System Tracking of Individual CEUS s1

Name: License Number:

This document is not required but is an optional tool to assist in tracking flexible training hours for EMT Basic standard renewal. Continuing education is a personal responsibility. You should evaluate your skills and knowledge to determine areas of weakness and plan educational opportunities in your scope of practice to improve your individual competence.

To be eligible for recertification as an EMT Intermediate Technician/AEMT, you must meet all of the following eligibility and training requirements as specified in DHS 110.07:  Complete a 42-hour EMT Intermediate Technician/AEMT refresher training between July 1, 2014, and June 30, 2016. Renewal education can be completed in the following format: a. Complete a 42-hour traditional refresher course at a Wisconsin-approved EMS Training Center. b. Complete a 30-hour traditional Basic refresher course at a Wisconsin-approved EMS Training Center AND a 12-hour EMT Intermediate Technician/AEMT refresher training at a Wisconsin-approved EMS Training Center. c. Complete an alternative flexible refresher which includes 24-hours of Basic flexible content, a six-hour mini refresher at a Wisconsin-approved EMS Training Center AND 12-hours of medical director-approved EMT Intermediate Technician/AEMT refresher based on curriculum. (The refresher must be approved by the medical director of the service where you are credentialed.)

Note: You can use portions of each described above in items a., or b. provided the full 42 hours have been met. Example: You could take a formal 30-hour traditional Basic refresher and 12 hours of medical director-approved flexible content based on the EMT Intermediate Technician/AEMT curriculum.

d. Complete an initial EMT-intermediate technician course or the didactic portion of the initial EMT-intermediate or initial EMT-Paramedic course. e. Complete the NREMT assessment examinations for this level.  Hold current CPR at the professional level by an organization specified in DHS 110.17(1).  Complete the 2016-2018 License Renewal application process by June 30, 2016.

If you have an arrest or conviction record, please include this information on your renewal application. Intermediate Technician Date of Completion Hours Topic/Course Name – CPR may not be included in any category July 1 2014 – June 30, 2016 Intermediate Technician level pharmacology 2.0

Intermediate Technician level patient assessment 2.0

IV access and medication administration 2.0

Intermediate Technician level flexible content 6.0

TOTAL 12.0

EMT-Intermediate Technician Training Record Page 1 EMT-Basic Date of Completion Hours Topic/Course Name – CPR may not be included in any category July 1 2014 – June 30, 2016 Basic level adult medical assessment and treatment 4.0

Basic level adult trauma assessment and treatment 4.0

Basic level airway – basic and advanced 2.0

Basic level pediatric medical assessment/treatment 2.0

Basic level pediatric trauma assessment/treatment 2.0

Basic level OB 1.0

Operations 2.0

WMD/Preparedness 2.0

Basic level flexible content 5.0

6-hour Basic Flexible Refresher at approved training center 6.0

TOTAL 30.0 Flexible education and training may be obtained through any format. It is highly suggested that education and training be obtained through any of the following: . Courses approved by the Continuing Education Coordinating Board for Emergency Medical Services (CECBEMS) . Conferences sponsored by recognized Wisconsin organizations or hospitals . In-house training approved by the EMS service medical director . You must have formal documentation verifying attendance and course completion . You must retain proof of attendance and course completion for at least 5 years. Providers are randomly audited, if selected; you are required to submit proof of education and training completion. Failure to provide proof of compliance with the requirements for renewal may result in the issuance of a conditional certificate or license, a reprimand, or the suspension or revocation of your certificate or license under Wis. Admin. Code § DHS 110.54 (12). I certify that I have completed all the above continuing education hours and that I have maintained documentation, as required. I agree to submit proof of attendance immediately upon request. ______Signature Date

EMT-Intermediate Technician Training Record Page 2