641—131.4 (147A) Emergency medical care providers—certification, renewal standards, procedures, continuing education, and fees.
	 131.4(1) Student application and candidate examination.
	  a.   	 Applicants shall complete the EMS Student Registration at the beginning of the course. EMS Student Registration shall be completed via the bureau of EMS Web site at www.idph.state.ia.us/ems.
	  b.   	 EMS Student Registration shall be completed within 14 days after the course start date.
	  c.   	 Upon satisfactory completion of the course and all training program requirements, including payment of appropriate fees, the candidate shall be recommended by the training program to take the state-approved certification examinations. A candidate recommended for state certification is not eligible to continue functioning as a student in the clinical and field setting. State certification must be obtained to perform appropriate skills.
	  d.   	 The practical examination shall be administered using the standards and forms provided by the department. The training program shall notify the department at least four weeks prior to the administration of a practical examination.
	  e.   	 Rescinded IAB 8/1/07, effective 9/5/07.
	  f.   	 Candidates eligible to take the state written examination shall submit an EMS Certification Application form to the department. EMS Certification Application forms are provided by the department.
	  g.   	 When a student’s EMS Student Registration or a candidate’s EMS Certification Application is referred to the department for investigation, or when a student or candidate is otherwise under investigation by the department, the individual shall not be eligible for certification, and the practical examination results will not be confirmed with the NREMT, until the individual is approved by the department.
	  h.   	 The written certification examination shall be administered at times and places determined by the department.
	  i.   	 No oral certification examinations shall be permitted; however, candidates may be eligible for appropriate accommodations. The candidate should contact the Iowa Department of Public Health, Bureau of Emergency Medical Services, Lucas State Office Building, Des Moines, Iowa 50319-0075 at least four weeks prior to the test date.
	  j.   	 Certifying examination fees shall be approved by the department.
	  k.   	 The fee for certification as an emergency medical care provider is $30, payable to the Iowa Department of Public Health. This nonrefundable fee shall be paid prior to a candidate’s receiving certification.
	  l.   	 A candidate who fails the practical certification examination shall be required to repeat only those stations that were failed and shall have two additional opportunities to attain a passing score. A candidate failing the practical certification examination on three full attempts must repeat the entire EMS training program to be eligible for certification.
	 (1) 	 An FR or EMT-B candidate will test all practical stations and have three opportunities to pass those stations. The candidate’s first attempt at all stations will constitute the first full attempt. Each retest of failed stations will constitute an additional full attempt.
	 (2) 	 A full attempt for an EMT-I, EMT-P or PS candidate will consist of completing all skills and two retesting opportunities, if eligible. The candidate must provide documentation of remediation before taking a second or third full attempt.
	  m.   	 The practical examination remains valid for a 12-month period from the date it was successfully completed. Required passing practical scores for FR, EMT-B, EMT-I, EMT-P, and PS shall be based on criteria established by the department.
	  n.   	 A candidate who fails to attain the appropriate overall score on the written certification examination shall have two additional opportunities to complete the entire examination and attain a passing score. Required passing written scores for FR, EMT-B, EMT-I, EMT-P, and PS shall be based on criteria established by the department.
	  o.   	 A candidate who fails to pass the written certification examination on the third attempt and who wishes to pursue certification must submit, at a minimum, written verification from an approved training program of successful completion of an appropriate refresher course or equivalent. Candidates failing the examination on six attempts must repeat the entire EMT training program to be eligible for certification.
	  p.   	 All examination attempts shall be completed within two years of the initial course completion date. If an individual is unable to complete the testing within two years due to medical reasons or military obligation, an extension may be granted upon submission of a signed statement from an appropriate medical/military authority and approval by the department.
	  q.   	 Examination scores shall be confidential except that they may be released to the training program that provided the training or to other appropriate state agencies, or released in a manner which does not permit the identification of an individual.
	  r.   	 To be eligible to take the practical examination, FR candidates shall have a current course completion card in CPR.
	  s.   	 Applicants for EMS-I endorsement shall successfully complete an EMS-Instructor curriculum approved by the department.
	  t.   	 Applicants for ERT endorsement shall successfully complete an ERT curriculum approved by the department in cooperation with the department of public safety.
	  u.   	 Payment of all appropriate certification/examination fees shall be made prior to the candidate’s receiving certification.
	 131.4(2) Multiple certificates and renewal.
	  a.   	 The department shall consider the highest level of certification attained to be active. Any lower levels of certification shall be considered idle.
	  b.   	 A lower level certificate may be issued if the individual fails to renew the higher level of certification or voluntarily chooses to move from a higher level to a lower level. To be issued a certificate in these instances, an individual shall:
	 (1) 	 Complete all applicable continuing education requirements for the lower level during the certification period and submit a change of status request, available through the Iowa Department of Public Health, Bureau of EMS, Lucas State Office Building, Des Moines, Iowa 50319-0075, or the bureau of EMS Web site (www.idph.state.ia.us/ems).
	 (2) 	 Complete and submit to the department an EMS Affirmative Renewal of Certification Application and the applicable fee.
	 (3) 	 Complete the reinstatement process in 131.4(3)“f” if renewal of the higher level is requested later.
	  c.   	 A citation and warning, denial, probation, suspension or revocation imposed upon an individual certificate holder by the department shall be considered applicable to all certificates issued to that individual by the department.
	 131.4(3) Renewal of certification.
	  a.   	 A certificate shall be valid for two years from issuance unless specified otherwise on the certificate or unless sooner suspended or revoked.
	  b.   	 All continuing education requirements shall be completed during the certification period prior to the certificate’s expiration date. Failure to complete the continuing education requirements prior to the expiration date shall result in an expired certification.
	  c.   	 The EMS Affirmative Renewal of Certification Application shall be submitted to the department within 90 days prior to the expiration date. Failure to submit a renewal application to the department within 90 days prior to the expiration date (based upon the postmark date) shall cause the current certification to expire.
	  d.   	 Emergency medical care providers shall not function on an expired certification.
	  e.   	 An individual who completes the required continuing education during the certification period, but fails to submit the EMS Affirmative Renewal of Certification Application within 90 days prior to the expiration date, shall be required to submit a late fee of $30 (in addition to the renewal fee) and complete the audit process pursuant to 131.4(4)“i” to obtain renewal of certification.
	  f.   	 An individual who has not completed the required continuing education during the certification period or who is seeking to reinstate an expired, inactive, or retired certificate shall:
	 (1) 	 Complete a refresher course or equivalent approved by the department.
	 (2) 	 Meet all applicable eligibility requirements.
	 (3) 	 Submit an EMS Reinstatement Application and the applicable fees to the department.
	 (4) 	 Pass the appropriate practical and written certification examinations.
	  g.   	 Rescinded IAB 4/7/10, effective 5/12/10.
	  h.   	 An individual may request an inactive or retired status for a certificate. The request must be made by submitting a change of status request, available through the Iowa Department of Public Health, Bureau of EMS, Lucas State Office Building, Des Moines, Iowa 50319-0075, or the bureau of EMS Web site (www.idph.state.ia.us/ems). Reinstatement of an inactive or retired certificate shall be made pursuant to 131.4(3)“f.” A request for inactive or retired status, when accepted in connection with a disciplinary investigation or proceeding, has the same effect as an order of revocation.
	  i.   	 An individual shall be deemed to have complied with the continuing education requirements during periods that the individual serves honorably on active duty in the military services or for periods that the individual is a government employee working as an emergency medical care provider and assigned to duty outside the United States. The individual must submit the Affirmative Renewal Application, all appropriate fees and documentation of assignment.
	 131.4(4) Continuing education renewal standards. To be eligible for renewal through continuing education, the following standards shall apply:
	  a.   	 The applicant shall sign and submit an Affirmative Renewal of Certification Application provided by the department and submit the applicable fee within 90 days prior to the certificate’s expiration date.
	  b.   	 The applicant shall complete the continuing education requirements, including current course completion in CPR, during the certification period for the following EMS provider levels:
	 (1) 	 FR, FR-D—12 hours of approved continuing education.
	 (2) 	 EMT-A, EMT-B, EMT-D—24 hours of approved continuing education.
	 (3) 	 EMT-I—36 hours of approved continuing education.
	 (4) 	 EMT-P—48 hours of approved continuing education.
	 (5) 	 PS—60 hours of approved continuing education.
	 (6) 	 EMS-I—Attend at least one EMS-I workshop sponsored by the department.
	 (7) 	 CCP—8 hours of approved CCP core curriculum topics.
	  c.   	 At least 50 percent of the required hours for renewal shall be formal continuing education including, but not limited to, refresher programs, seminars, lecture programs, scenario-based programs, conferences, and Internet-delivered courses approved by CECBEMS and shall meet the criteria established in paragraph 131.4(6)“d.”
	  d.   	 Up to 50 percent of the required continuing education hours may be made up of any of the following:
	 (1) 	 Nationally recognized EMS-related courses;
	 (2) 	 EMS self-study courses;
	 (3) 	 Medical director or designee case reviews;
	 (4) 	 Clinical rounds with medical team (grand rounds);
	 (5) 	 Rescinded IAB 8/1/07, effective 9/5/07.
	 (6) 	 Working with students as an EMS field preceptor;
	 (7) 	 Hospital or nursing home clinical performance;
	 (8) 	 Skills workshops/maintenance;
	 (9) 	 Community public information education projects;
	 (10) 	 Emergency driver training;
	 (11) 	 EMS course audits;
	 (12) 	 Injury prevention or wellness initiatives;
	 (13) 	 EMS service operations, e.g., management programs, continuous quality improvement;
	 (14) 	 EMS system development meetings to include county, regional and state;
	 (15) 	 Disaster preparedness;
	 (16) 	 Emergency runs/responses as a volunteer member of an authorized EMS service program (primary attendant).
	  e.   	 Additional hours may be allowed for any of the following (maximum):
	 (1) 	 CPR—2 hours;
	 (2) 	 Disaster drill—4 hours;
	 (3) 	 Rescue—4 hours;
	 (4) 	 Hazardous materials—8 hours;
	 (5) 	 Practical examination evaluator—4 hours;
	 (6) 	 Topics outside the provider’s core curriculum—8 hours.
	  f.   	 With training program approval, persons who are not enrolled in an emergency medical care provider course may audit those courses for CEHs.
	  g.   	 Certificate holders must notify the department within 30 days of a change in address.
	  h.   	 The certificate holder shall maintain a file containing documentation of continuing education hours accrued during each certification period for four years from the end of each certification period.
	  i.   	 A group of individual certificate holders will be audited for each certification period. Certificate holders to be audited will be chosen in a random manner or at the discretion of the bureau of EMS. Falsifying reports or failure to comply with the audit request may result in formal disciplinary action. Certificate holders who are audited will be required to submit verification of continuing education compliance within 45 days of the request. If audited, the certificate holders must provide the following information:
	 (1) 	 Date of program.
	 (2) 	 Program sponsor number.
	 (3) 	 Title of program.
	 (4) 	 Number of approved hours.
	 (5) 	 Appropriate supervisor signatures if clinical or practical evaluator hours are claimed.
	  j.   	 Instructors of EMS initial or continuing education courses may use those courses for renewal as approved under subrule 131.4(6).
	 131.4(5) Renewal by testing.
	  a.   	 To be eligible for renewal by testing, candidates shall meet the following standards:
	 (1) 	 Submit a request to renew by testing to the department six months prior to the certificate’s expiration date. Any testing fees will be in addition to renewal fees.
	 (2) 	 Complete a Renewal by Testing Application provided by the department and schedule a test date with an EMS training program.
	 (3) 	 Successfully complete the practical and written examinations.
	  b.   	 Candidates who are unsuccessful by testing may renew under the continuing education standards in subrule 131.4(4); however, renewal must be completed prior to the certificate’s expiration date.
	  c.   	 Candidates who are unsuccessful by testing or who do not complete the continuing education requirements prior to the expiration date shall reinstate an expired certificate pursuant to 131.4(3)“f” if active certification is sought.
	 131.4(6) Continuing education approval. The following standards shall be applied for approval of continuing education:
	  a.   	 Required CEHs identified in 131.4(4)“c” shall be approved by the department, CECBEMS, or an authorized EMS training program, using a sponsor number assignment system approved by the department.
	  b.   	 Optional CEHs identified in 131.4(4)“d” and 131.4(4)“e” require no formal sponsor number; however, CEHs awarded shall be verified by an authorized EMS training program, a national EMS continuing education accreditation entity, a service program medical director, an appropriate community sponsor, or the department. Documentation of CEHs awarded shall include program or event, date and title, number of hours approved, and applicable signatures.
	  c.   	 Courses in physical, social or behavioral sciences offered by accredited colleges and universities are approved for CEHs and need no further approval.
	  d.   	 Courses approved as formal education must meet the following criteria:
	 (1) 	 Involve live interaction with an instructor or be an Internet-delivered course approved by CECBEMS; and
	 (2) 	 Be based on the appropriate department curricula for EMS providers and include one or more of the following topic areas: airway, patient assessment, trauma assessment and management, medical assessment and management, behavioral emergencies, obstetrics, gynecology, pediatrics, or patient care record documentation.
	  e.   	 Programs developed and delivered by the department may be approved for formal education.
	 131.4(7) Out-of-state continuing education. Out-of-state continuing education courses will be accepted for CEHs if they meet the criteria in subrule 131.4(4) and have been approved for emergency medical care personnel in the state in which the courses were held. A copy of course completion certificates (or other verifying documentation) shall, upon request, be submitted to the department with the EMS Affirmative Renewal of Certification Application.
	 131.4(8) Fees. The following fees shall be collected by the department and shall be nonrefundable:
	  a.   	 FR, EMT-B, EMT-I, EMT-P, and PS certification fee—$30.
	  b.   	 Certification renewal fees:
	 (1) 	 FR and EMT-B—no fee.
	 (2) 	 Renewal of EMT-I certification fee—$10.
	 (3) 	 Renewal of EMT-P and PS certification fee—$25.
This fee is refundable if the applicant’s certification renewal status is not posted on the bureau of EMS Web site in the certification database within ten working days from the date the department receives the completed renewal application.
	  c.   	 Endorsement certification fee—$50.
	  d.   	 Reinstatement fee—$30.
	  e.   	 Late fee—$30.
	  f.   	 Rescinded IAB 12/3/08, effective 1/7/09.
	  g.   	 Duplicate/replacement card—$10.
	  h.   	 Returned check—$20.
	  i.   	 Extension fee—$50.
	 131.4(9) Certification through endorsement. An individual currently certified by another state or a registrant of the National Registry of EMTs must also possess a current Iowa certificate to be considered certified in this state. The department shall contact the state of certification or the National Registry of EMTs to verify certification or registry and good standing.
	  a.   	 To receive Iowa certification, the individual shall:
	 (1) 	 Complete and submit the EMS Endorsement Application available from the department.
	 (2) 	 Provide verification of current certification in another state or registration with the National Registry of EMTs.
	 (3) 	 Provide verification of current course completion in CPR.
	 (4) 	 Pass the appropriate Iowa practical and written certification examinations in accordance with subrule 131.4(1) within one year of the department’s approval of the endorsement candidate’s application. Current National Registry endorsement candidates are exempt from testing.
	 (5) 	 Meet all other applicable eligibility requirements necessary for Iowa certification pursuant to these rules.
	 (6) 	 Submit all applicable fees to the department.
	  b.   	 An individual certified through endorsement shall satisfy the renewal and continuing education requirements set forth in subrule 131.4(3) to renew Iowa certification.
	 131.4(10) Temporary certification through endorsement. Upon written request, the endorsement applicant may be issued a temporary FR or EMT-B certification by the department. Temporary certification shall not exceed 12 months per application.
	 131.4(11) National registration in lieu of continuing education.
	  a.   	 An individual who is certified in Iowa and is registered with the NREMT may renew the individual’s certification by meeting the NREMT reregistration requirements.
	  b.   	 The individual shall submit the NREMT Registration in Lieu of Continuing Education Application, available through the Iowa Department of Public Health, Bureau of EMS, Lucas State Office Building, Des Moines, Iowa 50319-0075, or the bureau of EMS Web site (www.idph.state.ia.us/ems), to the department, with proof of NREMT registration exceeding the current certification expiration date, within 90 days prior to the expiration date.
	 131.4(12) Extension of certification.
	  a.   	 If an individual is unable to complete the required continuing education during the certification period due to a medical reason, an extension of certification may be issued upon submission of a signed statement from an appropriate medical provider and approval by the department. The letter must include information concerning the reason the individual could not complete the continuing education requirements, the time period affected, and the length of time requested for extension.
	  b.   	 If an individual is unable to attain all continuing education requirements within the certification period, a 45-day extension may be granted. To complete the extension process, the individual shall:
	 (1) 	 Submit a Request for Extension Application, available through the Iowa Department of Public Health, Bureau of EMS, Lucas State Office Building, Des Moines, Iowa 50319-0075, or the bureau of EMS Web site (www.idph.state.ia.us/ems), at least 7 days prior to the expiration date, but no more than 90 days prior to the expiration date, and a $50 extension fee.
	 (2) 	 Be given 45 days from the current expiration date to complete continuing education requirements.
	 (3) 	 Submit the EMS Affirmative Renewal of Certification Application, with all applicable renewal fees, to the department prior to the extended expiration date (based on the postmark date).
	 (4) 	 Not use continuing education completed during the extension period in the subsequent renewal.
[ARC 8660B, IAB 4/7/10, effective 5/12/10]