NOTICE OF INTENT TO CONDUCT INITIAL EMS TRAINING COURSE

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Request Date: NOTICE OF INTENT TO CONDUCT INITIAL EMS TRAINING COURSE Note: This form MUST be submitted to the Office of EMS & Trauma System (ems@snhdmail.org) at least THIRTY (30) DAYS prior to course start date. and ending on. course beginning on intends to conduct a The course Medical Director will be, M.D./D.O. The course coordinator will be. Tentative testing date for National Registry Exam: 1 st choice 2 nd choice. Note: EMS Course/Instruction Evaluation Forms must be submitted to the OEMSTS within ten days of course completion. Any modifications to previously approved courses need to go through a new approval process, which includes a re-submission of the class syllabus lesson plan. Competency Based. National EMS Education Standards estimate the following course hour ranges: EMT: AEMT: 150 to 190 TOTAL DIDACTIC AND LAB HOURS 150 to 250 TOTAL DIDACTIC AND LAB HOURS PARAMEDIC: 670 to 850 TOTAL DIDACTIC AND LAB HOURS Check the box(s) to indicate the level(s) of EMS education you are applying to conduct: 1. The First time the Course is offered, submit a copy of the Course lesson plan which indicates: A. Course title; B. Date and time of the topic(s) to be discussed; C. Detailed outline of each topic; D. Time allotted for each topic; E. Section/lesson that the topic(s) fits into; F. Method of presentation; and G. Instructor(s) name 2. Each time the Course is offered, submit a copy of the Course syllabus which indicates: A. Course title; B. Date and time of the topic(s) to be discussed; C. Time allotted for each topic; D. Section/lesson that the topic(s) fits into; and E. Instructor(s) name

Required Field Section/Lesson # of hours Scheduled Instructor(s) Preparatory EMS Systems EMT Paramedic Research EMT Paramedic Workforce Safety and Wellness Documentation EMS System Communication Therapeutic Communication EMT Paramedic Medical/Legal and Ethics Lab Section Anatomy and Physiology Medical Terminology Pathophysiology Life Span Development Public Health Pharmacology Principles of Pharmacology Medication Administration Emergency Medications Airway Management, Respiration & Artificial Ventilation Airway Management Respiration Artificial Ventilation

Required Field Section/Lesson # of hours Scheduled Instructor Assessment EMT Paramedic Scene Size-Up Primary Assessment EMT Paramedic History Taking Secondary Assessment Monitoring Devices EMT Paramedic Reassessment Medicine Medical Overview Neurology EMT Paramedic Abdominal & GI Disorders Immunology Infectious Disease Endocrine Disorders EMT Paramedic Psychiatric Cardiovascular Toxicology Respiratory Hematology Genitourinary/Renal EMT Paramedic Gynecology EMT Paramedic Paramedic Non-Traumatic Musculoskeletal Disorders Diseases of the Eyes, Ears, Nose, and Throat Shock and Resuscitation

Required Field Section/Lesson # of Hours Scheduled Instructor Trauma EMT Paramedic Trauma Overview Bleeding Chest Trauma Abdominal & GU Trauma Orthopedic Trauma Soft Tissue Trauma Head, Facial, Neck & Spine Trauma Nervous System Trauma Special Considerations in Trauma EMT Paramedic Environmental Emergencies Multi-System Trauma Special Patient Populations EMT Paramedic Obstetrics EMT Paramedic Neonatal Care EMT Paramedic Pediatrics Geriatrics Patients with Special Challenges EMS Operations EMT Paramedic Principles of Safely Operating a Ground Ambulance EMT Paramedic Incident Management EMT Paramedic Multiple Casualty Incidents Paramedic Air Medical Vehicle Extrication Hazardous Materials Awareness Mass Casualty Incidents due to Terrorism & Disaster

In addition to the recommended hours listed above, each EMT and AEMT student is required to have practical experience hours as approved by the Health District in a hospital or EMS field setting. TOTAL EMT PRACTICAL EXPERIENCE HOURS: 10 TOTAL AEMT PRACTICAL EXPERIENCE HOURS: 24 In addition to the recommended hours listed above, each Paramedic student is required to have the following number of clinical course hours as approved by the Health District. Anesthesia 24 Adult and Pediatric Critical Care 30 Emergency Department (A maximum of 40 hrs field experience may be substituted) 120 Triage 10 OR Observation (Including pediatric cases) 10 Pediatric ED - Pediatric Post Anesthesia 40 Recovery - General Pediatrics Psychiatric 8 Labor & Delivery 24 Elective/Miscellaneous (Cath Lab, EPS, Morgue/Autopsy, nursing homes Day care centers, special clinics) Total Clinical Hours 290 24 All EMS providers must have documentation of completion of an approved Weapons of Mass Destruction Course to include: Introduction to Terrorism Chemical Biological (including Syndromic Surveillance & Health Alert Network) Radiological/Nuclear Agents Personal Protective Equipment Decontamination