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 within 14 days after the beginning of the course. The EMS Student Registration shall be completed via the bureau of EMS Web site at www.idph.state.ia.us/ems.
	  b.   	 Upon satisfactory completion of the course and all training program requirements, including payment of appropriate fees, a candidate shall be recommended by a training program to take the appropriate NREMT certification examination. A candidate is not eligible to continue functioning as a student in the clinical and field settings and must obtain state certification to perform appropriate skills.
	  c.   	 A candidate shall submit an EMS Certification Application form to the department. EMS Certification Application forms are provided by the department.
	  d.   	 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.
	  e.   	 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.
	  f.   	 A candidate must successfully complete the NREMT practical and cognitive examinations to be eligible for state certification.
	  g.   	 The practical examination may be conducted by an authorized training program and must be conducted according to the policies and procedures of the NREMT.
	  h.   	 A candidate must meet all certification requirements within two years of the initial course completion date. If a candidate is unable to complete the requirements 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 or military authority and approval by the department.
	  i.   	 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.
	  j.   	 An applicant for EMS-I endorsement shall successfully complete an EMS-Instructor curriculum approved by the department.
	 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(4)“f” if renewal of the higher level is requested later.
	  c.   	 A citation and warning, denial, probation, restriction, 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) Certification transition.
	  a.   	 An individual certified as a first responder based on the 1996 National Standard Curriculum for First Responders, an EMT-B, an EMT-I, an EMT-P or a PS shall complete the following certification transition requirements. Transition documents for each level are 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).
	  b.   	 FR transition to EMR.
	 (1) 	 The FR shall complete training identified in the FR to EMR Documentation (January 2011).
	 (2) 	 The FR shall verify completion of training on the Affirmative Renewal of Certification Application by the certification’s regular expiration date prior to October 1, 2014.
	 (3) 	 An FR who does not complete the transition requirements will not satisfy the renewal requirements for the certification period immediately prior to October 1, 2014.
	  c.   	 EMT-B transition to EMT.
	 (1) 	 The EMT-B shall complete training identified in the EMT-B to EMT Documentation (January 2011).
	 (2) 	 The EMT-B shall verify completion of training on the Affirmative Renewal of Certification Application by the certification’s regular expiration date prior to April 1, 2015.
	 (3) 	 An EMT-B who does not complete the transition requirements will not satisfy the renewal requirements for the certification period immediately prior to April 1, 2015.
	  d.   	 EMT-I transition to AEMT.
	 (1) 	 The EMT-I shall submit documentation of training identified in the EMT-I to AEMT Documentation (January 2011) to the department.
	 (2) 	 The EMT-I shall successfully complete the NREMT computer-based AEMT examination.
	 (3) 	 A provider certified as an EMT-I who has not completed the transition to AEMT will be issued an EMT certification on April 1, 2016.
	  e.   	 EMT-P transition to paramedic.
	 (1) 	 The EMT-P shall submit documentation of training identified in the EMT-P to Paramedic Documentation (January 2011) to the department.
	 (2) 	 The EMT-P shall successfully complete the NREMT computer-based paramedic examination.
	 (3) 	 A provider certified as an EMT-P who has not completed the transition to paramedic will be issued an AEMT certification on April 1, 2018.
	  f.   	 PS transition to paramedic.
	 (1) 	 The PS shall complete training identified in the PS to Paramedic Documentation (January 2011).
	 (2) 	 The PS shall verify completion of training on the Affirmative Renewal of Certification Application by the certification’s regular expiration date prior to April 1, 2015.
	 (3) 	 A PS who does not complete the transition requirements will not satisfy the renewal requirements for the certification period immediately prior to April 1, 2015.
	 131.4(4) 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, unless the emergency medical care provider requests an extension as described in 131.4(11)“b.”
	  c.   	 An emergency medical care provider shall submit the EMS Affirmative Renewal of Certification Application 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 (date of submission is based upon the postmark date) shall cause the current certification to expire.
	  d.   	 An emergency medical care provider shall not function with an expired certification.
	  e.   	 An emergency medical care provider 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(5)“i” to obtain renewal of certification.
	  f.   	 An emergency medical care provider 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 cognitive certification examinations.
	  g.   	 An emergency medical care provider 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(4)“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.
	  h.   	 An emergency medical care provider shall be deemed to have complied with the continuing education requirements during periods in which the provider serves honorably on active duty in the military services or for periods in which the provider is a government employee working as an emergency medical care provider and assigned to duty outside the United States. The emergency medical care provider must submit the Affirmative Renewal of Certification Application, all appropriate fees and documentation of assignment.
	 131.4(5) Continuing education renewal standards. The following standards apply to renewal through continuing education:
	  a.   	 An 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.   	 An applicant shall complete the continuing education requirements, including current course completion in CPR, during the certification period for the following emergency medical care provider levels:
	 (1) 	 EMR, FR, FR-D—12 hours of approved continuing education.
	 (2) 	 EMT, EMT-A, EMT-B, EMT-D—24 hours of approved continuing education.
	 (3) 	 AEMT, EMT-I—36 hours of approved continuing education.
	 (4) 	 EMT-P—48 hours of approved continuing education.
	 (5) 	 PS, paramedic—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 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) 	 Working with students as an EMS field preceptor.
	 (6) 	 Hospital or nursing home clinical performance.
	 (7) 	 Skills workshops/maintenance.
	 (8) 	 Community public information education projects.
	 (9) 	 Emergency driver training.
	 (10) 	 EMS course audits.
	 (11) 	 Injury prevention or wellness initiatives.
	 (12) 	 EMS service operations, e.g., management programs, continuous quality improvement.
	 (13) 	 EMS system development meetings that occur at the county, regional or state level.
	 (14) 	 Disaster preparedness.
	 (15) 	 Emergency runs/responses as a volunteer member of an authorized EMS service program (primary attendant).
	 (16) 	 EMS-Instructor development.
	  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, a person who is not enrolled in an emergency medical care provider course may audit the course for CEHs.
	  g.   	 The certificate holder must notify the department within 30 days of a change in address.
	  h.   	 The certificate holder shall maintain a file containing documentation of CEHs 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 an Audit Report Form provided by the department 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.   	 An EMS instructor who teaches EMS initial or continuing education courses may use those courses for renewal as approved under subrule 131.4(6).
	 131.4(6) Continuing education approval. The following standards shall be applied for approval of continuing education:
	  a.   	 Required CEHs identified in 131.4(5)“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(5)“d” and 131.4(5)“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 the date and title of the program or event, the number of hours approved, and the 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. One quarter credit equals 10 hours. One semester credit equals 15 hours.
	  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 management, 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(5) 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, EMR, EMT-B, EMT, EMT-I, AEMT, EMT-P, PS and paramedic certification fee—$30.
	  b.   	 Certification renewal fees:
	 (1) 	 FR, EMR, EMT-B, and EMT—no fee.
	 (2) 	 EMT-I, AEMT—$10.
	 (3) 	 EMT-P, PS and paramedic—$25.
A certification renewal 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.   	 Duplicate/replacement card—$10.
	  g.   	 Returned check—$20.
	  h.   	 Extension fee—$50.
	 131.4(9) Certification through reciprocity. An individual currently certified by the NREMT must also possess a current Iowa certificate to be considered certified in this state. The department shall contact the NREMT to verify certification or registry and good standing.
	  a.   	 To receive Iowa certification, the individual shall:
	 (1) 	 Complete and submit the EMS Reciprocity Application available from the department.
	 (2) 	 Provide verification of current certification in another state, if applicable, and registration with the NREMT.
	 (3) 	 Provide verification of current course completion in CPR.
	 (4) 	 Meet all other applicable eligibility requirements necessary for Iowa certification pursuant to these rules.
	 (5) 	 Submit all applicable fees to the department.
	  b.   	 An individual certified through reciprocity shall satisfy the renewal and continuing education requirements set forth in subrule 131.4(4) to renew Iowa certification.
	 131.4(10) National registration in lieu of continuing education.
	  a.   	 An emergency medical care provider who is certified in Iowa and is registered with the NREMT may renew certification by meeting the NREMT reregistration requirements.
	  b.   	 The emergency medical care provider 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(11) Extension of certification.
	  a.   	 If an emergency medical care provider 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 statement must include information concerning the reason the emergency medical care provider could not complete the continuing education requirements, the time period affected, and the length of time requested for extension.
	  b.   	 If an emergency medical care provider 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 provider 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 (date of submission is based on the postmark date).
	 (4) 	 Not use continuing education completed during the extension period in the subsequent renewal period.
[ARC 9443B, IAB 4/6/11, effective 8/1/11]