMT initial courses and refresher training. The State Office has the ability to inspect any AFMS, F&ES or Pararescue EMS program or agency and evaluate its curriculum and instructors (which would be coordinated through AFCEC/CXF). In the event the program or agency is not meeting State standards, based on the severity of the findings, AFCEC/CXF may elect to develop a plan of action to address the discrepancies or revoke the program or agency accounts.

3.2. State Licensing Agent. The State Licensing Agent (AFCEC/CXF) is responsible for the oversight of the AF F&ES EMS Program. This includes reviewing and updating the program as needed, the development and delivery of training, overseeing all AF F&ES Flights, programs and agencies, and conducting audits as directed.

3.3. Program Directors. Program Directors are responsible for validating the competency of candidates seeking National EMS Certification. While responsibilities vary slightly by state, Program Directors are normally responsible for verifying successful course completion for all certification levels. In some states, Program Directors are responsible for conducting EMT level psychomotor examinations. If you have questions about Program Director responsibilities, please contact AFCEC/CXF points of contact.

3.4. Training Officers. The role of Training Officer is to validate the continued competency of Nationally Registered EMS personnel by approving continuing education records entered by agency affiliates. In some agencies, Training Officers enter course records on behalf of affiliated personnel.

3.5. Medical Directors. Medical Directors ensure the continued competency of Nationally Registered EMS personnel by validating level specific skills. To maintain an 'Active' National EMS Certification, all advanced level providers (Paramedics and Advanced-EMTs) are required to have a licensed physician medical director attest to their skill competency every 2-year recertification cycle.

3.6. AF F&ES EMS Instructor Trainers. Instructor Trainers are responsible for instructing AF F&ES EMS Instructor courses at various locations, as needed. They are extremely limited and selected against stringent criteria by the AFCEC/CXF to fill the agreed upon (8) Instructor Trainer positions throughout

AF F&ES.

3.6.1. Continental United States (CONUS) – 4 AF F&ES Instructor Trainers

3.6.2. United States Air Forces in Europe (USAFE) – 2 AF F&ES Instructor Trainers

3.6.3. Pacific Air Forces (PACAF) – 2 AF F&ES Instructor Trainers

3.7. AF F&ES EMS Instructors. AF F&ES Flights will identify instructors that will be assigned. A minimum of (2) is desired to allow for quality training and recurring certifications. Instructors will be, at a minimum: Fire Instructor II, current certified NREMT with 4-years minimum experience to instruct NREMR and NREMT refresher level courses and 8-years minimum experience to instruct NREMR and NREMT initial level courses. This stringent standard enforces the experienced instructor requirements across all AF F&ES Flights. AF F&ES Flights should contact AFCEC/CXF to identify and coordinate training for instructors at the installation.

3.8. Candidates. Recognized as someone who is completing or has completed an approved initial EMS education program. The first step of the national certification process is to create a National Registry profile. After candidates complete the education program and they meet eligibility requirements, candidates are required to demonstrate entry level competency on both cognitive and psychomotor examinations.

3.8.1. Submit your application about four weeks before you complete your education. Your Program Director needs to approve your application. The Director will approve your application when you complete the course requirements. The payment for your cognitive exam is due when you are ready to test.

3.8.2. You need three things for your application to be complete: submitted application, submitted payment, and your Program Director’s approval. Once your application is complete, we will update your National Registry account with your Authorization to Test (ATT) within 1-2 business days.

3.8.3. You have 90 days from the day we issue your ATT to complete your cognitive exam. You will lose your ATT and the money you paid if you do not use your ATT in 90 days.

3.8.4. Go to the Pearson VUE website (https://home.pearsonvue.com/Military/Test-takers.aspx) to schedule your cognitive exam. After your exam, your results will post to your National Registry account within 1-2 business days.

https://home.pearsonvue.com/Military/Test-takers.aspx

CHAPTER 4

AIR FORCE FIRE & EMERGENCY SERVICES EMERGENCY MEDICAL SERVICES

SHAREPOINT PAGE

4.1. Purpose. The AF F&ES EMS SharePoint page has been updated to reflect the most current information and data for use by installation-level personnel. The site is maintained and updated by AFCEC/CXF and can be found here, https://portal.afcec.hedc.af.mil/CX/F&ES/EMS/SitePages/Home.aspx.

4.2. Contents. The newly updated EMS SharePoint page has become an interactive tool for all users.

Instructor Trainers, EMS Instructors, and registering students have sections within the SharePoint page to conduct or attend courses. Provide the site contents here:

4.2.1. Mission Statement. To provide the highest level of pre-hospital patient care and advance the EMS program with a comprehensive and coordinated system.

4.2.2. EMS Calendar. Interactive calendar for Program Directors and Training Officers to add courses they wish to host. This allows AF F&ES Flights the visibility of all EMS courses being instructed and the opportunity to attend.

4.2.3. Resources. Library of documentation from policy to materials needed to instruct the various National Registry courses.

4.2.3.1. Policy Documents. Specifies the rules, guidelines and regulations that AF F&ES Flights must follow.

4.2.3.2. Instructor Trainers. Educational resources and contact information for AF F&ES Instructor Trainers.

4.2.3.3. EMS Instructor Course. Contents include host base documentation that must be completed prior to hosting a base, pre-course work for Instructor Candidates, and the NREMT Refresher program information.

4.2.3.4. NREMR/NREMT/NRAEMT. Folders that include all course materials required for the listed course.

4.2.3.5. EMS Links. Websites with valuable educational information for use by all AF F&ES EMS Program users.

4.2.4. Course Pages. Links for candidates to register for the designated course of their choice. When selected, candidates will submit contact information that will be added to a roster. Once approved, candidates will complete pre-course work from NREMT.org registration to review of course materials.

NREMR Initial Course.

NREMR Refresher Course.

NREMT Initial Course.

NREMT Refresher Course.

NRAEMT Initial Course.

NRAEMT Refresher Course.

EMS Instructor Course.

4.3. User Agreement. The information provided to the installation-level personnel on the AF F&ES EMS SharePoint page is updated as needed. Although there are interactive tools on the site, each individual is responsible for using the information and interactive tools responsibly.

CHAPTER 5

MEMORANDUM OF UNDERSTANDING

5.1. General Information. Department of Defense (DoD) and AF policies direct that support agreements be developed between affected Suppliers and Receivers to document recurring support. AF F&ES provides care at the EMT (Non-Transport) level at Air Force installations. Any role in EMS above the EMT level must clearly be articulated in a Memorandum of Understanding (MOU) per Department of Defense Instruction (DoDI) 4000.19, Support Agreements and AFI 25-201, Intra-Service, Intra-Agency, and Inter-Agency Support Agreements Procedures. The MOU must be coordinated and approved at the lowest level, by the MAJCOM/A4/AFIMSC Det and MAJCOM/SG.

5.2. Contents. An MOU will be used to document issues of general understanding between the agencies that do not involve reimbursement. The contents of the agreement may contain various items but include basic topics.

5.2.1. Background.

5.2.2. References/Definitions.

5.2.3. Purpose. Establishes standards for pre-hospital emergency care.

5.2.4. Responsibilities/Understanding of the parties.

5.2.5. Personnel.

5.2.6. General Provisions. This can include finances, insurance billing, and liability.

5.2.7. MOU sample template can be found on the AF F&ES EMS Program SharePoint Page, https://portal.afcec.hedc.af.mil/CX/F&ES/EMS/SitePages/Home.aspx.

5.3. Review & Edits. An MOU should be reviewed on a constant basis, usually annually to ensure its accuracy with current conditions and/or operations of the support agreement. If changes occur or are warranted with the agreement, whether it involves resources or activities, the agreement must be reviewed and submitted for formal signatures. As a reminder, The MOU must be coordinated and approved at the lowest level, by the MAJCOM/A4/AFIMSC Det and MAJCOM/SG.

CHAPTER 6

NATIONAL REGISTRY EDUCATION PROGRAMS & CERTIFICATION

6.1. General Information. National Registry of Emergency Medical Technicians is the agreed upon enterprise level of certification by AF F&ES and the AF/SG office.

6.2. National Registry of Emergency Medical Technicians. The National Registry, established in 1970 as a non-profit organization, is the Nation’s Emergency Medical Services Certification organization. The mission of the National Registry of Emergency Medical Technicians has always been centered on protecting the public and advancing the EMS profession.

6.3. Education Programs.

6.3.1. National Registry Emergency Medical Responder (NREMR). Emergency Medical Responders provide immediate lifesaving care to critical patients who access the emergency medical services system.

NREMRs have the knowledge and skills necessary to provide immediate lifesaving interventions while awaiting additional EMS resources to arrive. NREMRs also provide assistance to higher-level personnel at the scene of emergencies and during transport. NREMRs are a vital part of the comprehensive EMS response. Under medical oversight, NREMRs perform basic interventions with minimal equipment.

6.3.1.1. Successful completion of the NREMR course requires a current Cardio Pulmonary Resuscitation/ Basic Life Support (CPR/BLS) for Healthcare Provider credential or an equivalent approved by the local Military Treatment Facility and successful completion of the NREMR cognitive (knowledge) examination and an approved psychomotor (skills) examination.

6.3.1.2. Passed portions of the cognitive and psychomotor exam remain valid for 24 months.

6.3.1.3. Additional information can be found in the NREMR Handbook, on the National Registry of Emergency Medical Technicians website, https://www.nremt.org/rwd/public/document/emr.

https://www.nremt.org/rwd/public/document/emr

6.3.2. National Registry Emergency Medical Technicians (NREMT). NREMTs provide out of hospital emergency medical care and transportation for critical and emergent patients who access the EMS system.

NREMTs have the basic knowledge and skills necessary to stabilize and safely transport patients ranging from non-emergency and routine medical transports to life threatening emergencies. NREMTs function as part of a comprehensive EMS response system, under medical oversight. NREMTs perform interventions with the basic equipment typically found on an ambulance. NREMTs are a critical link between the scene of an emergency and the health care system.

6.3.2.1. Successful completion of the NREMT course requires a current CPR/BLS for Healthcare Provider credential or an equivalent approved by the local Military Treatment Facility and successful completion of the NREMT cognitive (knowledge) examination and an approved psychomotor (skills) examination.

6.3.2.2. Passed portions of the cognitive and psychomotor exam remain valid for 24 months.

6.3.2.3. Additional information can be found in the NREMT Handbook, on the National Registry of Emergency Medical Technicians website, https://www.nremt.org/rwd/public/document/emt.

https://www.nremt.org/rwd/public/document/emt

CHAPTER 7

NATIONAL REGISTRY RECERTIFICATION

7.1. Recertification Guidance. Nationally Registered certification levels (NREMR & NREMT) are required to renew their certification every two years. Recertification can be accomplished by either taking the cognitive examination or by completing continuing education.

7.1.1. Courses that cannot be applied towards recertification requirements include duplicate courses, clinical rotations, instructor courses, management/leadership courses, performance of duty, preceptor hours, serving as a skill examiner, and volunteer time with agencies. If you have questions on accepted education, please review the Recertification Guide, https://www.nremt.org/rwd/public.

7.1.2. Recertification is an individual responsibility with oversight from Training Officers and Program Directors. AF F&ES has incorporated National Continued Competency Program (NCCP) requirements into the AF F&ES Training Plan. Training Officers must ensure Local Continued Competency Program (LCCP) and Individual Continued Competency Program (ICCP) requirements are established and met.

7.2. National Registry Emergency Medical Responder (NREMR). The EMR NCCP requires a total of 16 hours of continuing education to recertify. The model requires continuing education in three components: a national component (8) hours, a local/state component (4) hours, and an individual component (4) hours.

Courses that cannot be applied towards recertification requirements include duplicate courses, clinical rotations, instructor courses, management/leadership courses, performance of duty, preceptor hours, serving as a skill examiner, and volunteer time with agencies. If you have questions on accepted education, please review the Recertification Guide.

NATIONAL COMPONENT

(A maximum of 3 hours distributive education may be used to meet the 8 hour requirement)

Airway/Respiration/Ventilation: 1 Hour

Cardiovascular: 2.5 Hours

Trauma: 0.5 Hour

Medical: 3 Hours

Operations: 1 Hour

LOCAL COMPONENT

You may use any state or Commission on Accreditation for Pre-Hospital Continuing Education (CAPCE) approved EMS-related education to fulfill these requirements. A maximum of 3 hours of distributive education may be used to meet the 4 hour requirement.

https://www.nremt.org/rwd/public

INDIVIDUAL COMPONENT

The individual hours are considered flexible content. You may use any state or Commission on Accreditation for Pre-Hospital Continuing Education (CAPCE) approved EMS-related education to fulfill these requirements. A maximum of 4 hours of distributive education may be used to meet the 4 hour requirement.

**NOTE** Courses are subject to change as program updates are made.

7.2.1. Recertification by exam. This option enables you to demonstrate continued cognitive competency without documenting continuing education.

Login to your National Registry account. Complete a recertification by examination application and pay the exam fee. (NOTE: Be sure you complete the Recertification by Exam application)

After 24-48 hours, login to your National Registry account and print your Authorization to Test (ATT) letter. Follow the directions in the letter to schedule your exam.

You may make one attempt to take and pass the exam beginning on October 1 (one year prior to your current expiration date) and September 30. A cognitive competency by exam form will become available through your National Registry account upon successful completion of the exam.

Return your completed cognitive competency by exam form by your expiration date with signatures and supporting documentation. All other recertification requirements (including criminal conviction statement, verification of skills, etc.) must still be met and verified.

7.3. National Registry Emergency Medical Technician (NREMT). The EMT National Continued Competency Program (NCCP) requires a total of 40 hours of continuing education to recertify. The model requires continuing education in three components: a national component (20 hours), a local/state component (10 hours), and an individual component (10 hours).

Courses that cannot be applied towards recertification requirements include duplicate courses, clinical rotations, instructor courses, management/leadership courses, performance of duty, preceptor hours, serving as a skill examiner, and volunteer time with agencies. If you have questions on accepted education, please review the Recertification Guide.

(A maximum of 7 hours distributive education may be used to meet the 8 hour requirement)

Airway/Respiration/Ventilation: 1.5 Hours

Cardiovascular: 6 Hours

Trauma: 1.5 Hours

Medical: 6 Hours

Operations: 5 Hours

If specific local and/or state are not specified, these required hours are considered flexible content. You may use any state or Commission on Accreditation for Pre-Hospital Continuing Education (CAPCE) approved EMS-related education to fulfill these requirements. A maximum of 7 hours of distributive education may be used to meet the 10 hour requirement.

The individual hours are considered flexible content. You may use any state or Commission on Accreditation for Pre-Hospital Continuing Education (CAPCE) approved EMS-related education to fulfill these requirements. A maximum of 10 hours of distributive education may be used to meet the 10 hour requirement.

**NOTE** Courses are subject to change as program updates are made.

7.3.1. Recertification by exam. This option enables you to demonstrate continued cognitive competency without documenting continuing education.

Login to your National Registry account. Complete a Recertification by Exam application and pay the exam fee. (NOTE: Be sure you complete the Recertification by Exam application)

After 24-48 hours, login to your National Registry account and print your Authorization to Test (ATT) letter. Follow the directions in the letter to schedule your exam.

You may make one attempt to take and pass the exam between April 1 (one year prior to your current expiration date) and March 31 (your expiration date). A cognitive competency by exam form will become available through your National Registry account upon successful completion of the exam.

Return your completed cognitive competency by exam form by March 31 with signatures and supporting documentation. All other recertification requirements (including criminal conviction statement, verification of skills, etc.) must still be met and verified.

7.4. National Registry Paramedic (NRP). The Paramedic National Continued Competency Program (NCCP) requires a total of 60 hours of continuing education to recertify. The model requires continuing education in three components: a national component (30 hours), a local/state component (15 hours), and an individual component (15 hours).

Courses that cannot be applied towards recertification requirements include duplicate courses, clinical rotations, instructor courses, management/leadership courses, performance of duty, preceptor hours, serving as a skill examiner, and volunteer time with agencies. If you have questions on accepted education, please review the Recertification Guide.

(A maximum of 10 hours distributive education may be used to meet the 30 hour requirement

Airway/Respiration/Ventilation: 3.5 Hours

Cardiovascular: 8.5 Hours

Trauma: 3 Hours

Medical: 8.5 Hours

Operations: 6.5 Hours

If specific local and/or state are not specified, these required hours are considered flexible content. You may use any state or Commission on Accreditation for Pre-Hospital Continuing Education (CAPCE) approved EMS-related education to fulfill these requirements. A maximum of 10 hours of distributive education may be used to meet the 15 hour requirement.

The individual hours are considered flexible content. You may use any state or Commission on Accreditation for Pre-Hospital Continuing Education (CAPCE) approved EMS-related education to fulfill these requirements. A maximum of 15 hours of distributive education may be used to meet the 15 hour requirement.

7.4.1. Recertification by exam. This option enables you to demonstrate continued cognitive competency without documenting continuing education.

Login to your National Registry account. Complete a Recertification by Exam application and pay the exam fee. (NOTE: Be sure you complete the Recertification by Exam application)

After 24-48 hours, login to your National Registry account and print your Authorization to Test (ATT) letter. Follow the directions in the letter to schedule your exam.

You may make one attempt to take and pass the exam between April 1 (one year prior to your current expiration date) and March 31 (your expiration date). A cognitive competency by exam form will become available through your National Registry account upon successful completion of the exam.

Return your completed cognitive competency by exam form by March 31 with signatures and supporting documentation. All other recertification requirements (including criminal conviction statement, verification of skills, etc.) must still be met and verified.

CHAPTER 8

PROGRAM AND AGENCY ACCOUNTS

8.1. General Information. In order for AF F&ES flights to maintain the capability to provide EMS delivery, specific National Registry training and certification requirements should be pursued. AF F&ES Flights need to establish an EMS Program account and an EMS Agency account with the National Registry under the AF State EMS Office. In addition, AF F&ES Flights must have an appointment letter assigning a Medical Director and should coordinate with their local MTF to utilize the current EMS Medical Director. Medical Directors will adhere to requirements in AFI 44-102, Medical Care Management, para

2.20.7. EMS Medical Director or Competent Medical Physician (CMP).

8.2. National Registry Program Account. The Program account side of the National Registry is where candidates document initial EMS education at the appropriate NREMT certification level. An EMS Education Program is an educational institution or organization at which candidates receive initial EMS education at any of the four National Registry certification levels. EMS Education Programs are required to have a designated Program Director, who will be responsible for authorizing candidates to undergo National Registry examinations.

8.2.1. The IFC must designate a Program Director who will be responsible for authorizing candidates to undergo National Registry examinations and a Training Officer who is responsible for annotating continuing education. The Program Director must work with AFCEC/CXF for all educational courses.

8.2.2. At the NREMR and NREMT levels, the Program Director is responsible for electronically verifying initial psychomotor skills completion. The EMS Medical Director must sign off skills above EMT and provide patient care oversight for all NREMT personnel participating in hospital and/or ambulance ride-along activities as approved by the AF State EMS Office and the AF F&ES EMS Program.

8.2.3. Key points.

AF F&ES Program Account is managed by a Program Director.

There can only be one Program Director.

The Program Director is responsible for electronically verifying successful course completion of an initial EMS education program.

By verifying course completion, Program Directors authorize candidates to undergo the National Registry cognitive exam.

At the NREMR and NREMT levels, the Program Director is responsible for electronically verifying initial psychomotor skills completion.

NRAEMT and NRP psychomotor skills are verified by the National Registry, however the Program Director will authorize candidates to undergo the advanced level psychomotor exam.

8.2.4. Establishing as a NREMT Program. To Request Authorization of a New EMS Education Program, the steps below must be followed.

8.2.4.1. Open the NREMT.org website.

8.2.4.2. Login with your user name and password.

8.2.4.3. Add the Program Director Role to your account.

8.2.4.4. Click on “ACCOUNT SETTINGS” in the left margin or the “SETTINGS” button in the upper right corner of the screen.

8.2.4.5. On the Account Settings screen locate Manage Roles on the right side of the screen and select Add Roles.

8.2.4.6. Select the link “Add a Program Director Role”.

8.2.4.7. Read the pop-up statement and select “Add Role”.

8.2.4.8. Under “My Current Role”, select Program Director.

8.2.4.9. Click on the Account Settings button on the left-side menu.

8.2.4.10. Under the Program Director Settings section, click on Request for EMS Program Authorization.

8.2.4.11. Click on Request Authorization of an EMS Education Program.

8.2.4.12. Complete the electronic form, include a .mil email address and the following naming convention, (EXAMPLE) AF***/Installation Name F&ES/Installation Name Fire Dept. The AF*** is your base/wing/squadron designated number (ex. 999 Civil Engineer Squadron would be AF999, 3 Civil Engineer Squadron would be AF003). When all information has been input on the form, read the attestation statement, then click the Submit button.

8.2.4.13. After you submit the New EMT Program Request Form, it will be sent to the AF State EMS Office for review and approval. Upon approval the requestor will be listed as the Program Director for the new program.

8.2.4.14. To view the status of an EMS Education Program Authorization Request, select Status of EMS Education Program Authorization Request, under Program Director Settings.

8.3. National Registry Agency Account. The agency account side of the National Registry is where AF F&ES flights will verify the continuing education and skills competency of assigned firefighter/EMTs.

An EMS Agency is an organization that providers works or volunteer for, utilizing their EMS skills. This agency will be responsible for verifying continuing education and skills competency. Agency providers will need to submit a request to become electronically affiliated with their agency on the National Registry Website, from the My Certification page.

8.3.1. The IFC will appoint a lead Training Officer the responsibility for verifying recertification applications submitted by the agency firefighter/EMTs via appointment letter.

8.3.2. Training Officers or the Lead EMT Instructor will enter the continuing educations course information on behalf of the assigned firefighter/EMTs. Training officers cannot approve their own recertification application so additional training officer/s need to be assigned under the agency for reviewing and approving in these situations.

8.3.3. Training Officers must work with the AFCEC/CXF office for all agency requests. AF F&ES agency coordinators will follow guidance from AFI 44-102, Medical Care Management, para 2.20.11., EMS Site Coordinator Responsibilities.

8.3.4. Key points.

Managed by Training Officers and Medical Director

There can be multiple Training Officers and Medical Directors.

Training Officers and Medical Directors are responsible for verifying recertification applications submitted by agency providers.

Training Officers and Medical Directors must be affiliated with their respective agencies, to access and manage the recertification applications of agency providers.

Training Officers will often enter continuing education course information on behalf of agency providers.

Training Officers cannot approve their own recertification application. Another Training Officer or a Medical Director with Training Officer access will be responsible for reviewing and approving that application.

8.3.5. Establishing as a NREMT Agency. To Request Authorization of a New EMS Education Program, the steps below must be followed.

8.3.5.1. Open the NREMT.org website.

8.3.5.2. Login with your user name and password.

8.3.5.3. If not yet completed, add the Training Officer Role to your account.

8.3.5.4. Click on “ACCOUNT SETTINGS” in the left margin or the “SETTINGS” button in the upper right corner of the screen.

8.3.5.5. On the Account Settings screen locate Manage Roles on the right side of the screen and select Add Roles.

8.3.5.6. Select the link “Add a Training Officer Role”.

8.3.5.7. Read the pop-up statement and select “Add Role”.

8.3.5.8. Under “My Current Role”, select Training Officer.

8.3.5.9. Click on the Agency button on the left-side menu.

8.3.5.10. Select “Create Agency”.

8.3.5.11. Complete the electronic form, use the following naming convention, (EXAMPLE) AF***/Installation Name F&ES/Installation Name Fire Dept. and select Air Force as the state. The AF*** is your base/wing/squadron designated number (ex. 999 Civil Engineer Squadron would be AF999, 3 Civil Engineer Squadron would be AF003). When all information has been input on the form, click the Submit button.

8.3.5.12. After you submit the Agency Request Form, it will be sent to National Registry for approval.

They will contact the AF State EMS Office for confirmation of the Agency and approve.

CHAPTER 9

EMERGENCY MEDICAL SERVICES PROGRAM COURSES

9.1. General Information. This chapter outlines the requirements for each level of EMS certification to include National Registry courses being instructed by AF F&ES Flights. Prior to instruction of any course, candidates must be current Cardio Pulmonary Resuscitation/Automated External Defibrillator (CPR/AED) certified.

9.1.1. To fulfill the CPR/AED requirements for firefighters, AF F&ES Flights should look to their local medical clinic or hospital to determine the training process. The American Heart Association (AHA) for the Health Care Provider CPR, American Red Cross CPR/AED for the Professional Rescuer or an equivalent course should be utilized.

9.2. NREMR Initial Course Requirements. Have a current CPR-BLS for “Healthcare Provider” or equivalent credential, successful completion of a state-approved Emergency Medical Responder course, state approved psychomotor (skills) examination, and the NREMR cognitive (knowledge) examination.

This course is the minimum level of emergency medical training necessary and has been approved through the guidelines of the National EMS Education Standards. Course length is estimated to take approximately 48-60 didactic and laboratory clock hours but should be based on competency, not hours. The course is instructed by a certified and approved AF F&ES EMS Instructor.

Note: The requirement for this certification is superseded by an Emergency Medical Technician or higher certification.

**NOTE** Requests to conduct an initial or refresher course should be accomplished by contacting the AFCEC/CXF at least 3-months prior to start date in order to complete all necessary administrative actions.

9.2.1. NREMR course curriculum is located on the Air Force Civil Engineer Center (AFCEC) EMS SharePoint page, https://portal.afcec.hedc.af.mil/CX/fes/EMS/NREMR/Forms/AllItems.aspx.

9.2.1.1. Review the course equipment requirements and confirm you have all items necessary to complete the psychomotor skills for the course. Additional sources for equipment are your local MTF and local agencies. These equipment items are necessary for psychomotor skills evaluation accomplishment.

9.2.1.2. Review the course curriculum (PowerPoints, hand-outs, etc.) and ensure you have the appropriate textbooks and online curriculum to instruct the course. Contact the AFCEC/CXF for guidance on how to purchase textbooks and curriculum.

9.2.1.3. Review the course schedule. Insert approved and certified Instructors into the schedule for the blocks of instruction. Credentials of each Instructor will be validated by the AFCEC/CXF. As the approval authority, there is no issue with various instructors for your course of instruction, however, validation and approval is done for every instructor. This ensures program consistency and effectiveness while preventing issues that may arise during audit.

9.2.1.4. Provide the following information directly to the AFCEC/CXF

Medical Director contact information List of Candidates with contact information (This gives awareness for the AFCEC/CXF to approve the candidates (psychomotor skills confirmation) to take the NREMT test when they have fulfilled all requirements for the course)

9.2.1.5. The Course Grade Sheet, found on the AF F&ES EMS SharePoint page, https://portal.afcec.hedc.af.mil/CX/F&ES/EMS/SitePages/Home.aspx, is a document that should be used to track progress of your candidates; it allows for reviewing candidate progress and sending the best candidates forward to take the National Registry cognitive exam and maintaining an effective pass rate.

9.2.2. NREMR Psychomotor Skills Evaluations. Each candidate must complete the required hands-on performance tests to meet the intent of the Department of Transportation National Standard Curriculum standards. The Psychomotor Skills sheets are also available on the AFCEC EMS SharePoint page.

9.2.3. Psychomotor skills evaluations are administered be either the State EMS Office or at the location being taught, with approval and oversight provided by the State EMS Office. Upon completion of the skills, the EMS Program Director will input the results in the National Registry Program Account and notify the State EMS Office of completion. The State EMS Official will validate the psychomotor skills in the National Registry Program Account. The data will be sent to the NREMT where final validation will take place, and an Authorization to Test (ATT) will be assigned to the candidate.

9.2.4. NREMR Cognitive Exam. A computer adaptive test (CAT) that each candidate can expect a range from 90 to 110 items. Each test will have 60 to 80 “live” items that count toward the final score. The exam will also have 30 “pilot” questions that do not affect the final score. The maximum amount of time given to complete the exam is 1 hour and 45 minutes.

9.2.4.1. The Cognitive exam will cover the entire spectrum of EMS care including Airway, Respiration & Ventilation, Cardiology & Resuscitation, Trauma, Medical, Obstetrics/Gynecology, and EMS Operations.

Items related to patient care are focused on adult and geriatric patients (85%) and pediatric patients (15%).

In order to pass the exam, candidates must meet a standard level of competency. The passing standard is defined by the ability to provide safe and effective entry level emergency medical care.

9.2.5. Test Failures. If a candidate is not successful in passing the cognitive exam, the National Registry will provide a candidate feedback on their performance. Candidates may apply to retest 15 days after the last examination. Candidates are given three opportunities to pass the cognitive exam provided all other requirements for National EMS Certification are met. Candidates who fail the examination on the third attempt will be required to repeat the entire NREMR course in order to apply for subsequent examination attempts.

9.3. NREMR Refresher Course Requirements. NREMRs are required to renew their certification every two years. Recertification can be accomplished by either taking the cognitive examination or by completing continuing education.

**NOTE** Requests to conduct an initial or refresher course should be accomplished by contacting the AFCEC/CXF at least 3-months prior to start date in order to complete all necessary administrative actions.

9.3.1. Courses that cannot be applied towards recertification requirements include duplicate courses, clinical rotations, instructor courses, management/leadership courses, performance of duty, preceptor hours, serving as a skill examiner, and volunteer time with agencies. If you have questions on accepted education, please review the Recertification Guide, https://www.nremt.org/rwd/public.

9.3.2. Recertification is an individual responsibility with oversight from Training Officers and Program Directors. Training Officers must ensure National Continued Competency Program (NCCP), Local Continued Competency Program (LCCP) and Individual Continued Competency Program (ICCP) requirements are established and met.

9.3.3. The NREMR NCCP requires a total of 16 hours of continuing education to recertify. The model requires continuing education in three components: a national component (8) hours, a local/state component (4) hours, and an individual component (4) hours.

9.3.3.1. National Component. A maximum of 3 hours distributive education may be used to meet the 8 hour requirement.

Airway/Respiration/Ventilation: 1 Hour Cardiovascular: 2.5 Hours Trauma: 0.5 Hour Medical: 3 Hours Operations: 1 Hour

9.3.3.2. Local Component. Use any state or Commission on Accreditation for Pre-Hospital Continuing Education (CAPCE) approved EMS-related education to fulfill these requirements. A maximum of 3 hours of distributive education may be used to meet the 4 hour requirement.

9.3.3.3. Individual Component. The individual hours are considered flexible content. Use any state or Commission on Accreditation for Pre-Hospital Continuing Education (CAPCE) approved EMS-related education to fulfill these requirements. A maximum of 4 hours of distributive education may be used to meet the 4 hour requirement.

Note: Courses are subject to change as program updates are made.

9.3.4. Recertification by exam. This option enables you to demonstrate continued cognitive competency without documenting continuing education.

9.3.4.1. Login to your National Registry account. Complete a recertification by examination application and pay the exam fee. After 24-48 hours, login to your National Registry account and print your Authorization to Test (ATT) letter. Follow the directions in the letter to schedule your exam.

Note: Be sure you complete the Recertification by Exam application

9.3.4.2. You may make one attempt to take and pass the exam beginning on October 1 (one year prior to your current expiration date) and September 30. A cognitive competency by exam form will become available through your National Registry account upon successful completion of the exam.

9.3.4.3. Return your completed cognitive competency by exam form by your expiration date with signatures and supporting documentation. All other recertification requirements (including criminal conviction statement, verification of skills, etc.) must still be met and verified.

9.4. NREMT Initial Course Requirements.

9.4.1. Initial Course Requirements. All documents can be found in the respective course…