EMS Publications #130: Paramedic — GUIDELINES FOR LOCAL EMS AGENCIES REGARDING EMT-P ACCREDITATION POLICIES AND PROCEDURES
Approved By EMS Commission September 20, 1995
The Legislature intended accreditation to be a process by which the local EMS agency and medical director could be assured that all EMT-Ps functioning in the EMS system were oriented to local policies, procedures, and EMS system features and to maintain medical control and integrity of the system. Accreditation was not intended to grant local EMS agencies the authority to duplicate licensure procedures. The requirements placed within accreditation should be carefully considered in the context of the needs of the EMS system and of the individual EMT-P. The accreditation process must not unfairly deny an EMT-P the ability to work within an EMS system.
Licensure is a prerequisite for local accreditation. State licensure means that the individual has met specified training and education standards and has been deemed competent to practice throughout the State in the EMT-P basic scope of practice, as defined in Title 22, CCR.
- IMPLEMENTATION OF ACCREDITATION POLICIES AND PROCEDURES
- Initial Accreditation
Accreditation is authorization by the medical director of the local EMS agency to practice EMT-P skills within a specific jurisdiction as required by a specific local EMS agency (Title 22, CCR, Section 100140). Accreditation allows local EMS agencies to ensure that EMT-Ps are trained in the optional skills and oriented to the local system. An EMT-P may be initially accredited by more than one local EMS agency.
- Initial accreditation is the first time a licensed EMT-P who meets local requirements is authorized to work in that local EMS agency's jurisdiction.
- An EMT-P may begin work in the basic scope of practice immediately following submission of an accreditation application with the local EMS agency and verification that the EMT-P has a valid license.
- Application Process
- A complete application is one in which the following information is provided:
- Phone Number
- Date of Birth
- Social Security Number
- Proof of EMT-P License
- CA Drivers License or other valid picture identification
- Information on previous licensure action
- Information on previous accreditation practice
- If the applicant does not complete accreditation requirements within thirty (30) days, then the applicant may be required to complete a new application and pay a new fee to begin another thirty (30) day period. By law, local EMS agencies must notify the applicant of a decision to accredit by the end of the thirty (30) days. Every effort should be made to eliminate the barriers in the accreditation process which may impede an EMT-P's ability to work. Provisional extension of up to 90 days is allowable for the accreditation process to be completed upon mutual consent of LEMSA and the applicant. (An extension should be the exception, not the rule, and for the convenience of the applicant.)
- Local EMS agencies may limit the number of times that a paramedic applies for initial accreditation to no more than three times per calendar year.
- A complete application is one in which the following information is provided:
- Orientation Process
- Orientation to the local EMS system includes policies and procedures, treatment protocols, radio communications, base and receiving hospitals, specialty care centers, and other unique system features.
- Orientation should only include information on local policies and treatment protocols. It should not repeat items within the basic EMT-P scope of practice which are already covered in the State written and skills examinations.
- Orientation may not exceed eight (8) hours. This maximum number of hours excludes testing in the undefined scope of practice. A local EMS agency has the option of using fewer than eight (8) hours for orientation.
- Orientation shall be completed within thirty (30) days of receipt of a completed application by the local EMS agency unless the applicant and the LEMSA have mutually consented to a provisional extension of up to 90 days.
- Testing shall be limited to local policies or treatment protocols provided in the orientation. The applicant should be provided with the information to be tested prior to testing.
- Optional Scope Of Practice
Training in any optional scope of practice skill must focus on local policies, procedures, equipment utilization and other aspects that may differ from another County, rather than repeating basic training. EMT-Ps shall be trained and evaluated on additions to the optional scope of practice. Local EMS agencies may choose to delegate this training to other EMS system participants, e.g., employers. Repeated training may be required until proficiency is achieved.
- Training in the optional scope of practice must be completed within the thirty (30) day time frame for accreditation, but may be outside the eight (8) hour orientation.
- Training on and evaluation of specific undefined scope of practice items must be offered expeditiously and be limited to items in which the EMT-P has not previously received similar instruction or proficiency evaluation.
- Proficiency evaluation must be limited to those items in which there is no other documented indication of competence.
- Testing in the optional scope of practice could be in a written, oral and/or skills format.
- Pre-accreditation Field Evaluation
The process of accreditation should not delay the EMT-P from practicing in the local EMS system.
- Pre-accreditation field evaluation is optional and is only a requirement of the accreditation process if the local EMS agency chooses to adopt it as a part of accreditation. Regulations limit the field evaluation to no more than ten (10) ALS calls.
- Field evaluation should only be used to determine if the applicant is knowledgeable to begin functioning under local policies and protocols.
- In the course of the field evaluation, if the applicant's proficiency in the basic scope of practice comes into question, then the qualification of the individual to hold a license becomes an issue.
- An EMT-P may practice their basic scope of practice as a second paramedic in a local EMS agency's jurisdiction for a period of up to 30 days while awaiting issuance of local accreditation.
- Performance of optional skills and procedures by the accreditation applicant will be done in the presence of a field evaluator who meets the pre-established standards of the local EMS agency. Although the applicant may be licensed as an EMT-P in California, the evaluator has the ultimate responsibility for patient care rendered by the EMT-P during the evaluation period.
- The medical director shall evaluate any candidate who fails to successfully complete the orientation process and may recommend further evaluation or training as required.
- Pre-established Training Courses
Initial accreditation may not be delayed pending completion of the pre-established training course(s), such as PHTLS, BTLS, PALS, etc. The local EMS agency must permit completion of these courses in a reasonable timeframe. The local EMS agency should facilitate the availability of the courses.
- Completion of the specialized training shall be credited towards the continuing education requirements for the EMT-P's next licensure cycle.
- Courses must be within the CE hours specified in the regulations for any one licensure cycle. This means that no one local EMS agency may require specialized training that exceeds thirty six (36) hours every two years.
Accreditation to practice shall be continuous as long as the EMT-P maintains a valid license, maintains the appropriate level of education and training, and adheres to local medical care standards and protocols as developed by the medical director after consultation with the EMS community. Given the recent changes in EMT-P licensure and the legislative intent to promote statewide paramedic recognition, it is recommended that no limitations or additional requirements be placed on field care audits (e.g., 50% completed at base hospitals in your jurisdiction). The LEMSA should not require reapplication or additional accreditation fees if accreditation has not been removed.
- The EMT-P should complete training courses on revised policies and procedures or treatment protocols.
- The EMT-P may be required to obtain education aimed at a specific clinical condition or problem identified in the quality improvement program, which may include specialized training or certification in pre-established courses.
- The EMT-P may be required to show skills competency on those skills infrequently used.
- The EMT-P should be able to easily obtain training in the local EMS jurisdiction or should be allowed to obtain equivalent training by an alternative method.
- Training and testing on the optional skills and on updates to local policies and procedures may be mandated by local EMS agencies.
- Adverse Actions On Accreditation
Accreditation may be denied or suspended by the local EMS agency. If an EMT-P does not maintain current licensure or meet local accreditation requirements, accreditation can be suspended until such time that the deficiencies are completed and documented to the localEMS agency. Suspension of accreditation privileges means that the EMT-P cannot work in either the basic or optional scope of practice in that local EMS agency jurisdiction.
- The EMT-P should be given ample notification of any deadlines and requirements.
- Accreditation should not be denied based on a paramedic's accreditation history with another county or their provider affiliation.
- A local EMS agency shall develop policies and procedures on due process for taking action against accreditation.
- Initial Accreditation
REFERENCES TO STATUTE/REGULATIONS RELATED TO EMT-P ACCREDITATION
Health and Safety Code, Division 2.5
- Section 1797.7 Legislative Intent: Statewide recognition of prehospital personnel
- Section 1797.185 Criteria for statewide recognition of prehospital personnel
- Section 1797.194 State licensure of EMT-P personnel
- Section 1797.214 Local EMS agency requirement for additional training Title 22, California Code of Regulations.
- Chapter 9 Section 100140 Local Accreditation
- Section 100144 Scope of Practice of EMT-Ps
- Section 100164 Accreditation to Practice
- Section 100172 Fees