Guam § 84111 - Certification Procedure.

§ 84111. Certification Procedure.

For the purpose of implementing § 84110, the following

certification procedures shall apply:

(a) Certification Application. There shall be four (4)

levels of emergency medical service personnel: Emergency

Medical Responder (EMR); Emergency Medical Technician

(EMT); Advance Emergency Medical Technician (AEMT);

and Paramedic.

(b) An application for certification shall be made

under oath on a form to be approved by the Commission and

provided by the Administrator, and shall require the

applicant to provide documentation as proof of eligibility as

established in the Guam EMS Rules and Regulations in

compliance with the U.S. Department of Transportation.

(c) Emergency Medical Responder:

(1) Training: Training for EMRs is offered at the

local level by approved training programs. A list of

approved training programs may be obtained through

the Department of Public Health and Social Services

(DPHSS) via telephone, mail, or from its web page.

Training hours consist of Ninety-six (96) hours, broken

down into Eighty (80) classroom and laboratory hours

and Sixteen (16) hours of supervised clinical

experience.

(2) Testing: In order to practice as an EMR, an

individual is certified after passing the National Registry

of Emergency Medical Technician (NREMT) written

and skills exams.

(3) Certification: After passing the written and

skills certification exams, applicants must obtain a

criminal background check, provide documentation of

current BLS/CPR certification, provide a current photo

ID (Guam driver’s license or U.S. Passport), and pay the

fee established in the fee schedule. The applicant may

then be certified through the Office of EMS which

issues an EMR certification card (they are also known

as the certifying entity). Certification is valid for two (2)

years from the date of issue.

(4) Recertification: Every two (2) years, an EMR

must provide the certifying entity with proof of sixteen

(16) hours of refresher course work or sixteen (16) hours

of EMS approved continuing education units (CEUs),

and have documented competency in ten (10) skills.

EMR shall also maintain current NREMT certification

and BLS certification. Applicants must pay the fee

established in the fee schedule and provide proof of

completion of these requirements in order for the

certifying entity to recertify an EMR.

(5) Reciprocity: Individuals from out-of-state

who meet the following criteria and complete the

application requirements of a certifying entity are

eligible for certification:

(A) possess a current and valid National

Registry EMR certificate;

(B) possess a current and valid out-of-state or

National Registry EMR certificate; or

(C) paramedic license, or have

documentation of successful completion of an out-

of-state EMR training course within the last two (2)

years that meets Guam’s EMR training

requirements.

(6) Scope of Practice: An EMR is trained and

certified in basic life support practices. Basic life

support (BLS) means emergency first aid and CPR

procedures which, at a minimum, include recognizing

respiratory and cardiac arrest and starting the proper

application of CPR to maintain life without invasive

techniques until the patient can be transported or until

advanced life support (ALS) is available.

(d) Emergency Medical Technician:

(1) Training: Training for EMTs is offered at the

local level by approved training programs. A list of

approved training programs may be obtained through

the DPHSS via telephone, mail, or from its web page.

Training hours consist of 120 hours, broken down into

110 classroom and laboratory hours and ten (10) hours

of supervised clinical experience.

(2) Testing: In order to practice as an EMT, an

individual is certified after passing the NREMT written

and skills exams.

(3) Certification: After passing the written and

skills certification exams applicants must obtain a

criminal background check, provide documentation of

current BLS/CPR certification, provide a current photo

ID (Guam driver’s license or U.S. Passport), and pay the

fee established in the fee schedule. The applicant may

then be certified through the Office of EMS which

issues an EMT certification card (they are also known

as the certifying entity). Certification is valid for two (2)

years from the date of issue.

(4) Recertification: Every two (2) years, an EMT

must provide the certifying entity with proof of forty

(40) hours of refresher course work or forty (40) hours

of EMS approved continuing education units (CEUs),

and have documented competency in ten (10) skills.

EMTs shall also maintain current NREMT certification

and BLS certification. Applicant must pay the fee

established in the fee schedule and provide proof of

completion of these requirements in order for the

certifying entity to recertify an EMT.

(5) Reciprocity: Individuals from out-of-state

who meet the following criteria and complete the

application requirements of a certifying entity are

eligible for certification:

(A) possess a current and valid National

Registry EMT certificate;

(B) possess a current and valid out-of-state or

National Registry EMT certificate; or

(C) paramedic license, or have

documentation of successful completion of an out-

of-state EMT training course within the last two (2)

years that meets Guam’s EMT training

requirements.

(6) Scope of Practice: An EMT is trained and

certified in basic life support practices. Basic life

support (BLS) means emergency first aid and CPR

procedures which, at a minimum, include recognizing

respiratory and cardiac arrest and starting the proper

application of CPR to maintain life without invasive

techniques until the patient can be transported or until

advanced life support (ALS) is available. Automated

external defibrillator (AED) training is now part of the

basic scope of practice.

(7) Optional Skills: EMTs may obtain additional

training to supplement their standard scope of practice.

EMTs may become locally-approved to use certain

medications and skills. The local EMS Medical Director

for each agency determines the use of these optional

scope items.

(e) Advance Emergency Medical Technician:

(1) Training: Training for AEMTs is offered at

the local level by approved training programs. A list of

approved training programs may be obtained through

the DPHSS via telephone, mail, or from its web page.

The required training hours for AEMTs is 228. The

minimum number of hours for each portion of the

training program is listed below, although most

programs may exceed this amount:

(A) Didactic and lab/skills: 168 hours

(B) Field Internship: 60 hours

(C) TOTAL 228 hours

(2) Testing: In order to practice as an AEMT, an

individual is certified after passing the NREMT written

and skills exams.

(3) Certification: After passing the written and

skills certification exams applicants must obtain a

criminal background check, provide documentation of

current BLS/CPR certification, provide a current photo

ID (Guam driver’s license or U.S. Passport), and pay the

fee established in the fee schedule. The applicant may

then be certified through the Office of EMS which

issues an AEMT certification card (they are also known

as the certifying entity). Certification is valid for two (2)

years from the date of issue.

(4) Recertification: Every two (2) years, an

AEMT must provide the local EMS agency with proof

of completion of fifty (50) hours of EMS approved

continuing education units (CEUs), and provide

documented competency in six (6) skills. AEMTs shall

also maintain current NREMT certification and BLS

certification. Applicants must pay the fee established in

the fee schedule and provide proof of completion of

these requirements in order for the certifying entity to

recertify an AEMT.

(5) Reciprocity: An individual who possesses or

has possessed a valid AEMT or Paramedic license from

another state or holds a current NREMT AEMT or

Paramedic certification may be eligible for certification.

(6) Scope of Practice: AEMTs are certified in the

use of advanced life support (ALS) skills. ALS includes

all EMT skills, intravenous infusion, perilaryngeal

airway, and eight (8) medications (jurisdictional scope

of practice may vary).

(7) Optional Skills: In addition to the EMT scope

of practice, AEMTs may practice additional skills and

administer certain medications. These additional

optional skills and medications may be utilized and are

approved by the local EMS agency and the EMS

Medical Director. The AEMT is typically employed by

public safety agencies, such as fire departments, and by

private ambulance companies.

(f) Paramedic:

(1) Training: Training for Paramedics is offered

at the local level by approved training programs. A list

of approved training programs may be obtained through

the DPHSS via telephone, mail, or from its web page.

The minimum number of hours for each portion of the

training program is listed below, although most

programs exceed these amounts:

(A) Didactic and lab/skills: 672 hours

(B) Hospital and clinical training: 120 hours

(C) Field Experience: 288 hours

(D) Field internship with 20 patient contacts

and at least 120 hours

(E) TOTAL 1,200 hours

(2) Testing: In order to practice as a paramedic,

an individual must pass the NREMT written and skills

exams. Tests are scheduled as needed on a program

requirement; and an individual can contact the EMS

Authority for further information.

(3) Licensure: Guam law requires an individual to

be licensed by the EMS Authority in order to practice as

a paramedic. Individuals seeking licensure should apply

directly to the EMS Authority. After passing the written

and skills certification exams, applicants must obtain a

criminal background check, provide documentation of

current BLS/CPR certification, provide a current photo

ID (Guam driver’s license or U.S. Passport), and pay the

fee established in the fee schedule. The applicant may

then be licensed through the Office of EMS which issues

a Paramedic License card (they are also known as the

certifying entity). Certification is valid for two (2) years

from the date of issue.

(4) Credentialing: In addition to licensure, a

paramedic must be locally credentialed by an approved

EMS agency in order to practice on Guam.

Credentialing is orientation to local protocols and

training in any local optional scope of practice for the

particular local EMS agency jurisdiction, as well as skill

and knowledge verification by an affiliated EMS agency

and EMS Medical Director. Paramedics must apply for

credentialing directly to the local EMS agency. All

provider credentialing shall be approved by the EMS

agency Medical Director.

(5) License Renewal: Paramedics must complete

a minimum of sixty (60) hours of approved continuing

education units (CEUs) every two (2) years to maintain

licensure. Paramedics shall also maintain current

NREMT certification and BLS certification. Applicant

must pay the fee established in the fee schedule and

provide proof of completion of these requirements in

order for the certifying entity to recertify a Paramedic.

(6) Reciprocity: Individuals who possess a

current paramedic certificate from the National Registry

of EMTs or valid state Paramedic License are eligible

for paramedic licensure on Guam when they submit

proof of successful completion of a field internship and

complete all license requirements.

(7) Scope of Practice: Paramedics are trained and

licensed in the use of advanced life support (ALS) skills.

ALS includes all EMT and AEMT skills, use of

laryngoscope, endotracheal and nasogastric intubation,

Valsalva’s Maneuver, needle thoracostomy,

administration of twenty-one (21) drugs, and other

skills.

(8) Optional Skills: The EMS Authority can

approve the use of additional skills and administration

of additional medications by paramedics upon the

request of a local EMS medical director.

(g) Temporary Certification: The Office of EMS shall

approve temporary certification of an applicant if the

applicant has completed an approved training program within

twelve (12) months of the date of application and has never

taken the written and practical examination of the National

Registry of Emergency Medical Technicians for that level of

practice but otherwise meets the requirements, has filed a

complete application with the Office of EMS, and has paid all

required fees. If the applicant fails to apply for, or to take, the

next succeeding examination or fails to pass the examination

or fails to receive a certificate, all privileges under this Section

shall automatically cease upon written notification sent to the

applicant by the Office of EMS. A temporary certificate for

each level of practice may be issued only once to each person.

Prior to practicing under temporary certification, applicants

shall notify the Office of EMS in writing of any and all

employers under whom they will be performing services.

(h) Extension of Licenses for Members of the Armed

Forces, National Guard, and Reserves.

(1) Notwithstanding any other law to the contrary, any

license held by a Member of the Armed Forces, National

Guard, or a Reserve component that expires, is forfeited, or

deemed delinquent while the Member is on active duty and

deployed during a state or national crisis shall be restored

under the restoration requirements provided in this Section.

For the purposes of this Section, “local or national

emergency” includes, but is not limited to:

(A) a situation requiring the proper defense of

nation or state;

(B) a federal or state disaster or emergency;

(C) a terrorist threat; or

(D) a homeland security or homeland defense event

or action.

(2) The licensing authority shall restore a license upon

the payment of the current renewal fee if the Member:

(A) requests a restoration of the license within one

hundred twenty (120) days after being discharged or

released from active duty deployment;

(B) provides the licensing authority with a copy of

the Member’s order calling the Member to active duty

deployment, and the Member’s discharge or release

orders; and

(C) if required for renewal, provides

documentation to establish the financial integrity of the

licensee or to satisfy a federal requirement.

(3) This Section:

(A) shall not apply to a Member who is on

scheduled annual or specialized training, or to any

person whose license is suspended or revoked, or who

otherwise has been adjudicated and is subject to

disciplinary action on a license; and

(B) shall also apply to a Member whose license is

current, but will expire within one hundred twenty (120)

days of the Member’s discharge or release from active

duty deployment.