Office of the Medical Director Version 5.3 CREDENTIALING MANUAL This manual is designed to guide you in the process of receiving medical director credentialing in the Wichita/Sedgwick County EMS System.
Contents Introduction... 4 Purpose of Credentialing... 4 Levels of Credentialing... 4 LEO... 4 EMR... 4 EMT... 5 AEMT... 5 Paramedic... 5 OMD... 5 Non-Credentialed Providers... 6 Local Scopes of Practice... 7 General Expectations of Credentialing... 9 Length of Credentialing Validity... 9 Clinical Investigation and Suspension of Credential... 10 Expiration of Credentials... 10 Validation of NREMT Skills... 10 Credentialing Process... 11 Requirements for Credentialing by Level... 11 Skills Verification... 11 Written Examination... 12 Integration Assessment... 12 Interview with the Medical Director... 13 New Graduates... 13 Sequence of Credentialing Requirements... 14 Attempts at Credentialing Requirements... 15 LEO Credentialing... 17 Psychomotor Skills Verification... 17 Clinical Knowledge Exam... 17 EMR Credentialing... 18 Psychomotor Skills Verification... 18 Written Exam... 18 1
Training and Validation of System Level Changes... 18 EMT Credentialing... 19 Psychomotor Skills Verification... 19 Written Exam... 19 Training and Validation of System Level Changes... 19 AEMT Credentialing... 20 Psychomotor Skills Verification... 20 Written Exam... 20 Training and Validation of System Level Changes... 20 Paramedic Credentialing... 21 Psychomotor Skills Verification... 21 Written Exam... 21 Integrative Assessment... 21 Training and Validation of System Level Changes... 22 Meeting with the Medical Director... 22 Appendix A Psychomotor Skills Check Sheets... 23 12-Lead... 24 Application of Cardiac Electrodes... 25 Aspirin... 26 Auto-Injector Administration... 27 AED... 28 Radio Reporting... 29 Blood Glucose Monitoring... 30 BVM with ETT or Supraglottic Airway... 31 Capnography... 32 Chest Decompression... 33 CPAP... 34 Cricothyrotomy... 35 ECG Interpretation... 36 Electrical Therapy (monitor usage)... 37 ET Tube & ET Suctioning... 38 FBAO & BVM... 39 2
Hemorrhage Control... 40 Vacuum Splint... 41 LUCAS... 42 Medication Administration Buccal... 43 Medication Administration Metered Dose Inhaler... 44 Medication Administration Oral... 45 Medication Administration Sublingual... 46 Medication Administration (Nebulized Bronchodilator)... 47 Medication Administration... 48 Oxygen Therapy NRB... 49 Pit Crew Resuscitation... 50 Pulse Oximeter... 51 Suction of the Upper Airway... 52 Supraglottic Airway... 53 Tourniquet Application... 54 Appendix B Integrated Scenario Check Sheet... 55 Appendix C LEO Psychomotor Skills Check Sheets... 56 HYFIN Chest Seal... 57 Tourniquet (Leg) Check Sheet... 58 Tourniquet (Arm) Check Sheet... 59 Hemostatic Agent Check Sheet... 60 3
Introduction Purpose of Credentialing Credentialing is a component of our system that is designed to ensure a number of outcomes: 1. Credentialing demonstrates that providers are maintaining at least minimal competency in the knowledge, skills, and abilities relevant to their clinical role in the Wichita/Sedgwick County EMS system. 2. Credentialing ensures that providers within the system are connecting both their initial and continuing education learning with their job performance. 3. Credentialing is part of our assurance to the Medical Society of Sedgwick County and the public that providers have met a system-defined minimum acceptable level of competence. 4. Credentialing assigns a local scope of practice to be utilized during care in the out-of-hospital setting. Local scope of practice shall not exceed state certification level, but may be narrower than the state certification level. Credentialing is the process by which providers establish an oversight relationship with the Medical Director, are assigned a local scope of practice, and allows the Office of the Medical Director to attest to clinical competency of individual providers. An individual s credentialing level is dependent on the combined factors of: state certification level, additional training, and clinical role within the system. Specifically, providers do not have to credential at the highest level that their state certification allows (i.e. - a paramedic can choose to credential at the EMT level if it better suits their role in the system.) Credentialing is an ongoing process. Credentialing of field providers is performed on a two year cycle. The credentialing process will continue to evolve as the system does to remain aligned with current clinical practice, provider scope of practice, and system and community needs and priorities. Levels of Credentialing There are currently six credentialing levels within the Wichita/Sedgwick County EMS System. The allowed local scope of practice for each level is listed in this section. Providers are encouraged to credential at a level that most closely matches their routine clinical practice, which may or may not be the same as their state certification level. LEO The LEO (Law Enforcement Officer) level of credentialing is designed law enforcement personnel. LEO is designed for the typical officer who may need to provide basic trauma care or basic life support. EMR The EMR (Emergency Medical Responder) level of credentialing is designed for prehospital providers who deliver basic life support such as splinting and oxygen administration. Credentialing at the EMR level provides evidence that the Office of the Medical Director has validated the provider s clinical knowledge and skills for the EMR scope of practice. 4
EMT The EMT (Emergency Medical Technician) level of credentialing is designed for prehospital providers who provide basic life support, a limited range of medication administration, and certain components of airway management such as BVM, basic airway adjuncts, and supraglottic airways. The minimum state certificate level for this credentialing level is EMT. AEMT The AEMT (Advanced Emergency Medical Technician) level of credentialing is designed for intermediate level providers to allow them to provide basic life support as well as certain advanced life support functions such as intravenous access, defibrillation, and an expanded list of medications approved for administration. The minimum state certificate level for this credentialing level is AEMT. Paramedic The Paramedic level of credentialing is designed for advanced level providers who deliver advanced life support within the system. ALS providers are granted permissions for a more extensive list of medications, intravenous access, electrical cardiac therapy, and advanced airway management such as endotracheal intubation. The minimum state certificate level for this level of credentialing level is Paramedic. OMD The OMD (Office of the Medical Director) level of credentialing is reserved for those individuals working within the Office of the Medical Director who have proprietary knowledge of the credentialing process, examinations, simulation scenarios, and results and thus are not able to be evaluated through the normal credentialing process. These individuals are evaluated directly by the Medical Director and are assigned an individual scope of practice and role within the system. The minimum state certificate level for this credentialing level is Paramedic. The requirements of each credentialing level are described in detail later in this document. 5
Non-Credentialed Providers Providers who do not credential within the EMSS are not assigned to a local scope of practice and are not endorsed by the Medical Director. As such, they are not permitted to practice beyond the level of an Emergency Medical Responder as defined by the Kansas State Board of EMS. Providers who intend to deliver care within the state defined EMR scope are encouraged to credential as an EMR within the system. As a credentialed EMR, the provider has the support and endorsement of the Medical Director. The Office of the Medical Director can attest to the competency of credentialed providers if their knowledge or skills are ever questioned, however this is not possible for noncredentialed providers. If an issue of liability were to occur, the OMD will not provide backing for individuals who have not credentialed, being that the OMD has no knowledge of their skills, knowledge, or abilities. 6
Local Scopes of Practice The local scopes of practice according to credentialing level are as listed in the table below: Skill Airway LEO EMR EMT AEMT Paramedic OMD Bag-Valve-Mask One Rescuer Yes Yes Yes Yes Yes Yes Bag-Valve-Mask Two Rescuer Yes Yes Yes Yes Yes Yes FBAO All Sequences Yes Yes Yes Yes Yes Yes Head-Tilt Chin Lift Yes Yes Yes Yes Yes Yes Modified Jaw Thrust Yes Yes Yes Yes Yes Yes Suctioning Oropharyngeal Yes Yes Yes Yes Yes Yes Nasal Cannula No Yes Yes Yes Yes Yes Nasopharyngeal Airway No Yes Yes Yes Yes Yes Non-Rebreather Mask No Yes Yes Yes Yes Yes Oropharyngeal Airway No Yes Yes Yes Yes Yes Oxygen Administration No Yes Yes Yes Yes Yes Pulse Oximetry No Yes Yes Yes Yes Yes Supraglottic Airway No No Yes Yes Yes Yes FBAO - Magill Forceps No No Yes Yes Yes Yes Intubation Assessment of Tube No No Yes Yes Yes Yes Capnography/Capnometry No No Yes Yes Yes Yes CPAP No No Yes Yes Yes Yes Suctioning Endotracheal No No No No Yes Yes Chest Decompression No No No No Yes Yes Intubation Orotracheal No No No No Yes Yes Cricothyrotomy No No No No No Yes Mechanical Ventilator Monitoring No No No No No Yes Pharmacologically Assisted Intubation (RSI) No No No No No Yes Finger Thoracostomy No No No No No Yes Cardiovascular/Circulation LEO EMR EMT AEMT Paramedic OMD CPR Adult, Child, Infant Yes Yes Yes Yes Yes Yes CCR Adult, Child, Infant Yes Yes Yes Yes Yes Yes CPR Newly Born Yes Yes Yes Yes Yes Yes Defibrillation Automated Yes Yes Yes Yes Yes Yes Pit Crew Resuscitation Process Yes Yes Yes Yes Yes Yes Tourniquet Yes Yes Yes Yes Yes Yes Cardiac Monitor - Limb Lead Acquisition No No Yes Yes Yes Yes Cardiac Monitor 12 Lead Acquisition No No Yes Yes Yes Yes Cardiac Monitor Limb Lead Interp. No No No Yes Yes Yes Defibrillation Manual No No No Yes Yes Yes Cardiac Monitor 12 Lead Interp. No No No No Yes Yes 7
Synchronized Cardioversion No No No No Yes Yes Transcutaneous Pacing No No No No Yes Yes Transvenous Pacing No No No No No Yes Immobilization LEO EMR EMT AEMT Paramedic OMD Application of Collar Yes Yes Yes Yes Yes Yes Long Board Supine Yes Yes Yes Yes Yes Yes Spinal Motion Restriction Protocol Yes Yes Yes Yes Yes Yes Manual/Rigid Splints Yes Yes Yes Yes Yes Yes Manual Stabilization Yes Yes Yes Yes Yes Yes Soft/Vacuum Splints Yes Yes Yes Yes Yes Yes KED No No Yes Yes Yes Yes Traction Splints No No Yes Yes Yes Yes IV Initiation/Maintenance/Fluids LEO EMR EMT AEMT Paramedic OMD Fluid Administration TKO No No No Yes Yes Yes Fluid Administration Bolus No No No Yes Yes Yes Intraosseous Initiation No No No Yes Yes Yes IV Initiation External Jugular No No No Yes Yes Yes IV Initiation Peripheral No No No Yes Yes Yes IV Line Troubleshooting No No No Yes Yes Yes Use of pre-existing central line No No No No Yes Yes Access implanted port No No No No No Yes Med. Administration Routes LEO EMR EMT AEMT Paramedic OMD Auto-Injector Yes Yes Yes Yes Yes Yes Medicated Inhaler No Yes Yes Yes Yes Yes Buccal No No Yes Yes Yes Yes Sub-Lingual No No Yes Yes Yes Yes Aerosolized/Nebulized No No Yes Yes Yes Yes Oral No No Yes Yes Yes Yes Intramuscular (IM) No No No Yes Yes Yes Intravenous (IV) Push/Piggyback No No No Yes Yes Yes Intranasal (IN) No No No Yes Yes Yes Nasogastric No No No Yes Yes Yes Subcutaneous (SQ) No No No Yes Yes Yes Transdermal No No No Yes Yes Yes Two or more vasoactive IV infusion medications No No No No No Yes Miscellaneous LEO EMR EMT AEMT Paramedic OMD Assisted Delivery Yes Yes Yes Yes Yes Yes Blood Glucose Monitoring Yes Yes Yes Yes Yes Yes Eye Irrigation Yes Yes Yes Yes Yes Yes Medication Administration Cross Check Yes Yes Yes Yes Yes Yes Point of Care Testing (istat) No No No No No Yes 8
General Expectations of Credentialing It is the provider s responsibility to display professional work behaviors while engaged in the credentialing process with the Office of the Medical Director. These professional work behaviors include the following: Demonstrates self-motivation, engagement in self-improvement, and accountability Reports on time for all credentialing appointments and evaluations Attends OMD Simulation Center sessions as needed Appropriate dress for credentialing appointments o o Duty uniform as assigned by agency Business casual dress Immediate written communication will be provided to both credentialing candidate and affiliated services when there is a change in credentialing status. If the candidate has successfully passed the credentialing process, a credentialing badge will be issued along with written notification. Providers will need to coordinate with their respective agency and OMD to schedule credentialing appointment dates/times. Attendance at scheduled credentialing appointments should be considered work assignments of the hiring authority of the provider. If a provider is unable to make a scheduled credentialing appointment, OMD and the provider s service should be notified prior to appointment. OMD and individual services will keep each other appraised of attendance/tardiness issues concerning credentialing appointments. Length of Credentialing Validity Credentials are granted by the Medical Director for periods of two years, except when a provider requires three attempts to pass one or more sections of the credentialing process. Subsequent attempt may be allowed if special circumstances exist. The OMD will consider individualized process in collaboration with the service or hiring authority. Additionally, the Medical Director retains the option to deny any credential or issue a credential for a shortened period in unusual circumstances. A candidate may choose to re-credential at any time prior to their expiration. Unless a shortened credential is issued, a renewed credential will expire two years from the month in which the final step of the credentialing process is completed. Examples: 1) If a provider completes the credentialing process in January of 2017, the provider will be issued a credential that expires at the end of January 2019. 9
2) If a provider has a credential that expires in October of 2018, but chooses to complete the credentialing process in February of 2018, the provider will be issued a credential that expires at the end of February 2020. Clinical Investigation and Suspension of Credential In the matter of a substantiated clinical protocol breach, the OMD/Agency staff will immediately contact the agency chief/omd and make them aware of the situation with full disclosure. The agency chief will reconcile the matter through an appropriate investigative process and will remedy the matter based on the investigation. If the result of the investigation reveals a provider has engaged in reckless behavior or repetitive at-risk behavior, that individual s credential may be suspended by the Medical Director. If a provider s credentialing status is suspended, the provider and service administration(s) will both be notified immediately of the change in status. In order to regain credentialed status, a pathway for recredentialing will be determined via cooperation between the individual s agency and OMD. Expiration of Credentials Credentials expire on the last day of the month displayed on the OMD issued credentialing badge. If a provider has not completed all of the requirements for re-credentialing when their badge expires, they are not permitted to provide care beyond the EMR scope until they have successfully completed the process. Providers are encouraged to begin the process sufficiently early to allow completion without allowing their credential to lapse. Validation of NREMT Skills The Medical Director will only validate credentialed providers skills for NREMT recertification. If a provider is not credentialed within the system, the Medical Director will not provide skills validation for NREMT recertification. March 15 th and 31 st of every year will be the only dates that the OMD will access NREMT website to conduct signoffs. Therefore, individuals are encouraged to have all of the required items submitted prior to these dates. 10
Credentialing Process Requirements for Credentialing by Level Each level of credentialing has specific requirements in order to validate competence at that level. A chart outlining the requirements for each level of credentialing is as follows: Credential Level Skills Verification Written Exam Integration Scenario Medical Director Interview LEO Integrated into skills verification EMR EMT AEMT Paramedic Skills Verification The credentialing candidate must demonstrate that he or she is competent performing the skills associated with their credentialing level. It is not logistically feasible to evaluate every skill that EMS providers perform, so a subset of skills for each credentialing level has been selected and will be considered sufficiently representative of competent practice. By demonstrating the skills listed for a given credentialing level, the OMD is confident that: a) The provider is proficient at routine skills expected to be utilized on a frequent basis. b) The provider is competent at high risk, low frequency skills. Direct observation of skills performed as part of actual patient care is the most accurate validation of the skills. However, it is not feasible to expect every provider to be able to demonstrate on live patients every skill within their scope. Simulated skills evaluations in a lab or classroom setting may replace actual field observation of skills. Skills may be verified by: 1) Direct observation by an OMD level credentialed provider during: a. Real-world patient care situations b. Simulation Center training or testing sessions c. Agency based skills verification events 2) Direct observation by an agency designated skills verifier* during: 11
a. Real-world patient care situations b. Agency based skills verification events *Agencies may designate individuals to become Psychomotor Skill Verifiers. These individuals must: 1) Be chosen by their agency and approved by OMD. 3) Maintain their own credentialing status at or above anyone they will be evaluating 4) Meet with the OMD Clinical Practice Manager to discuss the skills verification process and expectations: Skill Verifiers must attend a train the trainer session hosted by OMD, focused on expectations of skill verification, at least once per credentialing cycle. Skill Verifiers must comply with documentation requirements for skill verification as laid forth in OMD train the trainer sessions. 5) Attest that they have not signed off on any skills that were taught on the same day as the evaluation (must have at least one day between learning and testing.) 6) Attest that they have not signed off on any skills for which they were the instructor (You cannot sign off skills for your own students). 7) Field attestation of actual skills witnessed on actual patients are not restricted by above guidelines. Written Examination Providers must demonstrate an entry level competence of current clinical knowledge concerning the practice of medical care and an acceptable working understanding of the medical protocols and how to apply them at their respective credentialing level. OMD will also provide free examinations of clinical and protocol knowledge that have been internally validated for the different credentialing levels within the system. The OMD will provide statistics on the written exams including pass and fail rates as well as line item validation and exam mapping criteria to system partners while maintaining test integrity. Integration Assessment Providers at the AEMT, Paramedic, and SCT level must demonstrate an ability to appropriately integrate their skills, clinical knowledge, and protocol in the context of scenarios. This is completed after successfully passing each of the previous three evaluations and is conducted at the OMD simulation center. This may be done in conjunction with simulator training time as part of continuing education provided by the OMD. 12
Interview with the Medical Director At the Paramedic level of credentialing, the interview with the Medical Director is an opportunity to discuss case studies, medical concepts, system level issues, and any other concerns with the Medical Director. This is a low-stakes conversation that is the final step in the credentialing process for Paramedic providers. Providers, except new-hires, are expected to bring two case studies of calls that they have experienced in the last two years to the interview to discuss. If a provider has completed all the steps leading up the interview, the provider can expect to receive their credentialing badge once they have met all the requirements of credentialing, with the understanding that they must attend their interview with the medical director as scheduled. New Graduates New hires and/or current employees whom have received a paramedic/emt certification from either Hutchinson Community College or Cowley County Community College EMS programs within one year of credentialing date are granted exemption from the skills verification and knowledge testing. These are currently the only two programs that have these exemptions. Other programs that are interested may contact the OMD. 13
Sequence of Credentialing Requirements 14
Skills verification, Clinical Knowledge Exam, and Protocol Familiarity Exam can be completed in any order prior to expiration of credential. Applicants for AEMT, Paramedic, must successfully complete Skills Verification, Clinical Knowledge Exam, and Protocol Exam prior to attempting the Integration Scenario. The Interview with the Medical Director for Paramedic only occurs after all other requirements for credentialing have been successfully completed. Attempts at Credentialing Requirements OMD is primarily a oversight and support office that validates that candidates have completed the requirements for specific credentials. As such, the OMD does not require specific remediation from providers under most circumstances for failed attemtps. That being said, it is highly recommended that individual services engage in the credentialing process of their respective employees and define their own internal stop points for remediation and training within the credentialing process. OMD will provide information to services and providers regarding individual provider attempts, including strengths, areas for improvement, and overall performance. Each credentialing component (knowledge exam, protocol familiarity exam, skills validation, and integration assessment) is allowed a maximum of three attempts. If one or more components are passed, only the failed components require reassessment. (See figure on next page). After one failed attempt at a credentialing component, the provider will be provided feedback and must take their second attempt no more than four weeks after the first failed attempt. The provider may continue to provide patient care while preparing for their second attempt. After the second failed attempt at a credentialing component, the provider will be provided feedback and must take their third attempt no more than six weeks after the second failed attempt. The provider may continue to provide patient care while preparing for their third attempt. At the point that a provider has failed a component three times, the OMD believes that this is a marker of significant deficit, to the point that the provider should not be engaged in unsupervised patient care. The provider s existing credential will be suspended. Additional attempts will be considered if special circumstances exist, OMD will consider an individualized process in collaboration with the service or hiring authority. 15
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LEO Credentialing The LEO credentialing candidate must complete the OMD approved LEO course. Psychomotor Skills Verification The LEO candidate must successfully perform the following skills: Windlass Commercial Tourniquet (Arm) Windlass Commercial Tourniquet (Leg) Chest Seal Hemostatic Agent Detailed check-sheets of criteria for successfully demonstrating these skills can be found in Appendix C Psychomotor Skills Check-sheets. Clinical Knowledge Exam There is no written exam for the LEO course, but the candidate will be tested on their knowledge as part of the skills verification process. 17
EMR Credentialing Psychomotor Skills Verification The skills required to be verified at the EMR level are: Application of cardiac electrodes Aspirin administration AED operation Blood glucose monitoring BVM with ETT or supraglottic airway Hemorrhage control Auto Injector Administration Medication Administration Metered Dose Inhaler Oxygen therapy Pit Crew Resuscitation Pulse Oximetry Suction of the Upper Airway Long bone splinting Detailed check-sheets of criteria for successfully demonstrating these skills can be found in Appendix A Psychomotor Skills Check-sheets. Written Exam The EMR credentialing candidate must pass an internally validated OMD approved written Exam to validate clinical knowledge expected of a practicing entry level EMR. If a credentialing candidate has passed the NREMT written exam within one year of credentialing attempt, that candidate may produce proof of passing the NREMT written exam and will be eligible to take an abbreviated OMD written exam focusing only on protocol knowledge. Training and Validation of System Level Changes Each provider must participate in system level courses delivered by their training staff. 18
EMT Credentialing Psychomotor Skills Verification The skills required to be verified at the EMT level are: 12-Lead ECG Acquisition Capnography FBAO & BVM Auto Injector Administration Medication Administration Buccal route Medication Administration Metered Dose Inhaler Medication Administration Nebulizer Medication Administration Oral Medication Administration Sublingual Pit Crew Resuscitation Supraglottic Airway Tourniquet Application Detailed check-sheets of criteria for successfully demonstrating these skills can be found in Appendix A Psychomotor Skills Check-sheets. Written Exam The EMT credentialing candidate must pass an internally validated OMD approved Written Exam to validate clinical knowledge expected of a practicing entry level EMT. If a credentialing candidate has passed the NREMT written exam within one year of credentialing attempt, that candidate may produce proof of passing the NREMT written exam and will be eligible to take an abbreviated OMD written exam focusing only on protocol knowledge. Training and Validation of System Level Changes Each provider must participate in system level courses delivered by their training staff. 19
AEMT Credentialing Psychomotor Skills Verification The skills required to be verified at the AEMT level are: 12-lead ECG Acquisition Capnography ECG Interpretation Electrical Therapy (monitor usage) FBAO & BVM Auto Injector Administration Medication Administration Albuterol Medication Administration Oral Pit Crew Resuscitation Supraglottic Airway Tourniquet Application Detailed check-sheets of criteria for successfully demonstrating these skills can be found in Appendix A Psychomotor Skills Check-sheets. Written Exam The AEMT credentialing candidate must pass an internally validated OMD approved written Exam to validate clinical knowledge expected of a practicing entry level AEMT. If a credentialing candidate has passed the NREMT written exam within one year of credentialing attempt, that candidate may produce proof of passing the NREMT written exam and will be eligible to take an abbreviated OMD written exam focusing only on protocol knowledge. Training and Validation of System Level Changes Each provider must participate in system level courses delivered by their training staff. 20
Paramedic Credentialing Psychomotor Skills Verification The skills required to be verified at the Paramedic level are: 12-lead ECG Acquisition Capnography Chest Decompression CPAP ECG Interpretation Electrical Therapy (monitor usage) ET Tube & ET Suctioning LUCAS operation Medication Administration Pit Crew Resuscitation Supraglottic Airway Tourniquet Application Detailed check-sheets of criteria for successfully demonstrating these skills can be found in Appendix A Psychomotor Skills Check-sheets. Written Exam The Paramedic credentialing candidate must pass an internally validated OMD approved written Exam to validate clinical knowledge expected of a practicing entry level Paramedic. If a credentialing candidate has passed the NREMT written exam within one year of credentialing attempt, that candidate may produce proof of passing the NREMT written exam and will be eligible to take an abbreviated OMD written exam focusing only on protocol knowledge. Integrative Assessment Paramedic credentialing candidates must successfully pass an integrative simulation scenario in the OMD Simulation Center that is designed to evaluate the candidate's integrative, critical thinking, patient and scene management skills. This assessment will be proctored by OMD staff and will assess the candidate s competence in the following areas: Scene management Patient assessment Patient management Interpersonal relations Integration (verbal report, field impression, and transport decision) A detailed check sheet for the integrative scenario can be found in Appendix B. 21
Training and Validation of System Level Changes Each provider must participate in system level courses delivered by their training staff. Meeting with the Medical Director Once you have successfully passed all of the Paramedic credentialing requirements, you will be invited to meet with the Medical Director. Providers will typically be issued their credentialing badge once they have successfully completed all credentialing requirements. The meeting with the medical director is a requirement for Paramedic credentialing, but issuance of a credentialing badge will not be delayed until this interview occurs because of potential scheduling conflicts. When arriving at the meeting with the medical director, you should be prepared to discuss two complex or interesting cases of your choosing (New-hires are exempt from the case discussion). You are welcome to bring anyone you choose to your meeting with the Medical Director. 22
Appendix A Psychomotor Skills Check Sheets 23
12-Lead 24
Application of Cardiac Electrodes 25
Aspirin 26
Auto-Injector Administration 27
AED 28
Radio Reporting 29
Blood Glucose Monitoring 30
BVM with ETT or Supraglottic Airway 31
Capnography 32
Chest Decompression 33
CPAP 34
Cricothyrotomy 35
ECG Interpretation 36
Electrical Therapy (monitor usage) 37
ET Tube & ET Suctioning 38
FBAO & BVM 39
Hemorrhage Control 40
Vacuum Splint 41
LUCAS 42
Medication Administration Buccal 43
Medication Administration Metered Dose Inhaler 44
Medication Administration Oral 45
Medication Administration Sublingual 46
Medication Administration (Nebulized Bronchodilator) 47
Medication Administration 48
Oxygen Therapy NRB 49
Pit Crew Resuscitation 50
Pulse Oximeter 51
Suction of the Upper Airway 52
Supraglottic Airway 53
Tourniquet Application 54
Appendix B Integrated Scenario Check Sheet 55
Appendix C LEO Psychomotor Skills Check Sheets 56
HYFIN Chest Seal 57
Tourniquet (Leg) Check Sheet 58
Tourniquet (Arm) Check Sheet 59
Hemostatic Agent Check Sheet 60