Application and Accreditation or Certification Requirements for Training Entities that Conduct Training for First Responders, Emergency

Medical Dispatchers, Emergency Medical TechniciansBasic, Emergency Medical Technicians-Intermediate, and Emergency Medical Technicians-Paramedic PURPOSE: This rule provides the requirements for the application and accreditation or certification of training entities that conduct EMS-related training programs. PUBLISHER’S NOTE: The secretary of state has determined that the publication of the entire text of the material which is incorporated by reference as a portion of this rule would be unduly cumbersome or expensive. This material as incorporated by reference in this rule shall be maintained by the agency at its headquarters and shall be made available to the public for inspection and copying at no more than the actual cost of reproduction. This note applies only to the reference material. The entire text of the rule is printed here. (1) General Requirements for Certification of Emergency Medical Technician-Basic (EMT-B) Training Entities, Emergency Medical Technician-Paramedic (EMT-P) Training Entities, Emergency Medical Technician-Intermediate (EMT-I) Training Entities, EMT-B Continuing Education Training Entities, and EMT-P Continuing Education Training Entities. (A) Each applicant for certification as an emergency medical services (EMS) training entity shall make application to the EMS Bureau and undergo a review by the EMS Bureau staff to determine compliance with these rules. An application shall include, but not be limited to, the following: trade name of the training entity; training entity business address; daytime telephone number of the training entity; type of accreditation applied for; name, address, telephone number, and signature of the program director; name, address, telephone number, and signature of the medical director; and certification by the applicant that the application contains no misrepresentations or falsifications and that the information given by them is true and complete to the best of their knowledge, and that the training entity has both the intention and the ability to comply with the regulations promulgated under the Comprehensive Emergency Medical Service Systems Act, Chapter 190, RSMo. The training entity accreditation application form, included herein, is available at the EMS Bureau office or by mailing a written request to the Missouri Department of Health and Senior Services, EMS Bureau, PO Box 570, Jefferson City, MO 65102-0570. (B) Only certified EMS training entities shall be authorized to conduct EMS training programs. Upon receipt of an application for EMS training entity certification, the EMS Bureau shall cause an inspection of the applicant to determine compliance with these rules, and such subsequent inspection as is necessary or desirable to ensure compliance with these rules. Such inspections shall occur not less than once every five (5) years. 1. Training entities shall be certified to conduct the following programs: A. EMT-P training entities shall be certified to conduct initial EMT-P; EMT-P refresher to include remedial training and National Registry bridge programs; EMT-P continuing education; initial EMT-I programs; EMT-I refresher to include remedial training; EMT-I continuing education; initial EMT-B; EMT-B refresher to include remedial training and National Registry bridge programs; EMT-B continuing education; initial first responder; first responder refresher; and emergency medical dispatcher (EMD) courses; B. EMT-P continuing education training entities shall be certified to conduct EMT-P continuing education courses, EMT-I continuing education courses, and EMT-B continuing education courses; C. EMT-B training entities shall be certified to conduct initial EMT-B; EMT-B refresher to include remedial training and National Registry bridge programs; EMT-B continuing education; initial first responder; first responder refresher; and emergency medical dispatcher courses; D. EMT-B continuing education training entities shall be certified to conduct EMT-B continuing education programs; E. First responder training entities shall be certified to conduct only initial first responder and first responder refresher courses; and F. EMD training entities shall be certified to conduct only EMD courses. (C) Each EMS training entity shall demonstrate an organizational structure that ensures responsibility for the organization, administration, periodic review, continued development, and effectiveness of all educational programs SENIOR SERVICES conducted by the EMS training entity. The EMS training entity shall have an organizational chart and job descriptions for relevant positions within the training entity and make this available to the EMS Bureau personnel on request. (D) Each EMS training entity shall demonstrate adequate resources for the continued operation of all educational programs conducted. This shall be available to the EMS Bureau personnel on request. (E) Each EMS training entity shall have a medical director who reviews and approves the educational content of the program and quality of medical instruction. The medical director for EMS training entities shall meet the requirements set forth in 19 CSR 30-40.303. (F) Each EMS training entity shall demonstrate a methodology to evaluate the need for training and to ensure availability of effective training programs. The tools used to develop the methodology shall be made available for review by the EMS Bureau. (G) Faculty Requirements. 1. Each EMS training entity shall have a qualified faculty. Credentials of faculty shall be available for review by the EMS Bureau. A. Primary faculty (those who teach twenty percent (20%) or more of classroom sessions) shall meet the EMS Bureau requirements for EMS instructors. B. The training entity shall describe qualifications and training for laboratory instructors, where lab instructors are used. C. The training entity shall describe qualifications and training for clinical instructors and field preceptors, where clinical instructors and field preceptors are used. 2. Qualifications for any adjunct instructors such as physicians, registered nurses, paramedics, clinical specialists, or expert lecturers shall be documented and available for review by the EMS Bureau. (H) Physical Facilities. 1. Classrooms and laboratories shall have sufficient space to accommodate the maximum planned number of students and shall be environmentally conducive to providing a quality learning environment. The EMS Bureau may inspect classroom and laboratory facilities to determine compliance. 2. Equipment and supplies used in the provision of instruction shall be available and consistent with the requirements of the curriculum and adequate for the volume of students enrolled. A. The EMS Bureau may periodically inspect such equipment and supplies to determine compliance with this requirement. B. The EMS training entity shall describe how they will meet this requirement to the EMS Bureau. C. The EMS training entity shall ensure that the equipment used in its training programs is in proper working order and appropriately cleaned. 3. Training entities that conduct initial courses of instruction shall make available to all students clearly defined and published policies and procedures. Such policies and procedures shall include the following: A. Admission criteria; B. Student withdrawal and refund of tuition and/or fees policies; C. Attendance policy; D. Grading and academic criteria; E. Class cancellation policy; F. Appeal and grievance procedures; G. Examination policies; H. Health and safety procedures; I. Certification requirements of the National Registry of Emergency Medical Technicians and licensing requirements for the state of Missouri; and J. Recent statutes and regulations of the state of Missouri that pertain to EMS which can be obtained from the EMS Bureau. This can either be in an electronic or paper format. (I) Program Self-Evaluation. 1. Each EMS training entity shall demonstrate that the programs conducted under its authority conduct program selfevaluation. Such evaluation shall include: A. Evaluation of students shall be conducted and documented on a recurring basis and with sufficient frequency to provide both the student and program faculty with valid and timely indicators of each student’s progress toward and achievement of the competencies and objectives stated in the curriculum; B. Test instruments and evaluation methods shall undergo periodic reviews by appropriate training entity staff and medical director; and C. Evaluation of the program by the students shall be documented and reviewed by the appropriate training entity staff and medical director. (J) Record Keeping and Reporting. 1. Records shall be maintained for each student that demonstrate all attendance, clinical, practical, and written examination records. 2. Records shall be maintained for each class session that document name of instructor, title of session, beginning and ending time of each session, and attendance at the session. 3. Records shall be maintained for each initial course of instruction that document location of course, primary instructor, beginning enrollment, drop-out rate, course fail rate, and number of students successfully completing the course. 4. Lesson plans shall be maintained for each course offered. 5. All records shall be available for review by the EMS Bureau and kept on file for at least five (5) years. 6. Each EMS training entity shall submit to the EMS Bureau an annual report indicating the number, type, and location of courses offered, the pass/fail rate for each course, and the numbers of students completing training. Each annual report shall contain an affidavit that the principal officers and medical director of the training entity remain the same as the original application, or shall indicate any change. 7. Certificates of completion shall be issued by the training entity to students, at the request of the student, after successful completion of the appropriate criteria. (K) EMS training entities may cooperate and develop satellite programs under their approval. In these cases, the EMS training entity remains responsible for ensuring quality EMS education and compliance with the EMS Bureau rules. (L) Upon EMS training entity approval by the EMS Bureau, the EMS Bureau shall assign an accreditation number to each EMS training entity. The EMS training entity shall reference this accreditation number on each course completion letter or certificate issued by the EMS training entity. (2) Specific Requirements for EMS Training Entities Offering Initial EMT-P Courses and EMT-I Courses. (A) Only EMS training entities certified by the EMS Bureau to conduct initial EMT-P courses shall offer initial EMT-P and EMT-I courses. (B) EMT-P and EMT-I students are only authorized to perform the skills and practice in accordance with the national standard curriculum for EMT-P and EMT-I and approved by the training entity medical director. The skills and practice performed by the student must be under the direct supervision of a clinical preceptor during scheduled clinicals at an approved site with a current clinical agreement and cannot be performed while on duty. (C) EMS training entities offering initial EMT-P and EMT-I courses shall also be certified to conduct EMT-I, EMT-B, and/ or first responder and/or emergency medical dispatcher, and/ or EMS continuing education programs. If the training entity conducts these programs, the training entity shall also be responsible for ensuring compliance with the rules set forth for those programs. (D) Each EMT-P training entity shall have a formal affiliation with an appropriately accredited university, senior college, community college, vocational school, technical school, or an appropriately accredited medical institution with dedication to educational endeavors. This affiliation shall include the following: 1. Ability for the EMT-P training program to require prerequisite post-secondary educational courses; 2. Responsibility by the accredited post-secondary educational institution and/or medical institution over the instructor(s) and the educational methodologies used by the EMT-P training program; 3. Access by the EMT-P training program into remedial education as may be necessary for the EMT-P training program; and 4. Access by the students to financial assistance such as, but not limited to, grants and Veteran’s Benefits. (E) Each EMT-P training program shall have a designated program director. Each EMT-P course shall have a designated primary instructor. (F) Each EMT-P training program shall demonstrate and document that the EMT-P courses taught under its authority meet or exceed the requirements of the current national standard curriculum for EMT-P training. (G) Training entities that provide EMT-P programs shall regularly assess the effectiveness of the training program. (H) Clinical Requirements. 1. Each EMS training entity that provides EMT-P programs shall document and demonstrate a supervised clinical experience for all students. Each training entity shall approve or disapprove clinical preceptors. 2. Clinical affiliations shall be established and confirmed in current written affiliation agreements with institutions and agencies that provide clinical experience under appropriate medical direction and clinical supervision. 3. Students shall be assigned in clinical settings where experiences are clinically and educationally effective in achieving the program’s objectives. 4. When participating in clinicals, students shall be clearly identified by name and student status using nameplate, uniform, or other apparent means to distinguish them from other personnel. 5. Clinical experience shall occur only in association with an Advanced Life Support ambulance service which demonstrates medical accountability and employs preceptors who meet the training entity requirements. Each training entity shall approve or disapprove services to be used as clinic experience sites. 6. The EMS Bureau shall establish minimum standards for clinical experiences in accordance with current clinical recommendations of the national standard curriculum for EMT-P training. 7. All EMT-I students shall be currently licensed as an EMTB. 8. All EMT-P students shall be currently licensed as an EMT-B or an EMT-I. (I) Examination Requirements. 1. Each EMT-P training entity shall ensure that graduating students meet entry level competence through the use of a final written and practical examination administered by that training entity. 2. Exam scores for all students shall be maintained and be made available for review by the EMS Bureau staff. 3. The EMS Bureau shall review the first attempt computer adaptive test examinations results (pass rates) from each EMT-P training entity. The computer adaptive test licensure examination pass rate for first attempt candidates from each EMT-P training entity shall be no less than the national pass rate, as documented by the National Registry of EMTs for each calendar year. The EMT-P training entity with a pass rate below the national pass rate shall: A. First year—provide the EMS Bureau with a report analyzing all aspects of the education program and identifying areas contributing to the unacceptable pass rate and a plan of action to resolve low pass rates; B. Second consecutive year—the program manager shall be required to appear before and present to the EMS Bureau an analysis of measures taken the first year, problems identified, and plan of correction; and C. The training entity must appear before the EMS Bureau and provide the information outlined in (2)(I)3.B. until they have two (2) consecutive years of pass rates on the first attempt at the national pass rate. (J) Training entities accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) and/or the Committee on Accreditation for EMS Professions (CoAEMSP) shall be considered to be compliant with the rules for training entities that conduct EMT-Paramedic programs. CAAHEP and/or CoAEMSP accredited programs shall attach to their application evidence of accreditation. The EMS Bureau may conduct periodic site reviews as necessary to verify compliance. (K) An EMT-P primary instructor must be present in at least eighty percent (80%) of all class sessions to ensure program continuity and to be able to identify that the students have cognitive, affective, and psychomotor skills necessary to function as an EMT-P. This primary instructor shall have attended a workshop that reviews the format, philosophy, and skills of the curriculum. (L) Minimum EMT-P course requirements: one thousand (1,000) hours of instruction to include: 1. Two hundred fifty (250) hours of clinical experience in a clinical setting with a Missouri licensed ambulance service; 2. Five hundred (500) hours of classroom/practical lab; 3. Two hundred fifty (250) hours of clinical hours in a health care facility; and 4. Clinical skills as outlined in the most current EMT-P National Standard Curriculum and the National Scope of Practice for EMT-P shall be the established minimums. The EMT-P National Standard Curriculum is incorporated by reference in this rule as published in 1998 and the refresher course in 2001 by the U.S. Department of Transportation and is available at the U.S. Department of Transportation, Office of Emergency Medical Services, West Building W44-314, 1200 New Jersey Ave. SE, NTI 140, Washington, DC 20590. This rule does not incorporate any subsequent amendments or additions. The National Scope of Practice is also incorporated by reference in this rule as SENIOR SERVICES published by the U.S. Department of Transportation in 2007 and is available at the U.S. Department of Transportation, Office of Emergency Medical Services, West Building W44-314, 1200 New Jersey Ave. SE, NTI 140, Washington, DC 20590. This rule does not incorporate any subsequent amendments or additions. (M) Minimum EMT-I course requirements: three hundred (300) hours of instruction to include: 1. Seventy-five (75) hours of clinical experience in a clinical setting with a Missouri licensed ambulance service; 2. One hundred seventy-five (175) hours of classroom/ practical lab; 3. Fifty (50) hours of clinical hours in a health care facility; and 4. Clinical skills as outlined in the most current EMT-I National Standard Curriculum and the National Scope of Practice for EMT-I shall be the established minimums. The EMT-I National Standard Curriculum is incorporated by reference in this rule as published in 1999 and the refresher course in 2001 by the U.S. Department of Transportation and is available at the U.S. Department of Transportation, Office of Emergency Medical Services, West Building W44-314, 1200 New Jersey Ave. SE, NTI 140, Washington, DC 20590. This rule does not incorporate any subsequent amendments or additions. The National Scope of Practice is also incorporated by reference in this rule as published by the U.S. Department of Transportation in 2007 and is available at the U.S. Department of Transportation, Office of Emergency Medical Services, West Building W44-314, 1200 New Jersey Ave. SE, NTI 140, Washington, DC 20590. This rule does not incorporate any subsequent amendments or additions. (N) United States Armed Forces Including National Guard and Reserves Option for EMT-I and EMT-P course requirements. 1. An EMT-B licensee that was issued a license by the EMS Bureau pursuant to 19 CSR 30-40.342(2)(A) and section (3) indicating the licensee is a current or past member of the United States Armed Forces including National Guard and Reserves and has met the EMS Bureau’s requirements for this license may present this license to a training entity certified by the EMS Bureau within two (2) years of the date of their honorable discharge if the licensee is a past member of the United States Armed Forces including National Guard and Reserves or at any time that the licensee is a current member of the United States Armed Forces including National Guard and Reserves. 2. The EMT-B licensee may request the training entity for the EMT-P or EMT-I programs evaluate their military training for advanced placement credit to determine which competencies have been met through their military training. The training entity shall allow the EMT-B licensee’s military training to be assessed for competencies through advanced placement if the EMT-B licensee presents an EMT-B United States Armed Forces license from the EMS Bureau indicating the licensee is a current or past member of the United States Armed Forces including National Guard and Reserves and has met the requirements in 19 CSR 30-40.342(2)(A) and section (3). Advanced placement is any process where a program formally recognizes prior learning of a student and applies that recognition toward meeting the program requirements. Advanced placement shall be applied on a case-by-case basis and allows a student to “place out” of specified program didactic, laboratory, clinical, or field requirements. This may shorten the time for completion of the program and is often thought of as an alternative pathway to program completion and eligibility for the National Registry of Emergency Medical Technicians or state examination at the paramedic level. The EMT-P and EMT-I training entities shall use the minimum training requirements for the appropriate licensure level in subsection (2)(L) above for the EMT-P program and subsection (2)(M) above for the EMT-I program to determine what the EMT-B licensee will place out of following the advanced placement review of the EMT-B licensee’s military training. The EMT-B licensee shall complete all of the minimum training requirements for the appropriate licensure level in subsection (2)(L) above for the EMT-P program and subsection (2)(M) above for the EMT-I program that the EMT-B licensee is not awarded credit for through the advanced placement assessment of the EMT-B licensee’s military training. (3) Specific Requirements for EMS Training Entities Offering Initial EMT-B Courses. (A) Only EMS training entities certified by the EMS Bureau to conduct initial EMT-B courses shall offer EMT-B courses. (B) EMS training entities offering initial EMT-B courses shall also be certified to conduct first responder, emergency medical dispatcher, and EMS continuing education programs. If the training entity conducts these programs, the training entity shall also be responsible for ensuring compliance with the rules set forth for those programs. (C) Each EMT-B training program shall have a designated program director. Each EMT-B course shall have a designated primary instructor. (D) Each EMT-B training program shall demonstrate and document that the EMT-B courses taught under its authority meet or exceed the requirements of the national standard curriculum for EMT-B training, except for endotracheal intubation which shall not be taught. (E) Clinical Requirements. 1. Each EMS training entity that provides EMT-B programs shall document and demonstrate a supervised clinical experience for all students. 2. Clinical affiliations shall be established and confirmed in current written affiliation agreements with institutions and agencies that provide clinical experience under appropriate medical direction and clinical supervision. Clinical supervision shall be conducted by a preceptor. 3. Students shall be assigned in clinical settings where experiences are clinically and educationally effective in achieving the program’s objectives. 4. When participating in clinicals, students shall be clearly identified by name and student status using nameplate, uniform, or other apparent means to distinguish them from other personnel. 5. The EMS Bureau shall establish minimum standards for clinical experiences in accordance with current clinical recommendations of the current national standard curriculum for EMT-B training. (F) Examination Requirements. 1. Each EMT-B training entity shall ensure that graduating students meet entry level competence through the use of a final written and practical examination administered by that training entity. The practical examination shall include all skills designated in the National Standard Curriculum, except endotracheal intubation. 2. Exam scores and practical examination forms for all students shall be maintained and be made available for review by the EMS Bureau staff. 3. The EMS Bureau shall review the first attempt computer adaptive test examinations results (pass rates) from each EMT-B training entity. The computer adaptive test licensure examination pass rate for first attempt candidates from each EMT-B training entity shall be no less than the national pass rate, as documented by the National Registry of EMTs for each calendar year. The EMT-B training entity with a pass rate below the national pass rate shall: A. First year—provide the EMS Bureau with a report analyzing all aspects of the education program and identifying areas contributing to the unacceptable pass rate and a plan of action to resolve low pass rates; B. Second consecutive year—the program manager shall be required to appear before and present to the EMS Bureau an analysis of measures taken the first year, problems identified, and plan of correction; and C. The training entity must appear before the EMS Bureau to provide the information outlined in (3)(F)3.B. until they have two (2) consecutive years of pass rates on the first attempt at the national pass rate. (G) An EMT-B primary instructor must be present in at least eighty percent (80%) of all class sessions to ensure program continuity and to be able to identify that the students have cognitive, affective, and psychomotor skills necessary to function as an EMT-B. The primary instructor is responsible for the teaching of a specific lesson of the EMT-B course. The primary instructor shall have attended a workshop that reviews the format, philosophy, and skills of the new curriculum. The course shall use the following minimums: 1. Minimum of one hundred ten (110) hours of instruction; and 2. Minimum of five (5) patient contacts in a clinical setting. (4) Specific Requirements for EMS Training Entities Offering EMS Continuing Education for EMT-B and EMT-P. (A) EMT-P continuing education training entities shall be certified to conduct EMT-P, EMT-I, and EMT-B continuing education. Continuing education training entities shall not conduct refresher courses, National Registry bridge programs, or remedial education. EMT-B continuing education training entities shall be certified to conduct only EMT-B continuing education courses. (B) Each EMS continuing education training entity shall have a designated program director. (C) In order for EMS training entities to assign continuing education unit credit for a program, the topic must be related to the appropriate national standard curriculum. Improper assignment of continuing education units may be grounds for action upon the training entity accreditation. (D) EMS training entities that provide continuing education shall assign continuing education units according to the formula of fifty (50) minutes training time equals one (1) continuing education unit. (E) When possible, programs shall be awarded continuing education units according to recommendations of the National Registry of EMTs or the Continuing Education Co-ordinating Board for Emergency Medical Services (CECBEMS). (F) EMS training entities that provide continuing education may assign continuing education units for instruction of EMS programs according to the formula of fifty (50) minutes training time equals one (1) continuing education unit for programs taught at the provider’s level of licensure or higher. (G) Accreditation of continuing education by appropriate recognized national accrediting bodies and other state EMS agencies shall constitute approval under the EMS Bureau rules. (5) Specific Requirements for EMS Training Entities Offering Emergency Medical Dispatcher Training. (A) Each training entity offering emergency medical dispatcher training shall demonstrate and document that the emergency medical dispatcher courses taught under its authority meet or exceed the standards set forth by the National Academy of Emergency Medical Dispatch. (B) Each training entity shall comply with subsections (1)(A) and (1)(B). (C) Each training entity shall ensure that graduating students meet entry level competence through the use of a final written examination administered by that training entity. (6) Specific Requirements for EMS Training Entities Offering First Responder Training. (A) Each training entity offering first responder training shall demonstrate and document that the first responder courses taught under its authority meet or exceed the requirements of a national standard curriculum for first responder training. (B) Each training entity shall comply with subsections (1)(A) and (1)(B). (C) Each training entity shall ensure that graduating students meet entry level competence through the use of a final written and practical examination administered by that training entity. The first responder in Missouri shall be taught and permitted to perform all skills including spinal motion restriction in the current First Responder National Standard Curriculum and the National Scope of Practice for First Responder shall be the established minimums. First Responder National Standard Curriculum is incorporated by reference in this rule as published in 1995 and the refresher course in 1996 by the U.S. Department of Transportation and is available at the U.S. Department of Transportation, Office of Emergency Medical Services, West Building W44-314, 1200 New Jersey Ave. SE, NTI 140, Washington, DC 20590. This rule does not incorporate any subsequent amendments or additions. The National Scope of Practice is also incorporated by reference in this rule as published by the U.S. Department of Transportation in 2007 and is available at the U.S. Department of Transportation, Office of Emergency Medical Services, West Building W44-314, 1200 New Jersey Ave. SE, NTI 140, Washington, DC 20590. This rule does not incorporate any subsequent amendments or additions. (7) EMT-B, EMT-I, and EMT-P Core Continuing Education Requirements. (A) EMS training entities may offer EMT-B and/or EMT-P core continuing education programs by offering a standalone program, by attending appropriate sessions of an initial training program, or through a continuing education format. (B) EMT-B and/or EMT-P core continuing education programs shall include a final or modular written evaluation and, if applicable, a practical evaluation. (C) Continuing education training entities must have a current copy of the most recent statutes and regulations of the state of Missouri that pertain to EMS which can be obtained from the EMS Bureau. These copies shall be available at all times for reference by the student and/or the training entity. (8) Primary Instructor Qualifications. (A) The EMS Bureau may authorize as primary instructors for EMS training programs those who can document the following: 1. EMT-B Instructor: A. Current Missouri licensure, National Registry, or other state license or certification as a paramedic and at least two (2) years clinical experience as an EMT-P, EMT-B, or licensure as a registered nurse or physician with at least two (2) years clinical experience; B. Successful completion of an instructor-training program that meets or exceeds the United States Department SENIOR SERVICES of Transportation EMS Instructor Curriculum which is incorporated by reference in this rule as published in 2002 by the U.S. Department of Transportation and is available at the U.S. Department of Transportation, Office of Emergency Medical Services, West Building W44-314, 1200 New Jersey Ave. SE, NTI 140, Washington, DC 20590. This rule does not incorporate any subsequent amendments or additions; C. EMS instructional experience, which meets the following: (I) Documentation of instructor status as an Advanced Cardiac Life Support, Basic Cardiac Life Support, International Trauma Life Support, or Pre-Hospital Trauma Life Support. Advanced Cardiac Life Support is incorporated by reference in this rule as published by the American Heart Association in 2005 and is available at the American Heart Association, 7272 Green-ville Avenue, Dallas, TX 75231. This rule does not incorporate any subsequent amendments or additions. International Trauma Life Support is incorporated by reference in this rule as published by ITLS International in 2007 and is available at ITLS International, 1 S. 280 Summit Ave., Court B-2, Oakbrook Terrace, IL 60181. This rule does not incorporate any subsequent amendments or additions. Pre-Hospital Trauma Life Support is incorporated by reference in this rule as published by the National Association of EMTs in 2006 and is available at the National Association of EMTs, PO Box 1400, Clinton, MS 39060-1400. This rule does not incorporate any subsequent amendments or additions; or (II) Experience as a laboratory or guest instructor with an EMS training entity; D. Continuing education in instructional topics of at least twenty (20) hours in total over the past five (5) years; and E. Competent in adult education theory and clinical skills consistent with the current EMT-B National Standard Curriculum which is incorporated by reference in this rule as published in 1994 by the U.S. Department of Transportation and is available at the U.S. Department of Transportation, Office of Emergency Medical Services, West Building W44-314, 1200 New Jersey Ave. SE, NTI 140, Washington, DC 20590. This rule does not incorporate any subsequent amendments or additions; 2. EMT-P and EMT-I Instructor: A. Current Missouri licensure, National Registry, or other state license or certification as a paramedic and at least two (2) years clinical experience as an EMT-P, or licensure as a registered nurse or physician with at least two (2) years clinical experience; B. Successful completion of an instructor training program that meets or exceeds the United States Department of Transportation EMS Instructor Curriculum. The United States Department of Transportation EMS Instructor Curriculum is incorporated by reference in this rule as published in 2002 and is available at the U.S. Department of Transportation, Office of Emergency Medical Services, West Building W44-314, 1200 New Jersey Ave. SE, NTI 140, Washington, DC 20590. This rule does not incorporate any subsequent amendments or additions; C. EMS instructional experience, which meets the following: (I) Documentation of instructor experience in Advanced Cardiac Life Support, International Trauma Life Support, PreHospital Trauma Life Support, Pediatric Advanced Life Support, or Pediatric Education for Pre-Hospital Professionals (PEPP). Advanced Cardiac Life Support (ACLS) is incorporated by reference in this rule as published by the American Heart Association in 2005 and is available at the American Heart Association, 7272 Green-ville Avenue, Dallas, TX 75231. This rule does not incorporate any subsequent amendments or additions. International Trauma Life Support (ITLS) is incorporated by reference in this rule as published by ITLS International in 2007 and is available at ITLS International, 1 S. 280 Summit Avenue, Court B-2, Oakbrook Terrace, IL 60181. This rule does not incorporate any subsequent amendments or additions. Pre-Hospital Trauma Life Support (PHTLS) is incorporated by reference in this rule as published by the National Association of Emergency Medical Technicians in 2006 and is available at the National Association of Emergency Medical Technicians, PO Box 1400, Clinton, MS 39060-1400. This rule does not incorporate any subsequent amendments or additions. Pediatric Advanced Life Support (PALS) is incorporated by reference in this rule as published by the American Heart Association in 2005 and is available at the American Heart Association, 7272 Green-ville Avenue, Dallas, TX 75231. This rule does not incorporate any subsequent amendments or additions. PEPP is incorporated by reference in this rule as published by the American Academy of Pediatrics in 2006 and is available at the American Academy of Pediatrics, 141 Northwest Point Blvd., Elk Grove Village, IL 60007. This rule does not incorporate any subsequent amendments or additions; and (II) Experience as a laboratory or guest lecturer; D. Continuing education in instructional topics of at least twenty (20) hours over the past five (5) years; E. Competent in adult education theory and clinical skills consistent with the most current EMT-P National Standard Curriculum and the National Scope of Practice for EMT-P shall be the established minimums. The EMT-P National Standard Curriculum is incorporated by reference in this rule as published in 1998 and the refresher course in 2001 by the U.S. Department of Transportation and is available at the U.S. Department of Transportation, Office of Emergency Medical Services, West Building W44-314, 1200 New Jersey Ave. SE, NTI 140, Washington, DC 20590. This rule does not incorporate any subsequent amendments or additions. The National Scope of Practice is also incorporated by reference in this rule as published by the U.S. Department of Transportation in 2007 and is available at the U.S. Department of Transportation, Office of Emergency Medical Services, West Building W44-314, 1200 New Jersey Ave. SE, NTI 140, Washington, DC 20590. This rule does not incorporate any subsequent amendments or additions; and F. As of July 1, 2012, all newly employed primary instructors of initial EMT-P training entities shall possess a minimum of sixty (60) credit hours from an accredited post secondary educational institution; 3. First Responder Instructor: A. The primary instructor must be a first responder, licensed EMT-B, EMT-I, EMT-P, registered nurse, or physician; B. The primary instructor must be knowledgeable in all aspects of out-of-hospital emergency medical care, in the techniques and methods of adult education, and in managing resources and personnel; C. The primary instructor shall have attended and successfully completed a program in EMS instruction methodology; D. The primary instructor must be present in at least eighty percent (80%) of all class sessions to ensure program continuity and to be able to identify that the students have cognitive, affective, and psychomotor skills necessary to function as a first responder. The primary instructor is responsible for the teaching of a specific lesson of the first responder course. The primary instructor shall have attended a workshop that reviews the format, philosophy, and skills of the new curriculum. (9) Initial licensure examination for EMT-B, EMT-Intermediate, and EMT-Paramedic. (A) The EMS Bureau shall use the National Registry of EMTs examination process as the basis for initial licensure examinations for all levels of EMTs. The EMT-Basic exam conducted in Missouri is considered “the state approved practical examination” by the National Registry of Emergency Medical Technicians. It shall serve as the state of Missouri’s examination used for National Registry of EMT’s certification as an EMT-Basic. 1. Any student of an accredited Missouri EMT-Basic program shall complete the EMT-B practical examination in Missouri. 2. If a student from a Missouri accredited EMT-B program attempts a state approved exam outside the state of Missouri, that student shall complete all practical testing in that state and shall be ineligible from completing the Missouri EMT-B practical examination. 3. EMT-I and EMT-P candidates shall complete the National Registry of EMTs practical exam in Missouri or at an approved National Registry of EMTs’ Advanced Level exam site in another state. (B) The EMS Bureau shall select providers of the practical licensure examination in the state of Missouri. The providers shall, with the EMS Bureau approval, operate all test sites and dates in accordance with the policies and procedures of the National Registry of EMTs and the EMS Bureau. 1. The EMS Bureau shall have oversight and review authority of all EMT-B, EMT-I, and EMT-P practical and written examinations administered in the state of Missouri used to obtain licensure. 2. Out-of-state applicants for EMT-B practical testing shall have their practical skills reviewed by a Missouri accredited EMT-B or EMT-P training entity. The training entity shall provide documentation to the EMS Bureau that verifies that the student is competent in all the skills listed in the National Standard Curriculum for EMT-B, except endotracheal intubation. The EMT-B National Standard Curriculum is incorporated by reference in this rule as published in 1994 by the U.S. Department of Transportation and is available at the U.S. Department of Transportation, Office of Emergency Medical Services, West Building W44-314, 1200 New Jersey Ave. SE, NTI 140, Washington, DC 20590. This rule does not incorporate any subsequent amendments or additions. SENIOR SERVICES AUTHORITY: sections 190.131 and 190.185, RSMo Supp. 2013.* Emergency rule filed Aug. 28, 1998, effective Sept. 7, 1998, expired March 5, 1999. Original rule filed Sept. 1, 1998, effective Feb. 28, 1999. Amended: Filed May 19, 2008, effective Jan. 30, 2009. Amended: Filed March 11, 2016, effective Oct. 30, 2016. ** *Original authority: 190.131, RSMo 1998, amended 2002 and 190.185, RSMo 1973, amended 1989, 1993, 1995, 1998, 2002. **Pursuant to Executive Orders 20-04 and 20-10, 19 CSR 30-40.331, subsections (1)(A) and (1)(B) was suspended from April 29, 2020 through June 15, 2020. Pursuant to Executive Order 21-07, 19 CSR 3040.331, paragraphs (2)(L)1. and (2)(L)3. was suspended from August 6, 2020 through August 31, 2021.