Welcome to Your EMS Certification Program Disclaimer All information for the forms presented - PowerPoint Presentation

Welcome to Your EMS Certification Program

Disclaimer All information for the forms presented by the Pennsylvania Department of Health (PA DOH), Bureau of Emergency Medical Services (BEMS), The Regional EMS Councils, and for the National Registry of Emergency Medical Technicians (NREMT) exams, at all levels. These forms, procedures and policies are subject to change at any time. The information for education, and certification is pursuant to Title 28, Act 37 of 2009, ( The EMS Systems Act) and the rules and regulations.

Who’s who?? EMS Education Institute The accredited organization that provides your education PA Dept. of Health, Bureau of EMS State agency who is Responsible for issuing certifications to providers, as well as, accrediting EMS Agencies and EMS Education Institutes. Regional EMS Councils Organization(s) that are contracted by the PA Dept. of Health, Bureau of EMS to conduct the local responsibilities of their office, to include: administering psychomotor exams, EMS course approvals, guidance, and processing and distribution of EMS certifications and related materials.

Objectives To complete the mandatory forms for the PA DOH to determine candidate eligibility for EMS certification. To explain how to complete the forms correctly, timely and legibly.To provide an overview of the certification examination process.To review the differences between the examination and certification.

Functional Position Description This document identifies the minimum qualifications, expectations, competencies and tasks expected of the (Level of Certification, you are seeking). To Qualify for Certification You Must: Successfully complete all requirements set forth by the EMS Education Institute and the minimum state entry requirements and completion of all required documentation. Meet requirements, such as attendance, grades, and all clinical and field patient contacts, as well as additional required training/ courses, if required. Successfully complete all certification examinations. Have a valid skills verification form signed.

Accommodation Request Upon review of the Functional Position Description (FPD), for the certification level you are seeking, and you decide to request an Accommodation for psychomotor/ skills testing , then sign the form following the paragraph shown below, you will need to complete the two page Accommodation Request Form.

Accommodation Request Cont’d Complete the two page Accommodation Request Form – including the required support documentation to the Council office, within 14 days from the course start date , for the psychomotor (skills) exam only. The DOH, Bureau of EMS and the Regional EMS Councils cannot and will not make an accommodation on the day of the exam, for a student that does not have prior written permission from the DOH.

Accommodation Request Cont’d If you need an accommodation for the cognitive (computer exam) that MUST be done through the NREMT directly. ( www.NREMT.org ), under the General Polices Section. You MUST complete all requirements/ documentation through NREMT to have your request considered.Questions related to the completion of this form can be addressed by your Regional EMS Council Education Specialist.

Memorandum of Agreement and Assumption of Risk Agreement This document is intended to review the exam process for certification. The EMR and EMT exam are made of two parts: Psychomotor – (practical skills) = “Hands-on” Cognitive – computer adaptive Psychomotor Exam consists of: 5 stations for the Emergency Medical Responder (EMR) 7 stations for the Emergency Medical Technician (EMT) The skill/grading sheets are adopted from the NREMT and are the official validation for EMR & EMT candidates, approved by PA DOH-BEMS.

Memorandum of Agreement and Assumption of Risk Agreement Cont’d Grading Areas for the BLS Psychomotor Skills exam are outlined in the first paragraphs on page one of the Memo and Assumption of Agreement. Skills performed will be within your scope of practice for the level of certification you are seeking. Please take a few minutes to review this section. This information and requirements will be reviewed throughout the course by your Instructor and again, the day you take your NREMT psychomotor skills exam.

Memorandum of Agreement and Assumption of Risk Agreement Cont’d Emergency Medical Responder (EMR) Retesting: Less than 3 of the 5 skills unsuccessful, re-testing of only the skills unsuccessful (could be offered and completed the same day, decisions for re-testing are the decision and discretion of the exam coordinator ) 3 or more of the skills unsuccessful, requires retesting of all 5 stations (this will not be completed on the same day). This would be considered exam attempt one (1).   Total exam attempts allowed will be six (6) and they must be completed within 2 years of successful completion of the certification class. After (3) failed exam attempts, the student must complete one of the following to become eligible for the next 3 exam attempts: Successfully complete the entire certification program Successfully complete a “hands-on” remedial course approved by the department. It cannot be less than 24 hours in duration and must be taught by a current PA EMS Instructor from an approved EMS Education Institute. After the documentation from the EMS Education Institute has been received by the Regional EMS council, the student candidate can be scheduled for re-test opportunities If all six (6) exam attempts are unsuccessful, the student would have to retake the entire certification program.

Memorandum of Agreement and Assumption of Risk Agreement Cont’d Emergency Medical Technician (EMT) Retesting: Less than 4 of the 7 skills unsuccessful, re-testing of only the skills unsuccessful (Could be offered and completed the same day, decisions for re-testing are the decision and discretion of the exam coordinator) 4 or more skills unsuccessful, requires retesting of all 7 stations (This will not be completed on the same day) This would be considered exam attempt one (1)   Total exam attempts are six (6) and they must be completed within 2 years of successful completion of the certification class. After (3) failed exam attempts, the student must complete one of the following to become eligible: Successfully complete the entire certification program Successfully complete a “hands-on” remedial course approved by the department. It cannot be less than 24 hours in duration and must be taught by a current PA EMS Instructor from an approved EMS Education Institute. After the documentation from the EMS Education Institute has been received by the Regional EMS council, the student candidate can be scheduled for re-test opportunities If all six (6) exam attempts are unsuccessful, the student would have to retake the entire certification program.

Memorandum of Agreement and Assumption of Risk Agreement Cont’d Exam process – what can you expect the day/night of your exam? Regional EMS Council / State Official will administer the exam. Stations will be set up and evaluators ready to evaluate your skills. Once the exam begins, no electronic devices are permitted , you may not leave the site, so you may wish to bring a snack or something to drink. You may NOT discuss the exam with any person(s) other than the exam administrator(s)before, during or after your skill station rotation. If you are found to be exchanging information, you will be removed from exam and your results will be invalidated.

Memorandum of Agreement and Assumption of Risk Agreement Cont’d Please read the information for the level you are attempting then, the last two paragraphs on page 2 of the form.

Memorandum of Agreement and Assumption of Risk Agreement Cont’d Once you have finished reading the last two paragraphs on Page 2 (two), please sign and date the form on line that reads EXAM CANDIDATE, then have a classmate witness signature . Print names where requested Insert name of Education Institute NOTE: if the candidate/ student is under 18 years of age, a parent or guardian MUST sign as the Witness.

Provider Certification Application, Page 1 Section A , Demographics LEGAL NAME (suffix if you legally have one) Address (where you can receive US Mail, MUST be a permanent address)Phone number(s) (preferred contact and a secondary) Email (must be valid and permanent, “will you have this email address in 3 years?”) Date of Birth Gender Country Education Level Social Security Number County (of residence ) Race

Provider Certification Application Page 1 Section B Certification Please select the level of Pennsylvania Certification you are applying for. Previous or Out of State Certifications Please document any previous certifications held in Pennsylvania. Please document any certifications held in another State. Military certification If your current or initial certification was obtained thru the United States military, please annotate which branch.

Provider Certification Application Page 1

Provider Certification Application Page 2 Section C Have you ever been convicted of a crime other than a summary or similar offense?MUST answer Yes or NoIf you answer No, skip to Section D Previous Reporting to Bureau of EMS, with letters attached. Key terms are convicted , not arrested Other than a summary = Means more than a citation to pay a fine . If tried and convicted , regardless of age= Check “Yes”

Provider Certification Application Page 2 Section C (cont.) Expungement = Having criminal convictions legally removed from your criminal record. Intermediate Punishment Program (IPP) IS a conviction. Accelerative Rehabilitative Disposition (ARD) and Probation without Verdict (PWOV) are NOT considered a conviction.

Provider Certification Application Page 2 Section C (cont.) If you answer YES, you MUST complete ALL of Section C today AND provide the BEMS with certified copies of the following documents. The Police Criminal Complaint, including Affidavit of Probable Cause The Criminal Information or Indictment Guilty Plea Doc or Jury/Court Document imposing a finding of guilt The Courts Sentencing Order

Provider Certification Application Page 2

Provider Certification Application Page 3 Section C – Criminal History / Convictions List offenses annotated with Yes. List name of offenseDate of ConvictionCounty of Conviction State of Conviction Describe circumstances surrounding crime(s). Provide as much detail as possible. Explain how the passage of time since your conviction(s) should be considered in determining your present fitness to serve as an EMS provider.

Provider Certification Application Page 3 Section C – Criminal History / Convictions What are you doing to avoid criminal activity and to improve yourself. Do you believe you will not be involved with future criminal activity? Why?Parole / Probation Status Yes or No – Currently on Probation and/or Parole. Date of completion Probation Officer’s name Probation Officer’s Telephone number.

Provider Certification Application Page 3

Provider Certification Application Page 4 Section C – Criminal History / Convictions Parole/Probation Status (cont.) City of Probation County of ProbationState of Probation Counseling Was counseling ordered by the courts. If Yes, detail the type of counseling Counseling Voluntarily If Yes, detail what type of counseling. Counselor’s Name and Telephone number

Provider Certification Application Page 4 Section D- Disciplinary Action Disclosure Have you been subject to disciplinary action or had a certification or license or authority to practice any profession or occupation revoked, suspended, or restricted? MUST answer YES or NO (if Yes, provide circumstances of the disciplinary action)

Provider Certification Application Page 4

Provider Certification Application Page 5 Section “E” Social Security Number Disclosure If you provided Social Security number on page 1 of application, skip Page 5 & 6 of application. Provide your name AS IT IS ON YOUR CARD (most persons have your full first, middle and last names) OR PA Drivers License or PA ID card (NO other state Licenses are accepted)

Provider Certification Application Page 6 WHAT IF I DON’T HAVE A Social Security Number?? International student? Work VISA? Complete the Waiver of SS# section and sign/ date at the bottom of the page.

Provider Certification Application Page 7 EMS Educational Inst. Enrolling in or Currently Attending This is the information for the program you are in TODAY Address ( of the EMS Educational Institute MAY not be the same as the location you are taking the class) Class number 7 digit number that identifies the students as a group for this time/ location (PLEASE KEEP THIS NUMBER)

Provider Certification Application Page 7 Most Recent EMS Educational Institute Previously Attended? You attended another EMS program and did not complete itYou attended another EMS program and completed it but did not become certified You were previously an EMS provider, let your certification lapse/ expire, and are taking the program again You completed another EMS program, became certified, but you are here to take the next higher level of a program Did you receive an EMS certification while in the military? You attained certification via the United States Military?

Provider Certification Application Page 7

Provider Certification Application Page 8 Section “G” Waiver and Signature States that you are attesting that the information is true and complete and the Commonwealth has the authority to refuse OR revoke a certification, if it is found that the information you provided is fraudulent. PRINT name, SIGNATURE, todays date

Provider Certification Application Page 8

Provider Certification Application Page 9 Student Release and Consent As a student, you must grant permission for the EMS Educational Institute to “share” your educational records/ information, etc. for you to become certified. If you do NOT grant this permission, the Commonwealth, cannot test/ certify you. Under 18?? Parent or Guardian must sign documents

Students Under 18 years of age Students who are at least 16 years of age but not yet 18 years of age, must have a parent or guardian sign off on the following forms: Student Release and Consent Form – which includes a section for permission for Certification Exam participation Memorandum and Assumption of Risk Agreement – parent or guardian must sign.

ONLINE Student Application Go to https://ems.health.state.pa.us/emsportal/ Use the USER ID ( mystudent) that the Regional EMS Council provides. Use the Password the Regional Council provides.

ONLINE Student Application Go to NEW STUDENT APPLICATION New Student Application This area allows new students who are enrolled in an EMS Certification program offered through a current EMS education institute to request entry into EMS Registry. DO NOT use Edit Profile!!!!!!!!!!!!!!! READ the Instructions for CREATE NEW STUDENT APPLICATION . Complete all spaces as required Region is your Regional EMS Council SSN is your Social Security Number WITHOUT spaces ( ex. 123456879). THIS MUST BE ACCURATE!!!

ONLINE Student Application Level is the certification level you are attempting. 0-EMR, 2-EMT, 9- Advanced EMT, 3- Paramedic Your certification class number will be provided by your Regional EMS Council staff OR your EMS Instructor, please enter WITHOUT spaces. ( ex. 1663123 or 1657456) Certification number is to be left blank Valid and accommodation boxes are to be left as NO Click “ SUBMIT ”

QUESTIONS????? Photo Identification is required to take the examination. Speak with your Regional EMS Council staff for assistance. Thank You for joining the EMS Family!!!!!!!