Tenn. Comp. R. & Regs. 1200-12-01-.13 - EMT, AEMT AND PARAMEDIC EDUCATION PROGRAMS

(1) Definitions. Terms used in this rule shall be defined as follows:
(a) "Approval" means the approval process the Tennessee Emergency Medical Services Board ("Board") uses to assure that EMT, AEMT, and Paramedic education programs comply with the educational standards, requirements, and policies it adopts.
(b) "Approved Program" means an education program approved by the Tennessee Emergency Medical Services Board.
(c) "Contract or Agreement" means a written agreement between the school and the cooperating agency.
(d) "EMS Educational Institution" means an institution sponsoring an EMT, AEMT, or Paramedic education program shall be an accredited post-secondary educational institution, such as a university, college, community college, technical school, or fire department in accordance with T.C.A. § 68-140-327, or a state agency conducting classes for state law enforcement employees at a state law enforcement training academy, with adequate resources and dedication to educational endeavors.
(e) "Medical Director" means a physician with an unencumbered Tennessee license having experience and current knowledge of emergency care of acutely ill and/or traumatized patients. This individual shall be familiar with base station operation including communication with, and direction of, pre-hospital emergency units. The medical director must have knowledge of administrative problems affecting EMS personnel education programs and legislative issues regarding educational programs for the pre-hospital provider.
(f) "National Accreditation" means accreditation from the Commission on Accreditation of Allied Health Education Programs ("CAAHEP").
(g) "National Education Standards" shall mean national education standards developed from the National EMS Scope of Practice Model for Emergency Medical Service Personnel as promulgated by the U.S. Department of Transportation, National Highway Traffic Safety Administration.
(2) EMS Educational Programs:
(a) Any EMS Educational Institution sponsoring an EMT, AEMT, or Paramedic education program to qualify applicants for licensure shall ensure that its program conforms, at a minimum, to the national education standards developed from the National EMS Scope of Practice Model for Emergency Medical Service Personnel promulgated by the U.S. Department of Transportation, National Highway Traffic Safety Administration, which the EMS Board has approved, and to such rules as the Board shall promulgate.
(b) Any EMS Educational Institution sponsoring an EMT, AEMT, or Paramedic education program shall adopt, at a minimum, all parts of the curricula as developed from the national education standards including skills, training requirements, and permitted practices and procedures for appropriate licensure classification which the EMS Board has adopted.
(c) The EMS Educational Institutions sponsoring EMS training programs shall:
1. File a written request for Division approval with the EMS Division at least thirty (30) days prior to the start date of classes;
2. Ensure that the training program has sufficient supervised practice, equipment, and experience for each required clinical skill;
3. Have a medical director whose affiliation is confirmed in writing;
4. File a description of curriculum with the EMS Division; and
5. Meet the instructor/student ratio approved by the Board.
(d) Only students from Tennessee approved programs or those who have met reciprocity requirements shall be eligible for state licensure.
(e) Purposes of Approval are as follows:
1. To set standards for education programs to prepare emergency medical services licensees to practice safely; and
2. To ensure that graduates of an approved EMS Educational Institution are eligible for admission to the licensure examinations.
(f) Approval shall be categorized, and awarded or revoked in accordance with the following criteria:
1. The Board may grant initial approval to a new program that has not been in operation long enough to graduate its first class, but demonstrates its eligibility for full approval. The Board shall review programs for full approval one year after initial approval or when their first class of students graduates.
2. Approval and renewal of approval shall be based on recommendations of the Division made to the Board based upon application information, survey and site visits, review of clinical experiences and documentation, instructor/ student ratio, instructor qualifications, and related evidence of continuing compliance with the regulations of the Board.
3. The Board may grant approval for a period of five (5) years to a program that has met the requirements that are set forth by the Board and the policies of the Division of EMS.
4. The Board may grant conditional approval to a program which has failed to maintain the standards and has been notified that it must meet the requirements within a specified time period or upon demonstration of compliance.
5. The Board shall deny approval for cause, or it may revoke or condition approval for failure to comply with the standards the Board establishes.
6. If the institution does not correct deficiencies within the specified time, and until the Board approves such action, the education program shall not convene a subsequent class.
7. Programs desiring to cease education activities shall notify the Director of EMS in writing.
(g) All programs must maintain for first attempt for licensure, an annual pass rate as approved by the Board. Should a program fail to maintain the required pass rate it shall:
1. Receive a "Letter of Concern" from the Division.
2. Should a program fail to achieve the required pass rate for a second year, the program shall receive a "Letter of Warning" from the Division and be required to submit a "Plan of Correction" to the Division outlining its recommendations for improvement.
3. Should a program fail to achieve the required pass rate for a third year, a representative from the approved program shall be required to appear before the Board to explain the "Plan of Correction" and the steps taken to improve.
4. The Board may, in accordance with the Uniform Administrative Procedures Act (UAPA), condition, suspend, or revoke the educational institution's approval.
(h) Requirements for Approval.
1. Sponsorship/Affiliation
(i) EMS Educational Institutions must have affiliation agreements with Tennessee licensed Emergency Medical Services, and with Tennessee licensed medical facilities or hospitals which are capable of supporting EMT, AEMT and/or Paramedic education with sufficient supervised practice and experience for the number of students enrolled in the program.
(ii) The EMS educational institution must provide the financial support, facilities, and leadership capable of ensuring a sound educational program and appropriate services to faculty and students.
(iii) The EMS educational institution shall maintain records of overall student competency in knowledge, skills and experience while maintaining the capability to endorse participants for the license examination.
(iv) The EMS educational institution shall notify the Division of any proposed major curriculum or program change in writing which will be subject to Board approval.
2. Curriculum
(i) Program Goals and Objectives
(I) The program shall have a written statement of program goals and objectives consistent with and responsive to the demonstrated needs and expectations of the various communities it serves.
(II) Statements of goals and objectives shall provide the basis for program planning, implementation, and evaluation.
(III) An advisory committee shall be designated and charged with assisting the program and sponsoring institutional personnel in formulating appropriate goals and standards, monitoring needs and expectations, and ensuring program responsiveness to change.
(ii) Minimum Expectations
(I) Program goals and objectives must include, but need not be limited to, providing assurance that graduates demonstrate entry-level competencies, as periodically defined by nationally accepted educational standards and scope of practice for the appropriate level of licensure.
(II) The curriculum shall follow planned outlines, that shall be kept on file for Division review, that appropriately integrate lecture, laboratory, clinical, and field experience sequenced to assure efficient learning and opportunity for every student. Content and support courses shall include basic theoretical and scientific knowledge reflective of state of the art patient care.
(III) The curriculum shall meet, or exceed, the national educational standards and competencies for the appropriate level of licensure as adopted in the United States Department of Transportation National EMS Scope of Practice Model and Education Standards.
3. Administration and Faculty
(i) Administration of EMS Educational Programs
(I) EMS Educational Institutions offering paramedic educational programs shall include the following:
I. A full time Division authorized EMS Program Director, whose primary responsibility and fulltime commitment is to the educational program.
II. The Program Director shall have appropriate training and experience to fulfill the role of program director as indicated in rule 1200-12-01-.12(1).
III. The Program Director shall be responsible for the organization, administration, periodic review, development and effectiveness of the paramedic educational program.
IV. The Program Director shall act as a liaison between faculty, the sponsoring service, students, the local medical community, and the Division of Emergency Medical Services.
V. The Program Director is responsible for recruitment and the continued development of faculty to meet the needs of the institution.
(II) EMS Educational Institutions offering AEMT education shall include the following;
I. At a minimum, a Division authorized AEMT Instructor/ Coordinator, who is responsible for the organization, administration, periodic review, development and effectiveness of the AEMT educational program.
II. An EMS Program Director in EMS institutions authorized to provide Paramedic educational programs may also administer AEMT educational programs.
(III) EMS Educational Institutions offering EMT education shall include the following:
I. At a minimum, a Division authorized EMT Instructor/ Coordinator, who is responsible for the organization, administration, periodic review, development and effectiveness of the EMT educational program.
II. An EMS Program Director in EMS institutions authorized to provide Paramedic or AEMT educational programs may also administer EMT educational programs.
(IV) Medical Director. The program shall appoint a medical director who shall be responsible for reviewing and approving the educational content of the program's curriculum. The medical director shall:
I. Review and approve the content and quality of the medical instruction and supervision the EMS educational program delivers;
II. Ensure that each student is appropriately assessed to assure that the student is making adequate progress toward the completion of the educational program; and
III. Attest that each student has achieved the desired level of competence prior to graduation.
(V) Instructional Faculty
I. The faculty shall be authorized by the Division and qualified through academic preparation, training, and experience to teach the courses or topics to which they are assigned in the curriculum.
II. Faculty members shall demonstrate individual proficiency and qualifications by submitting a personal Curriculum Vitae that will be kept on file with the Program Director.
III. The number of faculty instructors shall be sufficient to provide instruction and supervision for each period of the program or field experience.
(VI) An Authorized Paramedic Instructor/Coordinator shall be responsible for the delivery of instruction in a Paramedic education program.
I. The Paramedic Instructor/Coordinator shall be knowledgeable in all aspects of pre-hospital care, capable of applying techniques and modalities of adult education, and of managing resources and resource personnel.
II. Paramedic Instructor Assistants shall be responsible for teaching practical skills to include: assisting the Program Director and/or Instructor/Coordinator in the delivery of instruction, evaluating student performance of skills under supervision of Program Director or Authorized Paramedic Instructor/Coordinator.
(VII) An authorized AEMT Instructor/Coordinator shall be responsible for the delivery of instruction in an AEMT educational program.
I. An authorized AEMT Instructor/Coordinator shall be in the classroom for, at least but not limited to, the following:
A. Delivery of didactic material;
B. Demonstration of the psychomotor skills;
C. Verification of skill proficiency; and
D. Supervision of AEMT Instructor Assistants.
II. The education program may utilize Authorized AEMT Instructor Assistants for teaching practical skills including, but not limited to, assisting the Program Director and/or AEMT Instructor/ Coordinator in the delivery of instruction and evaluating student performance of skills during a lab.
(VIII) An authorized EMT Instructor/Coordinator shall be responsible for the delivery of instruction in an EMT educational program.
I. An authorized EMT Instructor/Coordinator shall be in the classroom for, at least but not limited to, the following:
A. Delivery of didactic material;
B. Demonstration of the psychomotor skills;
C. Verification of skill proficiency; and
D. Supervision of EMT Instructor Assistants.
II. The education program may utilize Authorized EMT Instructor Assistants for teaching practical skills including, but not limited to, assisting the Program Director and/or EMT Instructor/Coordinator in the delivery of instruction and evaluating student performance of skills during a lab.
4. Resources.
(i) Finances. Financial resources adequate for the continued operation of the educational program shall be provided for each class of students enrolled.
(ii) Facilities.
(I) Instructional resources shall include:
I. Classrooms, laboratories and administrative offices with sufficient space to accommodate the number of students matriculating in the program and the supporting faculty;
II. Library resources, related to the curriculum, shall be readily accessible to students and shall include current EMS and medical periodicals, scientific books, audiovisual and self-instructional resources, and other references; and
III. Available sufficient supplies and equipment to be used in the provision of instruction that are consistent with the needs of the curriculum and adequate for the students enrolled.
(II) Clinical Resources
I. The educational program shall establish clinical affiliations that are confirmed by written affiliation agreements with the institutions and agencies that provide students with clinical experience under appropriate medical direction and clinical supervision.
II. Students shall have access to an adequate number of patients and in distribution by sex and age who present common problems encountered in the delivery of basic and advanced emergency care.
III. Students shall be assigned in clinical settings where experiences are educationally sufficient to achieve the national educational standards for the appropriate level of licensure.
IV. Program instructors or hospital personnel, such as nurses or physicians, who have been approved by the program to so function, shall provide supervision in the clinical setting. The ratio of students to instructors in the clinical facilities shall be adequate to assure effective learning.
V. Students shall be clearly identified by name plate, uniform, or other apparent means to distinguish them from graduate emergency medical services personnel, other health professionals, workers, and other students.
(III) Field Internship
I. The program's field internship shall occur within an emergency medical system which demonstrates medical accountability. The student must be under direct supervision of preceptors the program and/or EMS services designate. Preceptors shall be physicians and/or nurses with pre-hospital experience, AEMTs or paramedics. The program shall assure that there is appropriate, objective evaluation of student progress in acquiring the desired competencies in accordance with the national education standards.
II. Field internship shall occur on an Advanced Life Support vehicle within an EMS system having capability of voice telecommunications with on-line medical direction. The vehicle shall be equipped with equipment and drugs necessary for basic and advanced life support.
III. The majority of the field internship experience shall occur following the completion of the didactic and clinical phases of the program. It must be structured to assure that upon completion of this portion of the program, each student will achieve the desired competencies of the national educational standards.
IV. Adequate manpower shall be available within the EMS system to assure that the assigned student is never a substitute for paid personnel or a required team member.
5. Student Admissions and Conduct.
(i) EMS Educational Institution admission requirements shall be clearly defined and published by the institution, and shall be non-discriminatory with respect to race, color, creed, sex, age, handicaps, or national origin.
(ii) Persons seeking admission to an EMT, AEMT, or Paramedic education program shall:
(I) Meet the admission requirements of the EMS educational institution;
(II) Possess an academic or equivalent high school diploma or general education equivalent (GED); or
(III) Be a high school senior who is eligible for dual enrollment for college credit, and who will be eighteen (18) years of age within ninety (90) days of completing the training for which admission to a program is sought.
(iii) Upon selection for admission into the EMT, AEMT, or Paramedic program, the student shall:
(I) Show good physical and mental health and possess no physical handicaps or disabilities which would impede the ability to fulfill the functions and responsibilities of an EMT, AEMT, or Paramedic.
(II) Submit a physical examination form indicating physical health sufficient to perform the duties of an EMT, AEMT, or Paramedic completed by a physician, physician assistant, or nurse practitioner, who has examined the individual. If there are any limitations in the individual's ability to perform adequately, additional documentation shall be submitted from the appropriate professional evaluator which indicates the applicant's abilities to perform adequately (i.e.):
I. Speech impairment - Speech Pathologist;
II. Hearing impairment - Audiologist;
III. Physical handicap or disability - Orthopedist or Registered Physical Therapist; or
IV. Vision - Ophthalmologist.
(III) Readmission or transfer of students shall be made in accordance with clearly defined and published practices of the institution which shall be non-discriminatory with respect to race, color, creed, sex, age, handicaps, or national origin.
(IV) Dismissal. Students shall be subject to dismissal from the education program for cause.
6. Program Records
(i) Each student record shall include the following:
(I) A transcript of high school graduation or graduate equivalent (GED), or official academic college transcript in each student's file;
(II) Medical evidence that the protection of students and the public from injury or the transmission of communicable diseases is assured for each student;
(III) A record of class and practice participation along with evidence of competencies attained throughout the education program;
(IV) Copies of examinations and assessments of the student's development and attainment of competencies;
(V) Sufficient information to document each student's satisfactory completion of all didactic, practical skills, laboratory, clinical, and field requirements.
(VI) Copies of proof of malpractice insurance on each student enrolled in the program with minimal coverage of $1,000,000.00/$3,000,000.00 which will extend for the entire duration of the education program; and
(VII) The records maintained by the institution shall be complete whether or not a student is successful in completing the prescribed course of instruction.
(ii) Each academic record shall include:
(I) A descriptive synopsis of the current curriculum; and
(II) A statement of course objectives, copies of course outlines, class and laboratory schedules, clinical and field internship experience schedules, and teaching plans.
7. Student Admission. In addition to requirements for admission to all EMT education programs, applicants for admission to AEMT Education programs shall meet requirements as follows:
(i) Hold a current Tennessee EMT license prior to admission; or
(ii) Have successfully completed the EMT education program within 120 days of beginning an Advanced EMT education program and have successfully completed a Board approved EMT competency written and practical examination.
(3) Paramedic Education Programs.
(a) Upon initial approval of a paramedic program by the EMS Board, all paramedic education programs must make application to the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP) and receive a letter of review for accreditation with the Commission of Accreditation of Allied Health Education Programs (CAAHEP) and shall be accredited within four (4) years of Initial application of CAAHEP.
(b) All Paramedic programs must maintain accreditation with CAAHEP.
(c) Additional admission requirements for paramedic education programs.
1. To be eligible for admission an applicant shall be currently licensed as an Advanced Emergency Medical Technician in the State of Tennessee.
2. The applicant must be evaluated using a scale where each requirement will receive a score of 0-5 depending on the quality of achievement with 5 being the highest and 0 being the lowest. Applicants selected shall receive an overall interview rating of 2.5 and above.
3. AEMT knowledge. The applicant having successfully completed an AEMT license exam more than one year prior to the start of Paramedic classes must successfully complete an AEMT assessment written examination approved by the Board.
4. An applicant shall be interviewed and evaluated. Each area evaluated in the interview shall be rated with a score of 0-5 depending on the quality of achievement, with 5 being the highest score and 0 being the lowest. Applicants selected shall receive an overall rating of 2.5 and above.
(i) The applicant shall be interviewed by a committee of at least four (4) individuals and a representative from the Division of Emergency Medical Services. Committee members shall be selected from the following: an EMS educator, a registered nurse, a physician, a paramedic, and/or an ambulance service director.
(ii) The following criteria shall be used for interview evaluation:
(I) EMS related experience;
(II) Level of maturity and motivation;
(III) Level of knowledge;
(IV) Communication ability; and
(V) Poise.

Notes

Tenn. Comp. R. & Regs. 1200-12-01-.13
Original rule filed November 30, 1985; effective February 12, 1985. Amendment filed October 22, 1987; effective December 6, 1987. Amendment filed January 17, 1989; effective March 3, 1989. Amendment filed September 24, 1990; effective November 8, 1990. Amendment filed October 22, 1993; effective January 5, 1994. Amendment filed August 5, 1996; effective October 19, 1996. Repeal and new rule filed January 11. 2013; effective April 11, 2013. Amendment filed May 26, 2010; effective August 24, 2010. Amendments filed September 23, 2019; effective 12/22/2019.

Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-140-304, 68-140-306, 68-140-307, 68-140-504, 68-140-506, 68-140-508, and 68-140-509.

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