EMERGENCY MEDICAL SERVICES

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Code of Colorado Regulations › 1000 Department of Public Health and Environment › 1011 Health Facilities and Emergency Medical Services Division (1011, 1015 Series) › 6 CCR 1015-3

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DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT

Health Facilities and Emergency Medical Services Division

EMERGENCY MEDICAL SERVICES

6 CCR 1015-3

[Editor’s Notes follow the text of the rules at the end of this CCR Document.]

_________________________________________________________________________

CHAPTER ONE – RULES PERTAINING TO EMS AND EMR EDUCATION, EMS CERTIFICATION OR

LICENSURE, AND EMR REGISTRATION

Chapter 1

Adopted by the Board of Health on April 17, 2024. Effective June 14, 2024.

Section 1 – Purpose and Authority For Rules

1.1

These rules address the recognition process for emergency medical services (EMS) and

Emergency Medical Responder (EMR) education programs; the certification or licensure process

for all levels of EMS Providers; the registration process for emergency medical responders; and

the procedures for denial, revocation, suspension, limitation, or modification of a certificate,

license, or registration.

1.2

The authority for the promulgation of these rules is set forth in Section 25-3.5-101 et seq., C.R.S.

Section 2 – Definitions

2.1

All definitions that appear in Section 25-3.5-103, C.R.S., shall apply to these rules.

2.2

“Accredited College or University” - For purposes of EMS provider licensing, a four-year college

or university that is accredited by an educational accrediting body recognized by the Council for

Higher Education Accreditation (CHEA) or the United States Department of Education, or is an

international program that is recognized to be the equivalent of a four-year accredited college or

university.

2.3

“Advanced Cardiac Life Support (ACLS)” - A course of instruction designed to prepare students in

the practice of advanced emergency cardiac care.

2.4

“Advanced Emergency Medical Technician (AEMT)” - An individual who has a current and valid

AEMT certificate or license issued by the Department and who is authorized to provide limited

acts of advanced emergency medical care in accordance with the Rules Pertaining to EMS

Practice and Medical Director Oversight

ion designed to prepare students in

the practice of advanced emergency cardiac care.

2.4

“Advanced Emergency Medical Technician (AEMT)” - An individual who has a current and valid

AEMT certificate or license issued by the Department and who is authorized to provide limited

acts of advanced emergency medical care in accordance with the Rules Pertaining to EMS

Practice and Medical Director Oversight.

2.5

“Basic Cardiac Life Support (CPR)” - A course of instruction designed to prepare students in

cardiopulmonary resuscitation techniques.

2.6

“Board for Critical Care Transport Paramedic Certification (BCCTPC)” - a non-profit organization

that develops and administers the Critical Care Paramedic Certification and Flight Paramedic

Certification exam.

2.7

“Certificate” - Designation as having met the requirements of Section 5 of these rules, issued to

an individual by the Department. Certification is equivalent to licensure for purposes of the State

Administrative Procedure Act, Section 24-4-101, et seq., C.R.S.

Code of Colorado Regulations

Secretary of State

State of Colorado

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Health Facilities and Emergency Medical Services Division

2.8

“Certificate Holder” - An individual who has been issued a certificate as defined in Section 2.7.

2.9

“Continuing Education” - Education required for the renewal of a certificate, license, or

registration.

2.10

“Department” - Colorado Department of Public Health and Environment.

2.11

“Emergency Medical Practice Advisory Council (EMPAC)” - The council established pursuant to

Section 25-3.5-206, C.R.S., that is responsible for advising the Department regarding the

appropriate scope of practice for EMS providers and for the criteria for physicians to serve as

EMS medical directors

nse, or

registration.

2.10

“Department” - Colorado Department of Public Health and Environment.

2.11

“Emergency Medical Practice Advisory Council (EMPAC)” - The council established pursuant to

Section 25-3.5-206, C.R.S., that is responsible for advising the Department regarding the

appropriate scope of practice for EMS providers and for the criteria for physicians to serve as

EMS medical directors.

2.12

“Emergency Medical Responder (EMR)” - An individual who has successfully completed the

training and examination requirements for emergency medical responders and who provides

assistance to the injured or ill until more highly trained and qualified personnel arrive.

2.13

“Emergency Medical Technician (EMT)” - An individual who has a current and valid EMT

certificate or license issued by the Department and who is authorized to provide basic emergency

medical care in accordance with the Rules Pertaining to EMS Practice and Medical Director

Oversight.

2.14

“Emergency Medical Technician Intermediate (EMT-I)” - An individual who has a current and valid

EMT-I certificate or license issued by the Department and who is authorized to provide limited

acts of advanced emergency medical care in accordance with the Rules Pertaining to EMS

Practice and Medical Director Oversight.

2.15

“Emergency Medical Technician with IV Authorization (EMT-IV)” - An individual who has a current

and valid EMT certificate or license issued by the Department and who has met the conditions

defined in the Rules Pertaining to EMS Practice and Medical Director Oversight relating to IV

authorization.

2.16

“EMR Education Center” - A state-recognized provider of initial courses, EMR continuing

education topics and/or refresher courses that qualify graduates for the National Registry of

Emergency Medical Technician’s EMR certification and for state registration renewal

s met the conditions

defined in the Rules Pertaining to EMS Practice and Medical Director Oversight relating to IV

authorization.

2.16

“EMR Education Center” - A state-recognized provider of initial courses, EMR continuing

education topics and/or refresher courses that qualify graduates for the National Registry of

Emergency Medical Technician’s EMR certification and for state registration renewal.

2.17

“EMR Education Group” - A state-recognized provider of EMR continuing education topics and/or

refresher courses that qualify individuals for renewal of a national registry EMR certification and

for state registration renewal.

2.18

“EMS Education Center” - A state-recognized provider of initial courses, EMS continuing

education topics and/or refresher courses that qualify graduates for state and/or National Registry

EMS provider certification or licensure.

2.19

“EMS Education Group” - A state-recognized provider of EMS continuing education topics and/or

refresher courses that qualify individuals for renewal of a state and/or National Registry EMS

provider certification or licensure.

2.20

“Education Program” - A state-recognized provider of EMS and/or EMR education including a

recognized education group or center.

2.21

“Education Program Standards” – Department-approved minimum standards for EMS or EMR

education that shall be met by state-recognized EMS or EMR education programs.

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“Education Program” - A state-recognized provider of EMS and/or EMR education including a

recognized education group or center.

2.21

“Education Program Standards” – Department-approved minimum standards for EMS or EMR

education that shall be met by state-recognized EMS or EMR education programs.

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2.22

“EMS Provider” - Means an individual who holds a valid emergency medical service provider

certificate or license issued by the Department and includes Emergency Medical Technician,

Advanced Emergency Medical Technician, Emergency Medical Technician Intermediate and

Paramedic.

2.23

“Equivalent Field” - For purposes of EMS provider licensing, a four-year bachelor’s degree

program that includes a minimum of 40 completed semester credit hours in courses that the

Department determines, pursuant to Section 5.4.2, to be comparable to health sciences fields

and disciplines.

2.24

“Field Related to the Health Sciences” - For purposes of EMS provider licensing, a four-year

bachelor’s degree program in emergency medical services or in health professions and related

programs as identified by the United States Department of Education, Institute of Education

Sciences, National Center For Education Statistics, Classification of Instructional Programs (CIP-

2020).

2.25

“Graduate Advanced Emergency Medical Technician” - An EMT certificate holder or licensee who

has successfully completed a Department-recognized AEMT education course but has not yet

successfully completed the AEMT certification requirements set forth in these rules.

2.26

“Graduate Paramedic” - An EMT, AEMT or EMT-I certificate holder or licensee who has

successfully completed a Department-recognized Paramedic education course but has not yet

successfully completed the Paramedic certification or licensure requirements set forth in these

rules

T education course but has not yet

successfully completed the AEMT certification requirements set forth in these rules.

2.26

“Graduate Paramedic” - An EMT, AEMT or EMT-I certificate holder or licensee who has

successfully completed a Department-recognized Paramedic education course but has not yet

successfully completed the Paramedic certification or licensure requirements set forth in these

rules.

2.27

“Initial Course” - A course of study based on the Department-approved curriculum that meets the

education requirements for issuance of a certificate, license, or registration for the first time.

2.28

“Initial Certification or Licensure” - First time application for and issuance by the Department of a

certificate or license at any level as an EMS provider. This shall include applications received

from persons holding any level of EMS certification or license issued by the Department who are

applying for either a higher or lower level certificate or license.

2.29

“Initial Registration” - First time application for and issuance by the Department of a registration

as an EMR. This shall include applications received from persons holding any level of EMS

certification or license issued by the Department who are applying for registration.

2.30

“International Board of Specialty Certification (IBSC)” - A non-profit organization that develops

and administers a national Community Paramedic certification exam.

2.31

“Letter of Admonition” - A form of disciplinary sanction that is placed in an EMS provider’s or

EMR’s file and represents an adverse action against the certificate holder, registration holder, or

licensee.

2.32

“License” - Designation as having met the requirements of Section 25-3.5-203(1)(b) and (b.5),

C.R.S., and Section 5.4 issued to an individual by the Department.

2.33

“Licensee” - An individual who has been issued a license as defined in Section 2.32

t is placed in an EMS provider’s or

EMR’s file and represents an adverse action against the certificate holder, registration holder, or

licensee.

2.32

“License” - Designation as having met the requirements of Section 25-3.5-203(1)(b) and (b.5),

C.R.S., and Section 5.4 issued to an individual by the Department.

2.33

“Licensee” - An individual who has been issued a license as defined in Section 2.32.

2.34

“Medical Director” - For the purposes of these rules, a physician licensed in good standing who

authorizes and directs, through protocols and standing orders, the performance of students-in-

training enrolled in Department-recognized EMS or EMR education programs and/or EMS

certificate holders or licensees who perform medical acts, and who is specifically identified as

being responsible to assure the performance competency of those EMS providers as described in

the physician's medical continuous quality improvement program.

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2.35

“National Registry of Emergency Medical Technicians (NREMT)” - A national non-governmental

organization that certifies entry-level and ongoing competency of EMS providers and EMRs.

2.36

“Paramedic” - An individual who has a current and valid Paramedic certificate or license issued by

the Department and who is authorized to provide acts of advanced emergency medical care in

accordance with the Rules Pertaining to EMS Practice and Medical Director Oversight.

2.37

“Paramedic with Community Paramedic Endorsement (P-CP)” - An individual who has a current

and valid Paramedic certificate or license issued by the Department and who has met the

requirements in these rules to obtain a Community Paramedic endorsement from the Department

and is authorized to provide acts in accordance with the Rules Pertaining to EMS Practice and

Medical Director Oversight relating to Community Integrated Health Care Services, as set forth in

Sections 25-3.5-206, C.R.S and 25-3.5-1301, et seq. C.R.S

te or license issued by the Department and who has met the

requirements in these rules to obtain a Community Paramedic endorsement from the Department

and is authorized to provide acts in accordance with the Rules Pertaining to EMS Practice and

Medical Director Oversight relating to Community Integrated Health Care Services, as set forth in

Sections 25-3.5-206, C.R.S and 25-3.5-1301, et seq. C.R.S.

2.38

“Paramedic with Critical Care Endorsement (P-CC)” - An individual who has a current and valid

Paramedic certificate or license issued by the Department and who has met the requirements in

these rules to obtain a Critical Care endorsement from the Department and is authorized to

provide acts in accordance with the Rules Pertaining to EMS Practice and Medical Director

Oversight relating to Critical Care, as set forth in Section 25-3.5-206, C.R.S.

2.39

“Practical Skills Examination” - A skills test conducted at the end of an initial course and prior to

application for national or state certification or licensure.

2.40

“Provisional Certification or Licensure” - A certification or license, valid for not more than 90 days,

that may be issued by the Department to an EMS provider applicant seeking certification or

licensure.

2.41

“Provisional Registration” - A registration, valid for not more than 90 days, that may be issued by

the Department to an EMR applicant seeking registration.

2.42

“Refresher Course” - A course of study based on the Department-approved curriculum that

contributes in part to the education requirements for renewal of a certificate, license or

registration.

2.43

“Registered Emergency Medical Responder (EMR)” - An individual who has successfully

completed the training and examination requirements for EMRs, who provides assistance to the

injured or ill until more highly trained and qualified personnel arrive, and who is registered with the

Department pursuant to Section 6 of these rules

equirements for renewal of a certificate, license or

registration.

2.43

“Registered Emergency Medical Responder (EMR)” - An individual who has successfully

completed the training and examination requirements for EMRs, who provides assistance to the

injured or ill until more highly trained and qualified personnel arrive, and who is registered with the

Department pursuant to Section 6 of these rules.

2.44

“Rules Pertaining to EMS Practice and Medical Director Oversight” - Rules adopted by the

Executive Director or Chief Medical Officer of the Department upon the advice of the EMPAC that

establish the responsibilities of medical directors and all authorized acts of EMS certificate

holders or licensees, located at 6 CCR 1015-3, Chapter Two.

2.45

“State Emergency Medical and Trauma Services Advisory Council (SEMTAC)” - A council

created in the Department pursuant to Section 25-3.5-104, C.R.S., that advises the Department

on all matters relating to emergency medical and trauma services.

Section 3 – State Recognition of Education Programs

3.1

Application for State Recognition as an Education Program

3.1.1

The Department may grant recognition for any of the following types of education

programs:

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EMR education center

EMR education group

EMT education center

EMT education group

EMT-IV education group

AEMT education center

AEMT education group

EMT-I education center

EMT-I education group

Paramedic education center

Paramedic education group

3.1.2

An education program recognized as an education center at any level shall also be

authorized to serve as an education group at the same level(s).

3.1.3

Any education provider seeking to prepare graduates for EMS certification or licensure or

EMR registration shall apply for state recognition as described in Section 3.1.9

cation group

Paramedic education center

Paramedic education group

3.1.2

An education program recognized as an education center at any level shall also be

authorized to serve as an education group at the same level(s).

3.1.3

Any education provider seeking to prepare graduates for EMS certification or licensure or

EMR registration shall apply for state recognition as described in Section 3.1.9.

3.1.4

Initial education program recognition shall be valid for a period of three (3) years from the

date of the Department's written notice of recognition.

3.1.5

Education programs shall utilize personnel who meet the qualification requirements in the

Department’s EMS or EMR education program standards.

3.1.6

State-recognized EMS education programs are required to present the Rules Pertaining

to EMS Practice and Medical Director Oversight at 6 CCR 1015-3, Chapter Two,

including the current Colorado EMS scope of practice content as established in those

rules, within every initial and refresher course.

3.1.7

EMS education centers that provide initial education at the Paramedic level shall obtain

accreditation from the Commission on Accreditation of Allied Health Education Programs

(CAAHEP). The EMS education center shall provide the Department with verification that

an application for accreditation has been submitted to CAAHEP prior to the EMS

education center initiating a second course.

3.1.8

EMS education centers that provide initial education at the Paramedic level shall maintain

accreditation from CAAHEP.

3.1.9

Applicants for education program recognition shall submit the following documentation to

the Department:

Completed application form provided by the Department;

Personnel roster, to include a current resume for the program director and

medical director;

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aintain

accreditation from CAAHEP.

3.1.9

Applicants for education program recognition shall submit the following documentation to

the Department:

Completed application form provided by the Department;

Personnel roster, to include a current resume for the program director and

medical director;

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Description of the facilities to be used for course didactic, lab, and clinical

instruction and a listing of all education aids and medical equipment available to

the program;

Policies and procedures, which at a minimum shall address:

Admission requirements;

Attendance requirements;

Course schedule that lists as separate elements the didactic, lab, clinical,

skills and written testing criteria of the education program;

Discipline/counseling of students;

Grievance procedures;

Successful course completion requirements;

Testing policies;

Tuition policy statement;

Infection control plan;

10)

Description of insurance coverage for students, both health and liability;

11)

Practical skills testing policies and procedures;

12)

A continuous quality improvement plan; and

13)

Recognition of continuing medical education provided by outside parties

including, but not limited to, continuing medical education completed by

members of the armed forces or reserves of the United States or the

National Guard, military reserves or naval militia of any state.

3.1.10 After receipt of the application and other documentation required by these rules, the

Department shall notify the applicant of recognition or denial as an education program, or

shall specify a site review or modification of the materials submitted by the applicant.

3.1.11 If the Department requires a site visit, the applicant shall introduce staff, faculty, and

medical director, and show all documentation, equipment, supplies and facilities.

3.1.12 Applications determined to be incomplete shall be returned to the applicant

ecognition or denial as an education program, or

shall specify a site review or modification of the materials submitted by the applicant.

3.1.11 If the Department requires a site visit, the applicant shall introduce staff, faculty, and

medical director, and show all documentation, equipment, supplies and facilities.

3.1.12 Applications determined to be incomplete shall be returned to the applicant.

3.1.13 The Department shall provide written notice of education program recognition or denial of

recognition to the applicant. The Department's determination shall include, but not be

limited to, consideration of the following factors:

Fulfillment of all application requirements;

Demonstration of ability to conduct education, at the requested level, in

compliance with the Department's education program standards; and

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Demonstration of necessary professional staff, equipment and supplies to

provide the education.

3.1.14 Denial of recognition shall be in accordance with Section 4 of these rules.

3.2

Education Program Recognition Renewal

3.2.1

Renewal of recognition shall be valid for a period of five (5) years from the date of the

Department's notice of recognition renewal and shall be based upon satisfactory past

performance and submission of an updated application form.

3.2.2

Additional information as specified in Section 3.1.9 may be required by the Department.

3.2.3

The Department may require a site review in conjunction with the renewal application.

Section 4 – Disciplinary Sanctions and Appeal Procedures for Education Program Recognition

4.1

The Department, in accordance with the State Administrative Procedure Act, Section 24-4-101, et

seq., C.R.S., may initiate proceedings to deny, revoke, suspend, limit or modify education

program recognition for, but not limited to, the following reasons:

4.1.1

The applicant fails to meet the application requirements specified in Section 3.1 of these

rules

ures for Education Program Recognition

4.1

The Department, in accordance with the State Administrative Procedure Act, Section 24-4-101, et

seq., C.R.S., may initiate proceedings to deny, revoke, suspend, limit or modify education

program recognition for, but not limited to, the following reasons:

4.1.1

The applicant fails to meet the application requirements specified in Section 3.1 of these

rules.

4.1.2

The applicant does not possess the necessary qualifications to conduct an education

program in compliance with the Department’s education program standards.

4.1.3

The applicant fails to demonstrate access to adequate clinical or internship services as

required by the Department’s education program standards.

4.1.4

Fraud, misrepresentation, or deception in applying for or securing education program

recognition.

4.1.5

Failing to conduct the education program in compliance with the Department’s education

program standards.

4.1.6

Failing to notify the Department of changes in the program director or medical director.

4.1.7

Providing false information to the Department with regard to successful completion of

education or practical skill examination.

4.1.8

Failing to comply with the provisions in Section 3 of these rules.

4.1.9

Losing CAAHEP accreditation by an EMS education center.

4.2

If the Department initiates proceedings to deny, revoke, suspend, limit or modify an education

program recognition, the Department shall provide notice of the action to the education program

(or program applicant) and shall inform the program (or program applicant) of its right to appeal

and the procedure for appealing. Appeals of Departmental actions shall be conducted in

accordance with the State Administrative Procedure Act, Section 24-4-101, et seq., C.R.S.

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to the education program

(or program applicant) and shall inform the program (or program applicant) of its right to appeal

and the procedure for appealing. Appeals of Departmental actions shall be conducted in

accordance with the State Administrative Procedure Act, Section 24-4-101, et seq., C.R.S.

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Section 5 – Emergency Medical Services Provider Certification or Licensure

5.1

General Requirements

5.1.1

The Department may issue the following EMS provider certifications or licenses:

EMT

AEMT

EMT-I

Paramedic

Provisional ninety (90)-day certification or license at the EMT, AEMT, EMT-I or

Paramedic level.

5.1.2

An EMS provider may apply for certification or licensure. Application for dual certification

and licensure shall not be permitted.

5.1.3

No person shall hold himself or herself out as a certificate holder or licensee or offer,

whether or not for compensation, any services included in these rules, or authorized acts

permitted by the Rules Pertaining to EMS Practice and Medical Director Oversight,

unless that person holds a valid certificate or license.

5.1.4

Certificates or licenses shall be effective for a period of three (3) years after the date of

issuance. The date of issuance shall be determined by the date the Department approves

the application.

5.1.5

Multiple certificates or licenses within the levels of EMS provider shall not be permitted.

Certification or licensure at a higher level indicates that the certificate holder or licensee

may also provide medical care allowed at all lower levels of certification or licensure.

5.1.6

If a certificate holder or licensee seeks a higher or lower level of certification or licensure,

he or she shall satisfy the requirements for initial certification or licensure at the new

level, except as described below

ion or licensure at a higher level indicates that the certificate holder or licensee

may also provide medical care allowed at all lower levels of certification or licensure.

5.1.6

If a certificate holder or licensee seeks a higher or lower level of certification or licensure,

he or she shall satisfy the requirements for initial certification or licensure at the new

level, except as described below.

If the higher level certificate or license is valid and in good standing or within six

months of the expiration date, the applicant for a lower level certificate or license

shall not be required to submit current and valid certification from the NREMT at

the lower level.

5.2

Initial Certification or licensure

5.2.1

Applicants for initial certification or licensure shall be no less than eighteen (18) years of

age at the time of application.

5.2.2

Applicants for initial certification or licensure shall submit to the Department a completed

application provided by the Department, including the applicant’s signature in a form and

manner as determined by the Department, that contains the following:

Evidence of compliance with criminal history record check requirements:

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The applicant must submit to a Federal Bureau of Investigation (FBI)

fingerprint-based national criminal history record check from the

Colorado Bureau of Investigations (CBI).

If the results of an applicant’s fingerprint-based national criminal history

record check reveal a record of arrest without a disposition, the applicant

must submit to a name-based criminal history record check as defined in

Section 22-2-119.3(6)(d), C.R.S.

If an applicant has twice submitted to a fingerprint-based criminal history

record check and the FBI or CBI has been unable to classify the

fingerprints, then the Department may accept a CBI and/or FBI name-

based criminal history report generated through the CBI

a disposition, the applicant

must submit to a name-based criminal history record check as defined in

Section 22-2-119.3(6)(d), C.R.S.

If an applicant has twice submitted to a fingerprint-based criminal history

record check and the FBI or CBI has been unable to classify the

fingerprints, then the Department may accept a CBI and/or FBI name-

based criminal history report generated through the CBI.

Evidence of current and valid certification from the NREMT at or above the EMS

Provider level being applied for.

Evidence of current and valid professional level Basic Cardiac Life Support

(CPR) course completion from a national or local organization approved by the

Department, except as provided for in Paragraph H) below.

In addition to Paragraph C), above, Paramedic applicants shall submit evidence

of current and valid Advanced Cardiac Life Support (ACLS) course completion

from a national or local organization approved by the Department, except as

provided in Paragraph H) below.

In addition to Paragraphs C) and D) above, a P-CC applicant shall submit

evidence of current and valid Critical Care Paramedic or Flight Paramedic

certification issued by the BCCTPC.

In additional to Paragraphs C) and D) above, a P-CP applicant shall submit the

following additional information:

Current and valid Community Paramedic certification issued by the

IBSC.

Proof of completion of a course in community paramedicine from one of

the following institutions:

An accredited paramedic training program,

A college accredited by an educational accrediting body, or

A university accredited by an educational accrediting body.

While stationed or residing within Colorado, all veterans, active military service

members, and members of the National Guard and reserves that are separating

from an active duty tour, or the spouse of a veteran or a member, may apply for

certification or licensure to practice in Colorado. The veteran, member, or spouse

is exempt from the requirements of Paragraphs C) and D)

l accrediting body.

While stationed or residing within Colorado, all veterans, active military service

members, and members of the National Guard and reserves that are separating

from an active duty tour, or the spouse of a veteran or a member, may apply for

certification or licensure to practice in Colorado. The veteran, member, or spouse

is exempt from the requirements of Paragraphs C) and D).

The Department may require evidence of military status and appropriate

orders in order to determine eligibility for this exemption.

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5.3

Renewal of Certification or Licensure

5.3.1

General Requirements

Upon the expiration date of a Department-issued certificate or license, the

certificate or license is no longer valid and the individual shall not hold himself or

herself out as a certificate or license holder, except under the circumstances

specified below in Paragraph F).

Persons who have permitted their certification or license to expire:

Shall not, until such time as the Department has issued a new or

renewed certification or license:

Hold themselves out as a certificate holder or licensee after the

certification or licensure has expired, except as provided in

Section 5.3.1.F,

Offer or perform, whether or not for compensation, any services

included in these rules, or

Offer or perform, whether or not for compensation, any

authorized acts permitted by the Rules Pertaining to EMS

Practice and Medical Director Oversight; and

May renew their certification or license by complying with the provisions

of Section 5.3 of these rules (Renewal of Certification or License) for a

period not to exceed six (6) months from the expiration date; or

Must, if certification or licensure has expired for a period of greater than

six (6) months from the expiration date, comply with the provisions of

Section 5.2 of these rules (Initial Certification or Licensure), unless

exempted pursuant to Section 5.3.1.F below.

ction 5.3 of these rules (Renewal of Certification or License) for a

period not to exceed six (6) months from the expiration date; or

Must, if certification or licensure has expired for a period of greater than

six (6) months from the expiration date, comply with the provisions of

Section 5.2 of these rules (Initial Certification or Licensure), unless

exempted pursuant to Section 5.3.1.F below.

All certificates or licenses renewed by the Department shall be valid for three (3)

years from the date of issuance.

Date of issuance is the date of application approval by the Department, except,

for applicants successfully completing the renewal of certification or licensure

requirements during the last six (6) months prior to their certificate or license

expiration date, the date of issuance shall be the expiration date of the current

valid certificate or license being renewed.

If a certificate holder or licensee has made timely and sufficient application for

certification or license renewal and the Department fails to take action on the

application prior to the certificate’s or license’s expiration date, the existing

certification or license shall not expire until the Department acts upon the

application. The Department, in its sole discretion, shall determine whether the

application was timely and sufficient.

Certificate holders or licensees who have been called to federally funded active

duty for more than 120 days to serve in a war, emergency or contingency, shall

be exempt from the requirements of Sections 5.3.2.B.2 and 5.3.2.B.3 and 5.3.2.C

below, provided the holder’s certificate or license expired:

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ertificate holders or licensees who have been called to federally funded active

duty for more than 120 days to serve in a war, emergency or contingency, shall

be exempt from the requirements of Sections 5.3.2.B.2 and 5.3.2.B.3 and 5.3.2.C

below, provided the holder’s certificate or license expired:

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During the service, or

During the six months after the completion of service.

The Department may require appropriate documentation of service to determine

eligibility for this exemption.

5.3.2

Application for Renewal of Certification or Licensure

An applicant for renewal of a certification or license shall:

Submit to the Department a completed application form provided by the

Department, including the applicant’s signature in a form and manner as

determined by the Department;

Submit to the Department with a completed application form all of the following:

Evidence of compliance with criminal history record check requirements:

The applicant is not required to submit to a subsequent

fingerprint-based criminal history record check if the applicant

has lived in Colorado for more than three (3) years at the time of

renewal application and the applicant has submitted to a Federal

Bureau of Investigation (FBI) fingerprint-based national criminal

history record check at the time of initial certification or licensure

or at the time of a previous renewal of certification or licensure.

If the applicant has lived in Colorado for three (3) years or less at

the time of renewal application and submitted to an FBI

fingerprint-based criminal history record check at the time of

initial certification or licensure or a previous renewal of

certification or licensure, the applicant shall submit to another

FBI fingerprint-based national criminal history record check from

the Colorado Bureau of Investigation (CBI)

ved in Colorado for three (3) years or less at

the time of renewal application and submitted to an FBI

fingerprint-based criminal history record check at the time of

initial certification or licensure or a previous renewal of

certification or licensure, the applicant shall submit to another

FBI fingerprint-based national criminal history record check from

the Colorado Bureau of Investigation (CBI).

If, in accordance with Subparagraph b) above, an applicant has

twice submitted to a fingerprint-based criminal history record

check and the FBI or CBI has been unable to classify the

fingerprints, then the Department may accept a CBI and/or FBI

name-based criminal history report generated through the CBI.

If the results of the applicant’s fingerprint-based national criminal

history record check reveal a record of arrest without a

disposition, the applicant must submit to a name-based criminal

history record check as defined in Section 22-2-119.3(6)(d),

C.R.S.

Evidence of current and valid professional level Basic Cardiac Life

Support (CPR) course completion from a national or local organization

approved by the Department.

In addition to Paragraph 2) above, EMT-I and Paramedic applicants shall

submit evidence of current and valid Advanced Cardiac Life Support

(ACLS) course completion from a national or local organization approved

by the Department.

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from a national or local organization

approved by the Department.

In addition to Paragraph 2) above, EMT-I and Paramedic applicants shall

submit evidence of current and valid Advanced Cardiac Life Support

(ACLS) course completion from a national or local organization approved

by the Department.

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In addition to Paragraphs 2) and 3) above, an applicant for P-CC shall

submit evidence of current and valid Critical Care Paramedic or Flight

Paramedic Certification issued by the BCCTPC.

In addition to Paragraphs 2) and 3) above, applicants for P-CP shall

submit evidence of current and valid Community Paramedic Certification

issued by the IBSC.

Complete one of the following:

Except for an EMT-I, current and valid NREMT certification at or above

the EMS provider level being renewed. The Department will continue to

accept education hours consistent with Section 5.3.3 for renewal of EMT-

I providers in the State of Colorado notwithstanding the discontinuance

of the EMT-I exam by the NREMT.

Appropriate level refresher course as described in Section 5.3.3

conducted or approved through signature of a Department-recognized

EMS education program representative and skill competency as attested

to by signature of medical director or Department-recognized EMS

education program representative.

The minimum number of education hours as described in Section 5.3.3

completed or approved through signature of a Department-recognized

EMS education program representative and skill competency as attested

to by signature of medical director or Department-recognized EMS

education program representative

y signature of medical director or Department-recognized EMS

education program representative.

The minimum number of education hours as described in Section 5.3.3

completed or approved through signature of a Department-recognized

EMS education program representative and skill competency as attested

to by signature of medical director or Department-recognized EMS

education program representative.

5.3.3

Education Requirements to Renew a Certificate or License Without the Use of a Current

and Valid NREMT Certification

For renewal of a certificate or license without the use of a current and valid

NREMT certification, the following education is required:

Education required for the renewal of an EMT or AEMT certificate or

license shall be no less than thirty-six (36) hours and shall be completed

through one of the following:

A refresher course at the EMT or AEMT level conducted or

approved by a Department-recognized EMS education program

plus additional continuing education topics such that the total

education hours is no less than thirty-six (36) hours; or

Continuing education topics consisting of no less than thirty-six

(36) hours of education that is conducted or approved through a

Department-recognized EMS education program consisting of

the following minimum content requirements on the EMT or

AEMT level:

One (1) hour of preparatory content that may include

scene safety, quality improvement, health and safety of

EMS providers, or medical legal concepts.

ii)

Two (2) hours of obstetric patient assessment and

treatment.

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nsisting of

the following minimum content requirements on the EMT or

AEMT level:

One (1) hour of preparatory content that may include

scene safety, quality improvement, health and safety of

EMS providers, or medical legal concepts.

ii)

Two (2) hours of obstetric patient assessment and

treatment.

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iii)

Two (2) hours of pediatric patient assessment and

treatment.

iv)

Six (6) hours of trauma patient assessment and

treatment.

Five (5) hours of patient assessment.

vi)

Three (3) hours of airway assessment and management.

vii)

Six (6) hours of medical/behavioral emergency patient

assessment and management.

viii)

Eleven (11) hours of elective content that is relevant to

the practice of emergency medicine.

Education required for the renewal of an EMT-I or Paramedic certificate

or license shall be no less than fifty (50) hours and shall be completed

through one of the following methods:

A refresher course at the EMT-I or Paramedic level conducted or

approved by a Department-recognized EMS education program

plus additional continuing education topics such that the total

education hours is no less than fifty (50) hours.

Continuing education topics consisting of no less than fifty (50)

hours of education that is conducted or approved through a

Department-recognized EMS education program consisting of

the following minimum content requirements at the EMT-I or

Paramedic level:

No less than twenty-five (25) hours as described below:

Eight (8) hours of airway, breathing, and cardiology

assessment and treatment.

ii)

Four (4) hours of medical patient assessment and

treatment.

iii)

Three (3) hours of trauma patient assessment and

treatment.

iv)

Four (4) hours of obstetric patient assessment and

treatment.

Four (4) hours of pediatric patient assessment and

treatment

el:

No less than twenty-five (25) hours as described below:

Eight (8) hours of airway, breathing, and cardiology

assessment and treatment.

ii)

Four (4) hours of medical patient assessment and

treatment.

iii)

Three (3) hours of trauma patient assessment and

treatment.

iv)

Four (4) hours of obstetric patient assessment and

treatment.

Four (4) hours of pediatric patient assessment and

treatment.

vi)

Two (2) hours of operational tasks and no less than

twenty-five (25) hours of elective content that is relevant

to the practice of emergency medicine.

Education cannot be used in lieu of a valid and current BCCTPC Critical

Care or Flight Paramedic Certification to maintain the Critical Care

endorsement.

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Education cannot be used in lieu of current and valid Community

Paramedic certification issued by the IBSC.

5.3.4

In satisfaction of the requirements of Section 5.3.3 above, the Department may accept

continuing medical education, training, or service completed by a member of the armed

forces or reserves of the United States or the National Guard, military reserves or naval

militia of any state, upon presentation of satisfactory evidence by the applicant for

renewal of certification or licensure.

Satisfactory evidence may include but is not limited to the content of the

education, method of delivery, length of program, qualifications of the instructor

and method(s) used to evaluate the education provided

ted States or the National Guard, military reserves or naval

militia of any state, upon presentation of satisfactory evidence by the applicant for

renewal of certification or licensure.

Satisfactory evidence may include but is not limited to the content of the

education, method of delivery, length of program, qualifications of the instructor

and method(s) used to evaluate the education provided.

5.4

Licensure

5.4.1

On or after January 1, 2021, an individual applying for an initial license or an individual

who currently holds a valid Colorado Emergency Medical Service provider certificate who

wishes to convert the certificate to a license shall:

Submit one transcript establishing that the applicant has:

Completed a four-year bachelor’s degree program from an accredited

college or university in a field related to the health sciences; or

Completed a four-year bachelor’s degree program from an accredited

college or university in an equivalent field as set forth in Section 5.4.2.

An applicant seeking initial licensure from the department as an EMS provider

must also satisfy all requirements set forth in Section 5.2 of these rules.

An applicant seeking to convert certification to licensure, or who subsequently

seeks renewal of licensure from the Department as an EMS provider, shall

satisfy all requirements set forth in Section 5.3 of these rules.

5.4.2

A licensure applicant who seeks to establish that a four-year bachelor’s degree program

is in a field equivalent to the health sciences, as defined in Section 2.23, shall

demonstrate the following:

The successful completion of a four-year bachelor’s degree from an accredited

college or university; and

Successful completion of a minimum of forty (40) semester credit hours from one

or more of the following content areas, as contained in a single transcript:

Chemistry;

Biology;

Physics;

Mathematics;

Sociology;

Psychology;

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r’s degree from an accredited

college or university; and

Successful completion of a minimum of forty (40) semester credit hours from one

or more of the following content areas, as contained in a single transcript:

Chemistry;

Biology;

Physics;

Mathematics;

Sociology;

Psychology;

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Public health;

Anthropology;

Exercise science;

10)

Philosophy;

11)

Education;

12)

Emergency medical services;

13)

Fire science;

14)

Public safety;

15)

Business/finance; or

16)

Communications.

5.5

Provisional Certification or Licensure

5.5.1

General Requirements

The Department may issue a provisional certification or license to an applicant

whose fingerprint-based criminal history record check has not been received by

the Department at the time of application for certification or licensure.

To be eligible for a provisional certification or license, the applicant shall, at the

time of application, have satisfied all requirements in these rules for initial or

renewal certification or licensure.

A provisional certification or license shall be valid for not more than ninety (90)

days.

The Department may impose disciplinary sanctions pursuant to these rules if the

Department finds that a certificate or license holder who has received a

provisional certification or license has violated any of the certification or license

requirements or any of these rules.

Once a provisional certification or license becomes invalid, an applicant may not

practice or act as a certificate or license holder unless an initial or renewal

certification or license has been issued by the Department to the applicant.

5.5.2

Application for Provisional Certification or Licensure

An applicant for a provisional certification or license shall:

Submit to the Department a completed provisional certification or licensure

application

nvalid, an applicant may not

practice or act as a certificate or license holder unless an initial or renewal

certification or license has been issued by the Department to the applicant.

5.5.2

Application for Provisional Certification or Licensure

An applicant for a provisional certification or license shall:

Submit to the Department a completed provisional certification or licensure

application.

Submit to a fingerprint-based criminal history record check as provided in

Sections 5.2.2 and 5.3.2 of these rules. At the time of application, the applicant

shall have already submitted the required materials to the CBI to initiate the

fingerprint-based criminal history record check.

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Submit to the Department with a completed application form all of the following:

A fee in the amount of $23.00.

A name-based criminal history record check.

If the applicant has lived in Colorado for more than three (3)

years at the time of application, a name-based criminal history

report conducted by the CBI, including any internet-based

system on CBI’s website, or other name-based report as

determined by the Department.

If the applicant has lived in Colorado for three (3) years or less at

the time of application, a name-based criminal history report for

each state in which the applicant has lived for the past three (3)

years, conducted by the respective states’ bureaus of

investigation or equivalent state-level law enforcement agency,

or other name-based report as determined by the Department.

Any name-based criminal history report provided to the

Department for purposes of this Paragraph c) shall have been

obtained by the applicant not more than ninety (90) days prior to

the Department’s receipt of a completed application

ed by the respective states’ bureaus of

investigation or equivalent state-level law enforcement agency,

or other name-based report as determined by the Department.

Any name-based criminal history report provided to the

Department for purposes of this Paragraph c) shall have been

obtained by the applicant not more than ninety (90) days prior to

the Department’s receipt of a completed application.

Section 6 – Emergency Medical Responder Registration

6.1

General Requirements

6.1.1

An EMR may register with the Department on a voluntary basis by meeting registration

requirements included in this Section.

Registration is not required to perform as an EMR.

Registration provides recognition that an EMR has successfully completed the

training from a recognized education program, passed the NREMT EMR

examination, and undergone a fingerprint-based criminal history record check by

the Department.

6.1.2

No person shall hold himself or herself out as a registered EMR unless that person has

registered with the Department in accordance with this Section.

6.1.3

Registrations shall be effective for a period of three (3) years after the registration date.

The registration date is the date the Department approves the application.

6.2

Initial Registration

6.2.1

Applicants for initial registration shall be no less than sixteen (16) years of age at the time

of application.

6.2.2

Applicants for initial registration shall submit to the Department a completed application

provided by the Department, including the applicant’s signature in a form and manner as

determined by the Department, which contains the following:

Evidence of compliance with criminal history record check requirements:

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initial registration shall submit to the Department a completed application

provided by the Department, including the applicant’s signature in a form and manner as

determined by the Department, which contains the following:

Evidence of compliance with criminal history record check requirements:

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If the applicant has lived in Colorado for more than three (3) years at the

time of application, the applicant is required to submit to a fingerprint-

based criminal history record check generated by the CBI.

If the applicant has lived in Colorado for three (3) years or less at the

time of application, the applicant shall submit to a fingerprint-based

criminal history record check generated by the FBI and processed

through the CBI.

If, in accordance with Subparagraphs 1) or 2) above, an applicant has

twice submitted to a fingerprint-based criminal history record check and

the FBI or CBI has been unable to classify the fingerprints, then the

Department may accept a CBI and/or FBI name-based criminal history

report generated through the CBI.

If the results of the applicant’s fingerprint-based national criminal history

record check reveal a record of arrest without a disposition, the applicant

must submit to a name-based criminal history record check as defined in

Section 22-2-119.3(6)(d), C.R.S.

Proof of adequate training and education with a current and valid certification

from the NREMT at the EMR level.

Evidence of current and valid professional level basic CPR course completion

from a national or local organization approved by the Department.

6.3

Renewal of Registration

6.3.1

General Requirements

Upon the expiration of an EMR registration, the registration is no longer valid and

the individual shall not hold him or herself out as a registered EMR

tification

from the NREMT at the EMR level.

Evidence of current and valid professional level basic CPR course completion

from a national or local organization approved by the Department.

6.3

Renewal of Registration

6.3.1

General Requirements

Upon the expiration of an EMR registration, the registration is no longer valid and

the individual shall not hold him or herself out as a registered EMR.

Persons who have permitted their registration to expire:

May renew their registration by complying with the provisions of Section

6.3 of these rules (renewal of registration) for a period not to exceed six

(6) months from the expiration date; or

Must, if the registration has expired for a period of greater than six (6)

months from the expiration date, comply with the provisions of Section

6.2 of these rules (Initial Registration).

All registrations renewed by the Department shall be valid for three (3) years

from the date of registration.

Registration date is the date of renewal application approval by the Department,

except, for applicants successfully completing the renewal of registration

requirements during the last six (6) months prior to their registration expiration

date, the registration date shall be the expiration date of the current valid

registration being renewed.

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If a registered EMR has made timely and sufficient application for registration

renewal and the Department fails to take action on the application prior to the

registration’s expiration date, the existing registration shall not expire until the

Department acts upon the application. The Department, in its sole discretion,

shall determine whether the application was timely and sufficient

sion

If a registered EMR has made timely and sufficient application for registration

renewal and the Department fails to take action on the application prior to the

registration’s expiration date, the existing registration shall not expire until the

Department acts upon the application. The Department, in its sole discretion,

shall determine whether the application was timely and sufficient.

6.3.2

Application for Renewal of Registration

An Applicant For Registration Renewal Shall:

Submit to the Department a completed application form provided by the

Department, including the applicant’s signature in a form and manner as

determined by the Department;

Submit to the Department with a completed application form all of the following:

Evidence of compliance with criminal history record check requirements:

The applicant is not required to submit to a fingerprint-based

criminal history record check if the applicant has lived in

Colorado for more than three (3) years at the time of application

and the applicant has submitted to a fingerprint-based criminal

history record check through the CBI for a previous Colorado

EMR registration application.

If the applicant has lived in Colorado for more than three (3)

years at the time of application and has not submitted to a

fingerprint-based criminal history record check as described in

Subparagraph a) above, the applicant shall submit to a

fingerprint-based criminal history record check generated by the

CBI.

If the applicant has lived in Colorado for three (3) years or less at

the time of application, the applicant shall submit to a fingerprint-

based criminal history record check generated by the FBI

through the CBI.

If, in accordance with Subparagraphs b) or c) above, an

applicant has twice submitted to a fingerprint-based criminal

history record check and the FBI or CBI has been unable to

classify the fingerprints, then the Department may accept a CBI

and/or FBI name-based criminal history report generated through

the CBI

ngerprint-

based criminal history record check generated by the FBI

through the CBI.

If, in accordance with Subparagraphs b) or c) above, an

applicant has twice submitted to a fingerprint-based criminal

history record check and the FBI or CBI has been unable to

classify the fingerprints, then the Department may accept a CBI

and/or FBI name-based criminal history report generated through

the CBI.

If the results of the applicant’s fingerprint-based national criminal

history record check reveal a record of arrest without a

disposition, the applicant must submit to a name-based criminal

history record check as defined in Section 22-2-119.3(6)(d),

C.R.S.

Evidence of current and valid professional level basic CPR course

completion from a national or local organization approved by the

Department.

Complete one of the following training requirements:

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Current and valid NREMT certification at the EMR level.

Appropriate level refresher course as described in Section 6.3.3

conducted or approved through signature of a Department-recognized

EMR education program representative and skill competency as attested

to by signature of medical director or Department-recognized EMR

education program representative.

The minimum number of education hours as described in Section 6.3.3

completed or approved through signature of a Department-recognized

EMR education program representative and skill competency as attested

to by signature of medical director or Department-recognized EMR

education program representative

y signature of medical director or Department-recognized EMR

education program representative.

The minimum number of education hours as described in Section 6.3.3

completed or approved through signature of a Department-recognized

EMR education program representative and skill competency as attested

to by signature of medical director or Department-recognized EMR

education program representative.

6.3.3

Education Requirement to Renew a Registration without the Use of a Current and Valid

NREMT Certification

For renewal of a registration without the use of a current and valid NREMT EMR

certification, the following education is required:

Education required for the renewal of an EMR registration shall be no

less than twelve (12) hours and shall be completed through one of the

following:

A refresher course at the EMR level conducted or approved by a

Department-recognized EMR education program plus additional

continuing education topics such that the total education hours is

no less than twelve (12) hours.

Continuing education topics consisting of no less than twelve

(12) hours of education that is conducted or approved through a

Department-recognized EMR education program consisting of

the following minimum content requirements:

One (1) hour of preparatory content that may include

scene safety, quality improvement, health and safety of

EMRs, or medical legal concepts

ii)

Two (2) hours of airway assessment and management

iii)

Two (2) hours of patient assessment

iv)

Three (3) hours of circulation topics

Three (3) hours of illness and injury topics

vi)

One (1) hour of childbirth and pediatric topics

6.4

Provisional Registration

6.4.1

General Requirements

The Department may issue a provisional registration to an applicant whose

fingerprint-based criminal history record check has not been received by the

Department at the time of application for registration.

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f childbirth and pediatric topics

6.4

Provisional Registration

6.4.1

General Requirements

The Department may issue a provisional registration to an applicant whose

fingerprint-based criminal history record check has not been received by the

Department at the time of application for registration.

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To be eligible for a provisional registration, the applicant shall, at the time of

application, have satisfied all requirements in these rules for initial or renewal

registration.

A provisional registration shall be valid for not more than ninety (90) days.

The Department may impose disciplinary sanctions pursuant to these rules if the

Department finds that an EMR who has received a provisional registration has

violated any requirements for registration or any of these rules.

Once a provisional registration becomes invalid, an applicant may not hold him or

herself out as a registered EMR unless an initial or renewal registration has been

issued by the Department to the applicant.

6.4.2

Application for Provisional Registration

An applicant for a provisional registration shall:

Submit to the Department a completed provisional registration application.

Submit to a fingerprint-based criminal history record check as provided in

Sections 6.2.2 and 6.3.2 of these rules. At the time of application, the applicant

shall have already submitted the required materials to the CBI to initiate the

fingerprint-based criminal history record check

a provisional registration shall:

Submit to the Department a completed provisional registration application.

Submit to a fingerprint-based criminal history record check as provided in

Sections 6.2.2 and 6.3.2 of these rules. At the time of application, the applicant

shall have already submitted the required materials to the CBI to initiate the

fingerprint-based criminal history record check.

Submit to the Department with a completed application form, a fee in the amount

of $23.00 and either:

A name-based criminal history report conducted by the CBI, including a

criminal history report from an internet-based system on CBI’s website,

or other name-based report as determined by the Department if the

applicant has lived in Colorado for more than three (3) years at the time

of application; or

A name-based criminal history report for each state in which the

applicant has lived for the past three (3) years, conducted by the

respective states’ bureaus of investigation or equivalent state-level law

enforcement agency, or other name-based report as determined by the

Department if the applicant has lived in Colorado for three (3) years or

less at the time of application.

Ensure the name-based criminal history report provided to the Department shall

have been obtained by the applicant not more than ninety (90) days prior to the

Department’s receipt of a completed application.

Section 7 – Disciplinary Sanctions and Appeal Procedures for EMS Provider Certification, EMS

Provider Licensure, or EMR Registration

7.1

For good cause, the Department may deny, revoke, suspend, limit, modify, or refuse to renew an

EMS provider certificate or license or EMR registration, may impose probation on an EMS

provider certificate holder, licensee, or registration holder, or may issue a letter of admonition in

accordance with the State Administrative Procedure Act, Section 24-4-101, et seq., C.R.S.

7.2

Good cause for disciplinary sanctions listed above shall include, but not be limited to:

dify, or refuse to renew an

EMS provider certificate or license or EMR registration, may impose probation on an EMS

provider certificate holder, licensee, or registration holder, or may issue a letter of admonition in

accordance with the State Administrative Procedure Act, Section 24-4-101, et seq., C.R.S.

7.2

Good cause for disciplinary sanctions listed above shall include, but not be limited to:

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7.2.1

Failing to meet the requirements of these rules pertaining to issuance and renewal of

certification, licensure, or registration.

7.2.2

Engaging in fraud, misrepresentation, or deception when applying for or securing

certification, licensure, or registration.

7.2.3

Aiding and abetting in the procurement of certification, licensure, or registration for any

person not eligible for certification, licensure, or registration.

7.2.4

Utilizing NREMT certification that has been illegally obtained, suspended or revoked, to

obtain a state certification, licensure, or registration.

7.2.5

Unlawfully using, possessing, dispensing, administering, or distributing controlled

substances.

7.2.6

Driving an emergency vehicle in a reckless manner, or while under the influence of

alcohol or other performance altering substances.

7.2.7

Responding to or providing patient care while under the influence of alcohol or other

performance altering substances.

7.2.8

Demonstrating a pattern of alcohol or other substance abuse.

7.2.9

Materially altering any Department certificate, license, or registration, or using and/or

possessing any such altered certificate, license, or registration.

7.2.10 Having any certificate, license, or registration related to patient care suspended or

revoked in Colorado or in another state or country.

7.2.11 Unlawfully discriminating in the provision of services.

7.2.12 Representing qualifications at any level other than the person's current EMS provider

certification or licensure level

possessing any such altered certificate, license, or registration.

7.2.10 Having any certificate, license, or registration related to patient care suspended or

revoked in Colorado or in another state or country.

7.2.11 Unlawfully discriminating in the provision of services.

7.2.12 Representing qualifications at any level other than the person's current EMS provider

certification or licensure level.

7.2.13 Representing oneself to others as a certificate or license holder or providing medical care

without possessing a current and valid certificate or license issued by the Department.

7.2.14 Representing oneself to others as a registered EMR without being currently registered

with the Department.

7.2.15 Failing to follow accepted standards of care in the management of a patient, or in

response to a medical emergency.

7.2.16 Failing to administer medications or treatment in a responsible manner in accordance

with the medical director's orders or protocols.

7.2.17 Failing to maintain confidentiality of patient information.

7.2.18 Failing to provide the Department with the current place of residence or failing to promptly

notify the Department of a change in current place of residence or change of name.

7.2.19 Engaging in a pattern of behavior that demonstrates routine response to medical

emergencies without being under the policies and procedures of a designated emergency

medical response agency and/or providing patient care without medical direction when

required.

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of residence or change of name.

7.2.19 Engaging in a pattern of behavior that demonstrates routine response to medical

emergencies without being under the policies and procedures of a designated emergency

medical response agency and/or providing patient care without medical direction when

required.

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7.2.20 Performing medical acts not authorized by the Rules Pertaining to EMS Practice and

Medical Director Oversight and in the absence of other lawful authorization to perform

such medical acts.

7.2.21 Performing medical acts requiring an EMS provider certification or license while holding

only a valid EMR registration.

7.2.22 Failing to provide care or discontinuing care when a duty to provide care has been

established.

7.2.23 Appropriating or possessing without authorization medications, supplies, equipment, or

personal items of a patient or employer.

7.2.24 Falsifying entries or failing to make essential entries in a patient care report, EMS or EMR

education document, or medical record.

7.2.25 Falsifying or failing to comply with any collection or reporting required by the state.

7.2.26 Failing to comply with the terms of any agreement or stipulation regarding certification,

licensure, or registration entered into with the Department.

7.2.27 Violating any state or federal statute or regulation, the violation of which would jeopardize

the health or safety of a patient or the public.

7.2.28 Engaging in unprofessional conduct at the scene of an emergency that hinders, delays,

eliminates, or deters the provision of medical care to the patient or endangers the safety

of the public.

7.2.29 Failure by a certificate or license holder or registered EMR to report to the Department

any violation by another certificate or license holder or registered EMR of the good cause

provisions of this Section when the certificate or license holder knows or reasonably

believes a violation has occurred

or deters the provision of medical care to the patient or endangers the safety

of the public.

7.2.29 Failure by a certificate or license holder or registered EMR to report to the Department

any violation by another certificate or license holder or registered EMR of the good cause

provisions of this Section when the certificate or license holder knows or reasonably

believes a violation has occurred.

7.2.30 Committing or permitting, aiding or abetting the commission of an unlawful act that

substantially relates to performance of a certificate or license holder or registered EMR’s

duties and responsibilities as determined by the Department.

7.2.31 Committing patient abuse including the willful infliction of injury, unreasonable

confinement, intimidation, or punishment, with resulting physical harm, pain, or mental

anguish, or patient neglect, including the failure to provide goods and services necessary

to attain and maintain physical and mental well-being.

7.2.32 With respect to EMS certificate holders and licensees, failing to attend or complete a peer

health assistance program as provided in Section 25-3.5-208(9), C.R.S.

7.2.33 Holding oneself out as a certificate holder or licensee after certification or licensure has

expired, except as provided in Section 5.3.1.A, including offering or performing, whether

or not for compensation, either any services included in these rules or any authorized

acts permitted by the Rules Pertaining to EMS Practice and Medical Director Oversight.

7.3

Good cause for disciplinary sanctions also includes conviction of, or a plea of guilty, or of no

contest, to a felony or misdemeanor that relates to the duties and responsibilities of a certificate,

license or registration holder, including patient care and public safety. For purposes of this

Paragraph, “conviction” includes the imposition of a deferred sentence.

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or a plea of guilty, or of no

contest, to a felony or misdemeanor that relates to the duties and responsibilities of a certificate,

license or registration holder, including patient care and public safety. For purposes of this

Paragraph, “conviction” includes the imposition of a deferred sentence.

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7.3.1

The following crimes set forth in the Colorado Criminal Code (Title 18, C.R.S.) are

considered to relate to the duties and responsibilities of a certificate or license holder:

Offenses under Article 3 - offenses against a person.

Offenses under Article 4 - offenses against property.

Offenses under Article 5 - offenses involving fraud.

Offenses under Article 6 - offenses involving the family relations.

Offenses under Article 6.5 - wrongs to at-risk adults.

Offenses under Article 7 - offenses related to morals.

Offenses under Article 8 - offenses - governmental operations.

Offenses under Article 9 - offenses against public peace, order and decency.

Offenses under Article 17 - Colorado Organized Crime Control Act.

Offenses under Article 18 - Uniform Controlled Substances Act of 2013.

7.3.2

The offenses listed above are not exclusive. The Department may consider other pleas or

criminal convictions, including those from other state, federal, foreign or military

jurisdictions.

7.3.3

In determining whether to impose disciplinary sanctions based on a plea or on a felony or

misdemeanor conviction, the Department may consider, but is not limited to, the following

information:

The nature and seriousness of the crime including but not limited to whether the

crime involved violence to or abuse of another person and whether the crime

involved a minor or a person of diminished capacity;

The relationship of the crime to the purposes of requiring a certificate, license, or

registration;

The relationship of the crime to the ability, capacity or fitness required to perform

the duties and di

ousness of the crime including but not limited to whether the

crime involved violence to or abuse of another person and whether the crime

involved a minor or a person of diminished capacity;

The relationship of the crime to the purposes of requiring a certificate, license, or

registration;

The relationship of the crime to the ability, capacity or fitness required to perform

the duties and discharge the responsibilities of a certified or licensed EMS

provider or registered EMR; and

The time frame in which the crime was committed.

7.4

Appeals

7.4.1

If the Department denies certification, licensure, or registration, the Department shall

provide the applicant with notice of the grounds for denial and shall inform the applicant

of the applicant’s right to request a hearing.

A request for a hearing shall be submitted to the Department in writing within

sixty (60) calendar days from the date of the notice.

If a request for a hearing is made, the hearing shall be conducted in accordance

with the State Administrative Procedure Act, Section 24-4-101, et seq., C.R.S.

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If the applicant does not request a hearing in writing within sixty (60) calendar

days from the date of the notice, the applicant is deemed to have waived the

opportunity for a hearing.

7.4.2

If the Department proposes disciplinary sanctions as provided in this Section, the

Department shall notify the certificate, license, or registration holder by first class mail to

the last address furnished to the Department by the certificate, license, or registration

holder. The notice shall state the alleged facts and/or conduct warranting the proposed

action and state that the certificate, license, or registration holder may request a hearing.

The certificate, license, or registration holder shall file a written answer within

thirty (30) calendar days of the date of mailing of the notice

ished to the Department by the certificate, license, or registration

holder. The notice shall state the alleged facts and/or conduct warranting the proposed

action and state that the certificate, license, or registration holder may request a hearing.

The certificate, license, or registration holder shall file a written answer within

thirty (30) calendar days of the date of mailing of the notice.

A request for a hearing shall be submitted to the Department in writing within

thirty (30) calendar days from the date of mailing of the notice.

If a request for a hearing is made, the hearing shall be conducted in accordance

with the State Administrative Procedure Act, Section 24-4-101, et seq., C.R.S.

If the certificate, license, or registration holder does not request a hearing in

writing within thirty (30) calendar days of the date of mailing of the notice, the

certificate, license, or registration holder is deemed to have waived the

opportunity for a hearing.

7.4.3

If the Department summarily suspends a certificate, license, or registration, the

Department shall provide the certificate, license, or registration holder notice of such in

writing, which shall be sent by first class mail to the last address furnished to the

Department by the certificate, license, or registration holder. The notice shall state that

the certificate, license, or registration holder is entitled to a prompt hearing on the matter.

The hearing shall be conducted in accordance with the State Administrative Procedure

Act, Section 24-4-101, et seq., C.R.S.

7.4.4

If the Department summarily suspends the certification or license of any EMS provider

pursuant to Section 25-3.5-208(9), C.R.S., and Section 7.2.32 of these rules, the EMS

provider may submit a written request to the Department for a formal hearing. The written

request must be submitted within two (2) days after receiving notice of the suspension

cedure

Act, Section 24-4-101, et seq., C.R.S.

7.4.4

If the Department summarily suspends the certification or license of any EMS provider

pursuant to Section 25-3.5-208(9), C.R.S., and Section 7.2.32 of these rules, the EMS

provider may submit a written request to the Department for a formal hearing. The written

request must be submitted within two (2) days after receiving notice of the suspension.

The certificate or license holder shall have the burden of proving that the certificate or

license holder's certification or licensure should not be suspended. The hearing shall be

conducted in accordance with Section 24-4-105, C.R.S.

Section 8 – Incorporation by Reference

8.1

These rules incorporate by reference:

8.1.1

The Commission on Accreditation of Allied Health Education Programs (CAAHEP)

Standards and Guidelines for the Accreditation of Educational Programs in the

Emergency Medical Services Professions as revised in 2015; and

8.1.2

United States Department of Education, Institute of Education Sciences, National Center

For Education Statistics, Classification of Instructional Programs (CIP-2020).

‘

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8.2

Such incorporation does not include later amendments to or editions of the referenced material.

The Health Facilities and Emergency Medical Services Division of the Department maintains

copies of the incorporated material for public inspection during regular business hours, and shall

provide certified copies of any non-copyrighted material to the public at cost upon request

rvices Division

8.2

Such incorporation does not include later amendments to or editions of the referenced material.

The Health Facilities and Emergency Medical Services Division of the Department maintains

copies of the incorporated material for public inspection during regular business hours, and shall

provide certified copies of any non-copyrighted material to the public at cost upon request.

Information regarding how the incorporated material may be obtained or examined is available

from the Division by contacting:

EMTS Branch Chief

Health Facilities and EMS Division

Colorado Department of Public Health and Environment

4300 Cherry Creek Drive South

Denver, CO 80246-1530

8.3

The incorporated material may be obtained at no cost from the websites of:

8.3.1

The Committee on Accreditation of Education Programs for the Emergency Medical

Services Professions at https://coaemsp.org/caahep-standards-and-guidelines#1; and

8.3.2

United States Department of Education, Institute of Education Sciences, National Center

for Education Statistics, Classification of Instructional Programs (CIP-2020) at

https://nces.ed.gov/ipeds/cipcode/cipdetail.aspx?y=55&cipid=88742

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CHAPTER TWO – RULES PERTAINING TO EMS PRACTICE AND MEDICAL DIRECTOR

OVERSIGHT

Adopted by the Chief Medical Officer on October 29, 2021. Effective December 30, 2021.

SECTION 1 – Purpose and Authority for Establishing Rules

1.1

These rules define the authorized medical acts of Emergency Medical Service (EMS) providers in

the settings in which they may practice: prehospital, as defined by Sections 25-3.5-206(5)(b) and

25-3.5-209, C.R.S. and these rules; out-of-hospital, as defined by 6 CCR 1011-3 and these rules;

and clinical, as defined by Section 25-3.5-207(1)(a), C.R.S and these rules.

1.2

These rules also define medical director qualifications and duties within EMS agencies,

Community Integrated Health Care Service (CIHCS) agencies, and clinical settings

hospital, as defined by Sections 25-3.5-206(5)(b) and

25-3.5-209, C.R.S. and these rules; out-of-hospital, as defined by 6 CCR 1011-3 and these rules;

and clinical, as defined by Section 25-3.5-207(1)(a), C.R.S and these rules.

1.2

These rules also define medical director qualifications and duties within EMS agencies,

Community Integrated Health Care Service (CIHCS) agencies, and clinical settings. These rules

apply to any physician functioning as a medical director in these settings.

1.3

These rules also define the duties of medical supervisors of EMS providers in the clinical setting.

1.4

The general authority for the promulgation of these rules by the executive director or chief

medical officer of the Department is set forth in Sections 25-3.5-203, 206, and 207, C.R.S.

SECTION 2 – Definitions

2.1

All definitions that appear in Sections 25-3.5-103, 25-3.5-205 – 207, C.R.S., and 6 CCR 1015-3,

Chapter One shall apply to these rules. Unless otherwise stated, the definitions in this section

shall apply to:

2.1.1

Prehospital and Interfacility Transport settings,

2.1.2

CIHCS (Out- of- Hospital) settings, and

2.1.3

Clinical settings.

2.2

“Advanced Cardiac Life Support (ACLS)” - a course of instruction designed to prepare students in

the practice of advanced emergency cardiac care.

2.3

“Advanced Emergency Medical Technician (AEMT)” - an individual who has a current and valid

AEMT certificate or license issued by the Department and who is authorized to provide limited

acts of advanced emergency medical care in accordance with these rules.

2.4

“Care Coordination” - the deliberate organization of patient care activities between two or more

participants, including the patient, involved in the patient’s care to facilitate the appropriate

delivery of medical care services.

2.5

“Certificate” - designation as having met the requirements of Section 5 of Chapter One, 6 CCR

1015-3, issued to an individual by the Department

with these rules.

2.4

“Care Coordination” - the deliberate organization of patient care activities between two or more

participants, including the patient, involved in the patient’s care to facilitate the appropriate

delivery of medical care services.

2.5

“Certificate” - designation as having met the requirements of Section 5 of Chapter One, 6 CCR

1015-3, issued to an individual by the Department. Certification is equivalent to licensure for

purposes of the State Administrative Procedure Act, Section 24-4-101, et seq., C.R.S.

2.6

“Clinical Medical Director” - for purposes of these rules, a physician licensed in Colorado and in

good standing who determines, authorizes, and directs, through protocols, standing orders, and

operational policies or procedures developed by the facility’s medical staff, the medical acts

performed by EMS providers in a clinical setting. The clinical medical director is also responsible

for assuring the competency of the performance of those acts by EMS providers as described in

the Facility’s Medical Continuous Quality Improvement Program.

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2.7

“Clinical Setting” - a health care facility licensed or certified by the Department pursuant to

Section 25-1.5-103(1)(a), C.R.S.

2.8

“Colorado Medical Board” - the Colorado Medical Board established in Title 12, Article 240,

C.R.S.

2.9

“Community Integrated Health Care Service (CIHCS)” - the provision of certain out-of-hospital

medical services that a Community Paramedic may provide and may include:

2.9.1

Services authorized pursuant to Section 25-3.5-1203(3), C.R.S.

2.9.2

Services authorized pursuant to 6 CCR 1011-3, Standards for Community Integrated

Health Care Service Agencies.

2.9.3

Services authorized under the scope of practice as set forth in this chapter.

2.9.4

Services authorized pursuant to Section 25-3.5-206(4)(a.5)(II), C.R.S

hat a Community Paramedic may provide and may include:

2.9.1

Services authorized pursuant to Section 25-3.5-1203(3), C.R.S.

2.9.2

Services authorized pursuant to 6 CCR 1011-3, Standards for Community Integrated

Health Care Service Agencies.

2.9.3

Services authorized under the scope of practice as set forth in this chapter.

2.9.4

Services authorized pursuant to Section 25-3.5-206(4)(a.5)(II), C.R.S.

2.10

“Community Integrated Health Care Service Agency (CIHCS Agency)” - a sole proprietorship,

partnership, corporation, nonprofit entity, special district, governmental unit or agency, or licensed

or certified health care facility that is subject to regulation under Article 1.5 or 3 of Title 25, C.R.S.,

that manages and offers, directly or by contract, community integrated health care services.

2.11

“CIHCS Agency Medical Director” - as used in these rules, means a Colorado licensed physician

in good standing who is identified as being responsible for supervising, directing, and assuring

the competency of those individuals who are employed by or contracted with the CIHCS Agency

to perform community integrated health care services on behalf of the agency.

2.12

“Consumer” - an individual receiving community integrated health care services.

2.13

“Consumer Service Plan” - the approved written plan specific to each consumer receiving CIHCS

in a series of visits that: identifies the consumer’s physical, medical, social, mental health, and/or

environmental needs, as necessary; sets forth the out-of-hospital medical services the CIHCS

Agency agrees to provide to the consumer; and is overseen by the CIHCS Agency medical

director.

2.14

“Department” - the Colorado Department of Public Health and Environment

o each consumer receiving CIHCS

in a series of visits that: identifies the consumer’s physical, medical, social, mental health, and/or

environmental needs, as necessary; sets forth the out-of-hospital medical services the CIHCS

Agency agrees to provide to the consumer; and is overseen by the CIHCS Agency medical

director.

2.14

“Department” - the Colorado Department of Public Health and Environment.

2.15

“Direct Verbal Order” - verbal authorization given by a physician to an EMS provider for the

performance of specific medical acts through a Medical Base Station or in person; or in a clinical

setting, given by a physician contemporaneous to when a patient is receiving treatment or by a

medical supervisor as an instruction based on a physician order.

2.16

“Emergency Medical Practice Advisory Council (EMPAC)” - the council established pursuant to

Section 25-3.5-206, C.R.S. that is responsible for advising the Department regarding the

appropriate scope of practice for EMS providers and for the criteria for physicians to serve as

EMS agency medical directors, CIHCS Agency medical directors or clinical medical directors.

2.17

“Emergency Medical Technician (EMT)” - an individual who has a current and valid EMT

certificate or license issued by the Department and who is authorized to provide basic emergency

medical care in accordance with these rules.

2.18

“Emergency Medical Technician with Intravenous Authorization (EMT-IV)” - an individual who has

a current and valid EMT certificate or license issued by the Department and who has met the

conditions defined in Section 6.6 of these rules.

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ic emergency

medical care in accordance with these rules.

2.18

“Emergency Medical Technician with Intravenous Authorization (EMT-IV)” - an individual who has

a current and valid EMT certificate or license issued by the Department and who has met the

conditions defined in Section 6.6 of these rules.

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2.19

“Emergency Medical Technician-Intermediate (EMT-I)” - an individual who has a current and valid

EMT-Intermediate certificate or license issued by the Department and who is authorized to

provide limited acts of advanced emergency medical care in accordance with these rules.

2.20

“EMS Agency Medical Director” - for purposes of these rules, means a physician licensed in

Colorado and in good standing who authorizes and directs, through protocols and standing

orders, the performance of students-in-training enrolled in Department-recognized EMS

education programs, Graduate AEMTs, EMT-Is, or Paramedics, or EMS providers of a

prehospital EMS service agency and who is specifically identified as being responsible to assure

the competency of the performance of those acts by such EMS providers as described in the

physician’s medical CQI program.

2.21

“EMS Provider” - means an individual who holds a valid emergency medical service provider

certificate or license issued by the Department and includes Emergency Medical Technician,

Advanced Emergency Medical Technician, Emergency Medical Technician-Intermediate, and

Paramedic.

2.22

“EMS Service Agency or EMS Agency” - any organized agency including but not limited to a

“rescue unit” as defined in Section 25-3.5-103(11), C.R.S., using EMS providers to render initial

emergency medical care to a patient prior to or during transport. This definition does not include

criminal law enforcement agencies, unless the criminal law enforcement personnel are EMS

providers who function with a “rescue unit” as defined in Section 25-3.5-103(11), C.R.S

uding but not limited to a

“rescue unit” as defined in Section 25-3.5-103(11), C.R.S., using EMS providers to render initial

emergency medical care to a patient prior to or during transport. This definition does not include

criminal law enforcement agencies, unless the criminal law enforcement personnel are EMS

providers who function with a “rescue unit” as defined in Section 25-3.5-103(11), C.R.S. or are

performing any medical act described in these rules.

2.23

“Graduate Advanced EMT” - an individual who has a current and valid Colorado EMT certification

or license issued by the Department and who has successfully completed a Department-

recognized AEMT initial course but has not yet successfully completed the certification or

licensing requirements set forth in the Rules Pertaining to EMS and EMR Education, EMS

Certification or Licensure, and EMR Registration, 6 CCR 1015-3, Chapter One, for the AEMT

level.

2.24

“Graduate Paramedic” - an individual who has a current and valid Colorado EMT certificate or

license, AEMT certificate or license, or EMT-I certificate or license issued by the Department and

who has successfully completed a Department-recognized Paramedic initial course but has not

yet successfully completed the certification or licensing requirements set forth in the Rules

Pertaining to EMS and EMR Education, EMS Certification and Licensure, and EMR Registration,

6 CCR 1015-3, Chapter One for the Paramedic level.

2.25

“In-Scope Tasks and Procedures” - tasks and procedures performed by an EMS provider within

the EMS provider’s scope of practice in a clinical setting as set forth in these rules.

2.26

“Interfacility Transport” - any transport of a patient from one licensed healthcare facility to another

licensed healthcare facility, after a higher level medical care provider (i.e., a physician, physician

assistant, or an individual of similar/equivalent training, certification, licensing, and patient

interaction) has initiated treatment

ce in a clinical setting as set forth in these rules.

2.26

“Interfacility Transport” - any transport of a patient from one licensed healthcare facility to another

licensed healthcare facility, after a higher level medical care provider (i.e., a physician, physician

assistant, or an individual of similar/equivalent training, certification, licensing, and patient

interaction) has initiated treatment.

2.27

“International Board of Specialty Certification (IBSC)” - a non-profit organization that develops

and administers a national Community Paramedic certification exam.

2.28

“Licensed in Good Standing” - as used in these rules, means that a physician functioning as a

medical director, or a physician, physician assistant, advanced practice nurse, or registered nurse

functioning as a medical supervisor, holds a current and valid Colorado license to practice the

applicable profession.

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2.29

“Maintenance” - to observe the patient while continuing, assessing, adjusting, and/or

discontinuing care of a previously established medical procedure or medication via standing

order, written physician order, or the direct verbal order of a physician.

2.30

“Medical Acts”- as used in these rules, means the tasks, medications, or procedures that an EMS

provider is authorized to perform or administer within the EMS provider’s applicable scope of

practice including in-scope tasks and procedures in a clinical setting.

2.31

“Medical Base Station” - the source of direct medical communications with EMS providers

the direct verbal order of a physician.

2.30

“Medical Acts”- as used in these rules, means the tasks, medications, or procedures that an EMS

provider is authorized to perform or administer within the EMS provider’s applicable scope of

practice including in-scope tasks and procedures in a clinical setting.

2.31

“Medical Base Station” - the source of direct medical communications with EMS providers.

2.32

“Medical Direction” - may include, but is not limited to, the following duties:

2.32.1 Approval of the medical components of treatment protocols and appropriate prearrival

instructions;

2.32.2 Routine review of program performance and maintenance of active involvement in quality

improvement activities, including access to prehospital recordings as necessary for the

evaluation of care;

2.32.3 Authority to recommend appropriate changes to protocols for the improvement of patient

care;

2.32.4 Provision of oversight for the ongoing education, training, and quality assurance of EMS

providers as appropriate for the medical acts being performed in the prehospital, out-of-

hospital, or clinical setting in which the EMS provider is practicing; and

2.32.5 Reporting of any misconduct by certified or licensed EMS providers that the medical

director knows or reasonably believes has occurred.

2.33

“Medical Supervision” - the oversight, guidance, and instructions that a medical supervisor

provides to an EMS provider in a clinical setting, as defined in Section 25-3.5-207(1)(d), C.R.S.

and these rules.

2.34

“Medical Supervisor” - in a clinical setting, means a Colorado licensed physician, physician

assistant, advanced practice nurse, or registered nurse.

2.35

“Monitoring” - to observe and detect changes, or the absence of changes, in the clinical status of

the patient for the purpose of documentation

provider in a clinical setting, as defined in Section 25-3.5-207(1)(d), C.R.S.

and these rules.

2.34

“Medical Supervisor” - in a clinical setting, means a Colorado licensed physician, physician

assistant, advanced practice nurse, or registered nurse.

2.35

“Monitoring” - to observe and detect changes, or the absence of changes, in the clinical status of

the patient for the purpose of documentation.

2.36

“Out-of-hospital Medical Services” - services performed by a Paramedic with a Community

Paramedic endorsement, including the initial assessment of the patient and any subsequent

assessments, as needed; the furnishing of medical treatment and interventions; care

coordination; resource navigation; patient education; medication inventory, compliance and

administration; gathering of laboratory and diagnostic data; nursing services; rehabilitative

services; complementary health services; as well as the furnishing of other necessary services

and goods for the purpose of preventing, alleviating, curing, or healing human illness, physical

disability, physical injury; alcohol, drug, or controlled substance abuse; behavioral health services

that may be provided in an out-of-hospital setting; and the medical acts identified in Appendix G

of these rules. Out-of-hospital medical services cannot be provided or performed in the

prehospital setting.

2.37

“Paramedic” - for purposes of this Chapter Two, an individual who has a current and valid

Paramedic certificate or license issued by the Department and who is authorized to provide

advanced emergency medical care in a prehospital or clinical setting in accordance with these

rules.

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tal setting.

2.37

“Paramedic” - for purposes of this Chapter Two, an individual who has a current and valid

Paramedic certificate or license issued by the Department and who is authorized to provide

advanced emergency medical care in a prehospital or clinical setting in accordance with these

rules.

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2.38

“Paramedic with Community Paramedic Endorsement (P-CP)” - an individual who has a current

and valid Paramedic certificate or license issued by the Department and who has met the

requirements in these rules to obtain a Community Paramedic endorsement from the Department

and is authorized to provide acts in accordance with these rules relating to community integrated

health care services, and as set forth in Sections 25-3.5-206, C.R.S., and 25-3.5-1301, et seq.,

C.R.S.

2.39

“Paramedic with Critical Care Endorsement (P-CC)” - an individual who has a current and valid

Paramedic certificate or license issued by the Department and who has met the requirements in

these rules to obtain a Critical Care endorsement from the Department and is authorized to

provide acts in accordance with conditions defined in these rules relating to critical care and as

set forth in Section 25-3.5-206, C.R.S.

2.40

“Point of Care Testing (POCT)” - medical diagnostic testing performed outside the clinical

laboratory in close proximity to where the patient is receiving care, the results of which are used

for clinical decision-making.

2.41

“Prehospital Care” - any medical acts performed prior to a patient receiving care at a licensed

healthcare facility.

2.42

“Prehospital Setting” - means one of the following settings in which an EMS provider performs

patient care, which care is subject to medical direction by an EMS agency medical director at the

site of an emergency, during emergency transport, or during interfacility transport

“Prehospital Care” - any medical acts performed prior to a patient receiving care at a licensed

healthcare facility.

2.42

“Prehospital Setting” - means one of the following settings in which an EMS provider performs

patient care, which care is subject to medical direction by an EMS agency medical director at the

site of an emergency, during emergency transport, or during interfacility transport.

2.43

“Protocol” - written standards for patient medical assessment and management approved by a

medical director.

2.44

“Scope of Practice” - refers to the tasks, medications, and procedures (medical acts) that an EMS

provider is authorized to perform or administer in accordance with Sections 25-3.5-203 and 25-

3.5-206, C.R.S., and rules promulgated pursuant to those sections.

2.45

“State Emergency Medical and Trauma Services Advisory Council (SEMTAC)” - a council created

in the Department pursuant to Section 25-3.5-104, C.R.S., that advises the Department on all

matters relating to emergency medical and trauma services.

2.46

“Standing Order” - written authorization provided in advance by a medical director for the

performance of specific medical acts by EMS.

2.47

“Supervision” - as applicable to physician medical direction, means the oversight, direction, or

medical management that the medical director provides to an EMS provider in any setting.

Supervision may be through direct observation or by indirect oversight as defined in the medical

director’s CQI program.

2.48

“Waiver” - a Department-approved exception to these rules granted to an EMS agency medical

director.

2.49

“Written Order” - written authorization that a physician issues to an EMS provider for the

performance of specific medical acts.

SECTION 3 – Emergency Medical Practice Advisory Council

3.1

The Emergency Medical Practice Advisory Council (EMPAC), under the direction of the executive

director of the Department, shall advise the Department in the areas set forth below in Section

3.8.

director.

2.49

“Written Order” - written authorization that a physician issues to an EMS provider for the

performance of specific medical acts.

SECTION 3 – Emergency Medical Practice Advisory Council

3.1

The Emergency Medical Practice Advisory Council (EMPAC), under the direction of the executive

director of the Department, shall advise the Department in the areas set forth below in Section

3.8.

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3.2

The EMPAC shall consist of the following thirteen members:

3.2.1

Ten voting members appointed by the governor as follows:

Two physicians licensed in good standing in Colorado who are actively serving

as EMS agency medical directors and are practicing in rural or frontier counties;

Two physicians licensed in good standing in Colorado who are actively serving

as EMS agency medical directors and are practicing in urban counties;

One physician licensed in good standing in Colorado who is actively serving as

an EMS agency medical director in any area of the state;

One EMS provider certified or licensed at an advanced life support level who is

actively involved in the provision of emergency medical services;

One EMS provider certified or licensed at a basic life support level who is actively

involved in the provision of emergency medical services; and

One EMS provider certified or licensed at any level who is actively involved in the

provision of emergency medical services;

One clinical psychiatrist licensed in good standing in Colorado who is

recommended by a statewide association of psychiatrists;

One anesthesiologist licensed in good standing in Colorado who is

recommended by a statewide association of anesthesiologists;

3.2.2

One voting member who is a member of the SEMTAC, appointed by the executive

director of the Department; and

3.2.3

Two nonvoting ex officio members appointed by the executive director of the Department.

3.3

EMPAC members shall serve four-year terms

f psychiatrists;

One anesthesiologist licensed in good standing in Colorado who is

recommended by a statewide association of anesthesiologists;

3.2.2

One voting member who is a member of the SEMTAC, appointed by the executive

director of the Department; and

3.2.3

Two nonvoting ex officio members appointed by the executive director of the Department.

3.3

EMPAC members shall serve four-year terms.

3.4

A vacancy on the EMPAC shall be filled by appointment by the appointing authority for that

vacant position for the remainder of the unexpired term.

3.5

EMPAC members serve at the pleasure of the appointing authority and continue in office until the

member’s successor is appointed.

3.6

The EMPAC shall meet at least quarterly and more frequently as necessary to fulfill its

obligations.

3.7

The EMPAC shall elect a chair and vice-chair from its members.

3.8

The duties of the EMPAC include:

3.8.1

Provide general technical expertise on matters related to the provision of patient care by

EMS providers.

3.8.2

Advise or make recommendations to the Department on:

The acts and medications that EMS providers are authorized to perform or

administer under the direction of all medical directors.

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Requests by medical directors for waivers to the scope of practice of EMS

providers as established in these rules.

Modifications to EMS provider certification or licensing levels and capabilities.

Criteria for physicians to serve as EMS agency medical directors.

SECTION 4 – Medical Director Qualifications and Duties

4.1

All medical directors subject to these rules shall be a physician currently licensed in good

standing to practice medicine in the State of Colorado.

4.2

In addition to 4.1 above, the expectations and requirements of a physician acting as a medical

director are located in the following sections:

4.2.1

For EMS agency medical director, see Section 5 of these rules,

4.2.2

Qualifications and Duties

4.1

All medical directors subject to these rules shall be a physician currently licensed in good

standing to practice medicine in the State of Colorado.

4.2

In addition to 4.1 above, the expectations and requirements of a physician acting as a medical

director are located in the following sections:

4.2.1

For EMS agency medical director, see Section 5 of these rules,

4.2.2.

For CIHCS agency (out-of-hospital) medical director, see Section 18, and

4.2.3

For clinical medical director, see Section 19.

4.3

Physicians acting as medical directors for Department-recognized EMS education programs must

possess authority under their licensure to perform any and all medical acts to which they extend

their authority to EMS providers, including any and all curricula presented by EMS education

programs.

4.4

Departmental review of all medical directors

4.4.1

The Department may review the records of any medical director subject to these rules to

determine compliance with the requirements and standards in these rules and with

accepted standards of medical oversight and practice.

4.4.2

Complaints in writing against medical directors for violations of these rules may be

initiated by any person, the Colorado Medical Board, or the Department.

4.4.3

Complaints in writing against medical directors may be referred to the Colorado Medical

Board for review as deemed appropriate by the Department.

SECTION 5 - EMS Agency Medical Directors

5.1

EMS agency medical directors are responsible for the medical direction of EMS providers in the

prehospital setting. Their duties shall include:

5.1.1

Be actively involved in the provision of emergency medical services in the community

served by the EMS service agency being supervised. Involvement does not require that a

physician have such experience prior to becoming a medical director but does require

such involvement during the time that he or she acts as a medical director

viders in the

prehospital setting. Their duties shall include:

5.1.1

Be actively involved in the provision of emergency medical services in the community

served by the EMS service agency being supervised. Involvement does not require that a

physician have such experience prior to becoming a medical director but does require

such involvement during the time that he or she acts as a medical director. Active

involvement in the community could include, by way of example and not limitation, those

inherent, reasonable, and appropriate responsibilities of a medical director to interact with

patients, the public served by the EMS service agency, the hospital community, the

public safety agencies, and the medical community and should include other aspects of

liaison, oversight, and communication normally expected in the supervision of EMS

providers.

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5.1.2

Be actively involved on a regular basis with the EMS service agency being supervised.

Involvement does not require that a physician have such experience prior to becoming a

medical director but does require such involvement during the time that he or she acts as

a medical director. Involvement could include, by way of example and not limitation,

involvement in continuing education, audits, and protocol development. Passive or

negligible involvement with the EMS service agency and supervised EMS providers does

not meet this requirement.

5.1.3

Notify the Department on an annual basis and upon any change of medical direction of

the EMS service agencies for which medical direction is being provided in a manner and

form as determined by the Department.

5.1.4

Establish a medical continuous quality improvement (CQI) program for each EMS service

agency being supervised. The medical CQI program shall assure the continuing

competency of the performance of that agency’s EMS providers

s and upon any change of medical direction of

the EMS service agencies for which medical direction is being provided in a manner and

form as determined by the Department.

5.1.4

Establish a medical continuous quality improvement (CQI) program for each EMS service

agency being supervised. The medical CQI program shall assure the continuing

competency of the performance of that agency’s EMS providers. This medical CQI

program shall include, but not be limited to: appropriate protocols and standing orders

and provision for medical care audits, observation, critiques, continuing medical

education, and direct supervisory communications.

5.1.5

Submit to the Department an affidavit that attests to the development and use of a

medical CQI program for all EMS service agencies supervised by the medical director. As

set forth in Section 4.4, the Department may review the records of a medical director to

determine compliance with the CQI requirements in these rules.

5.1.6

Provide monitoring and supervision of the medical field performance of EMS providers.

This includes ensuring that EMS providers have adequate clinical knowledge of, and are

competent in performing, medical acts within the EMS provider’s scope of practice

authorized by the medical director. These duties and operations may be delegated to

other physicians or other qualified health care professionals designated by the medical

director. However, the medical director shall retain ultimate authority and responsibility for

the monitoring and supervision, for establishing protocols and standing orders, and for

the competency of the performance of authorized medical acts.

5.1.7

Ensure that all protocols issued by the medical director are appropriate for the

certification or license and skill level of each EMS provider to whom the performance of

medical acts is authorized and compliant with accepted standards of medical practice.

Ensure that a system is in place for timely access to communication of direct verbal

orders

of the performance of authorized medical acts.

5.1.7

Ensure that all protocols issued by the medical director are appropriate for the

certification or license and skill level of each EMS provider to whom the performance of

medical acts is authorized and compliant with accepted standards of medical practice.

Ensure that a system is in place for timely access to communication of direct verbal

orders.

5.1.8

Be familiar with the training, knowledge, and competence of EMS providers under his or

her supervision and ensure that EMS providers are appropriately trained and

demonstrate ongoing competency in all medical acts authorized in accordance with

Section 15.1 and, as applicable, Appendices A-G.

5.1.9

Be aware that certain medical acts authorized in accordance with Section 15.1 and, as

applicable, Appendices A-G (and as identified by the Department) may not be included in

the National EMS Education Standards and ensure that appropriate additional training is

provided to supervised EMS providers.

5.1.10 Ensure that any data and/or documentation required by the rules are submitted to the

Department.

5.1.11 Notify the Department within fourteen business days excluding state holidays prior to his

or her cessation of duties as medical director.

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5.1.12 Notify the Department within fourteen business days excluding state holidays of his or her

termination of the supervision of an EMS provider for reasons that may constitute good

cause for disciplinary sanctions pursuant to the Rules Pertaining to EMS and EMR

Education, EMS Certification or Licensure, and EMR Registration 6 CCR 1015-3,

Chapter One. Such notification shall be in writing and shall include a statement of the

actions or omissions resulting in termination of supervision and copies of all pertinent

records

of an EMS provider for reasons that may constitute good

cause for disciplinary sanctions pursuant to the Rules Pertaining to EMS and EMR

Education, EMS Certification or Licensure, and EMR Registration 6 CCR 1015-3,

Chapter One. Such notification shall be in writing and shall include a statement of the

actions or omissions resulting in termination of supervision and copies of all pertinent

records.

5.1.13 Physicians acting as medical directors for EMS education programs recognized by the

Department that require clinical and field internship performance by students shall be

permitted to delegate authority to a student-in-training during their performance of

program-required medical acts and only while under the control of the education

program.

5.1.14 Physicians acting as medical directors responsible for the supervision and authorization

of a P-CC shall have training and experience in the medical acts for which they are

providing supervision and authorization. Additional duties related to medical directors

responsible for the supervision and authorization of a P-CC are set forth in Section 17 of

these rules.

5.2

EMS agency medical directors shall be trained in Advanced Cardiac Life Support.

SECTION 6 – Medical Acts Allowed for the EMT

6.1

An EMT may, under the authorization of an EMS agency medical director or clinical medical

director, perform medical acts consistent with and not to exceed those listed in Appendices A and

C of these rules for an EMT.

6.2

An EMT may, under the authorization of an EMS agency medical director or clinical medical

director, administer and monitor medications and classes of medications consistent with and not

to exceed those listed in Appendices B and D of these rules for an EMT.

6.3

Any EMT who is a member or employee of an EMS service agency and who performs medical

acts in a prehospital setting must have authorization and be supervised by an EMS agency

medical director to perform the medical acts

medical

director, administer and monitor medications and classes of medications consistent with and not

to exceed those listed in Appendices B and D of these rules for an EMT.

6.3

Any EMT who is a member or employee of an EMS service agency and who performs medical

acts in a prehospital setting must have authorization and be supervised by an EMS agency

medical director to perform the medical acts.

6.4

Any EMT who performs medical acts in a clinical setting must have the authorization of a clinical

medical director and be supervised by a medical supervisor.

6.5

An EMT may carry out a physician order for a mental health hold as set forth in Section 27-65-

105(1), C.R.S. Such physician order may be a direct verbal order or by electronic

communications.

6.6

An EMT who has successfully completed a Department-recognized Intravenous Therapy and

Medication Administration Course may be referred to as an Emergency Medical Technician with

Intravenous Authorization (EMT-IV). Any provisions of these rules that are applicable to an EMT

shall also be applicable to an EMT-IV. In addition to the acts an EMT is allowed to perform, an

EMT-IV may, under authorization of an EMS agency medical director or clinical medical director,

perform medical acts consistent with and not to exceed those listed in Appendices A and C of

these rules for an EMT-IV. In addition to the medications and classes of medications an EMT is

allowed to administer and monitor pursuant to these rules, an EMT-IV may, under authorization of

an EMS agency medical director or clinical medical director, administer and monitor medications

and classes of medications consistent with and not to exceed those listed in Appendices B and D

of these rules for an EMT-IV.

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er and monitor pursuant to these rules, an EMT-IV may, under authorization of

an EMS agency medical director or clinical medical director, administer and monitor medications

and classes of medications consistent with and not to exceed those listed in Appendices B and D

of these rules for an EMT-IV.

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6.7

An EMT-IV may, under the authorization of an EMS agency medical director or clinical medical

director, administer and monitor medications and classes of medications which exceed those

listed in Appendices B and D of these rules for an EMT-IV under the direct visual supervision of

an AEMT, EMT-I, or Paramedic when in the prehospital setting, or the medical supervisor in a

clinical setting, when the following conditions have been established:

6.7.1

The patient must be in cardiac arrest or in extremis.

6.7.2

Drugs administered must be limited to those authorized by these rules for an AEMT,

EMT-I, or Paramedic as stated in Appendices B and D.

6.7.3

The EMS agency medical director or clinical medical director shall amend the appropriate

protocols and medical CQI program used to supervise the EMS providers to reflect this

change in patient care. The applicable medical director and the protocols of the EMT-IV

and the AEMT, EMT-I, or Paramedic shall all be in agreement.

6.8

In the event of a governor-declared disaster or public health emergency, the Chief Medical Officer

for the Department or designee may temporarily authorize the performance of additional medical

acts, such as the administration of other immunizations, vaccines, biologicals, or tests not listed in

these rules.

SECTION 7 – Medical Acts Allowed for the Advanced EMT

7.1

An AEMT may, under the authorization of an EMS agency medical director or clinical medical

director, perform medical acts consistent with and not to exceed those listed in Appendices A and

C of these rules for an AEMT

medical

acts, such as the administration of other immunizations, vaccines, biologicals, or tests not listed in

these rules.

SECTION 7 – Medical Acts Allowed for the Advanced EMT

7.1

An AEMT may, under the authorization of an EMS agency medical director or clinical medical

director, perform medical acts consistent with and not to exceed those listed in Appendices A and

C of these rules for an AEMT.

7.2

An AEMT may, under authorization of an EMS agency medical director or clinical medical

director, administer and monitor medications and classes of medications consistent with and not

to exceed those listed in Appendices B and D of these rules for an AEMT.

7.3

Any AEMT who is a member or employee of an EMS service agency and who performs medical

acts in a prehospital setting must have authorization and be supervised by an EMS agency

medical director to perform medical acts.

7.4

Any AEMT who performs medical acts in a clinical setting must have the authorization of a clinical

medical director and be supervised by a medical supervisor.

7.5

An AEMT may carry out a physician order for a mental health hold as set forth in Section 27-65-

105(1), C.R.S. Such physician order may be a direct verbal order or by electronic

communications.

7.6

An AEMT may, under the authorization of an EMS agency medical director or clinical medical

director, administer and monitor medications and classes of medications which exceed those

listed in Appendices B and D of these rules for an AEMT under the direct visual supervision of an

EMT-I or Paramedic when in the prehospital setting, or a medical supervisor in a clinical setting,

and the following conditions have been established:

7.6.1

The patient must be in cardiac arrest or in extremis.

7.6.2

Drugs administered must be limited to those authorized by these rules for EMT-I or

Paramedic as stated in Appendices B and D.

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setting, or a medical supervisor in a clinical setting,

and the following conditions have been established:

7.6.1

The patient must be in cardiac arrest or in extremis.

7.6.2

Drugs administered must be limited to those authorized by these rules for EMT-I or

Paramedic as stated in Appendices B and D.

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7.6.3

The EMS agency medical director or clinical medical director shall amend the appropriate

protocols and medical CQI program used to supervise the EMS providers to reflect this

change in patient care. The applicable medical director and the protocols of the AEMT

and the EMT-I or Paramedic shall all be in agreement.

7.7

In the event of a governor-declared disaster or public health emergency, the Chief Medical Officer

for the Department or designee may temporarily authorize the performance of additional medical

acts, such as the administration of other immunizations, vaccines, biologicals or tests not listed in

these rules.

SECTION 8 – Medical Acts Allowed for the EMT-Intermediate

8.1

In addition to the acts an EMT, an EMT-IV, and an AEMT are allowed to perform pursuant to

these rules, an EMT-I may, under the authorization of an EMS agency medical director or clinical

medical director, perform medical acts consistent with and not to exceed those listed in

Appendices A and C of these rules for an EMT-I.

8.2

In addition to the medications and classes of medications an EMT, an EMT-IV, and an AEMT are

allowed to administer and monitor pursuant to these rules, an EMT-I may, under the authorization

of an EMS agency medical director or clinical medical director, administer and monitor

medications and classes of medications defined in Appendices B and D of these rules for an

EMT-I.

8.3

Any EMT-I who is a member or employee of an EMS service agency and who performs medical

acts in a prehospital setting must have the authorization of and be supervised by an EMS agency

medical director

horization

of an EMS agency medical director or clinical medical director, administer and monitor

medications and classes of medications defined in Appendices B and D of these rules for an

EMT-I.

8.3

Any EMT-I who is a member or employee of an EMS service agency and who performs medical

acts in a prehospital setting must have the authorization of and be supervised by an EMS agency

medical director.

8.4

Any EMT-I who performs medical acts in a clinical setting must have the authorization of a clinical

medical director and be supervised by a medical supervisor.

8.5

An EMT-I may carry out a physician order for a mental health hold as set forth in Section 27-65-

105(1), C.R.S. Such physician order may be a direct verbal order or by electronic

communications.

8.6

An EMT-I may, under the authorization of an EMS agency medical director or clinical medical

director, administer and monitor medications and classes of medications which exceed those

listed in Appendices B and D of these rules for an EMT-I under the direct visual supervision of a

Paramedic in a prehospital setting, or a medical supervisor in a clinical setting, when the following

conditions have been established:

8.6.1

Drugs administered must be limited to those authorized by these rules for Paramedics as

stated in Appendices B and D.

8.6.2

The EMS agency medical director or clinical medical director shall amend the appropriate

protocols and medical CQI program used to supervise the EMS providers to reflect this

change in patient care. The applicable medical director and protocols of the EMT-I and

Paramedic shall all be in agreement.

8.7

In the event of a governor-declared disaster or public health emergency, the Chief Medical Officer

for the Department or designee may temporarily authorize the performance of additional medical

acts, such as the administration of other immunizations, vaccines, biologicals, or tests not listed in

these rules.

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nt of a governor-declared disaster or public health emergency, the Chief Medical Officer

for the Department or designee may temporarily authorize the performance of additional medical

acts, such as the administration of other immunizations, vaccines, biologicals, or tests not listed in

these rules.

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6 CCR 1015-3

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SECTION 9 – Medical Acts Allowed for the Paramedic

9.1

In addition to the acts all other EMS providers are allowed to perform pursuant to these rules, a

Paramedic may, under the authorization of an EMS agency medical director or under the

authorization of a clinical medical director and supervision of a medical supervisor, perform

advanced medical acts consistent with and not to exceed those listed in Appendices A and C of

these rules for a Paramedic.

9.2

In addition to the medications and classes of medications all other EMS providers are allowed to

administer and monitor pursuant to these rules, a Paramedic may, under the authorization of an

EMS agency medical director or clinical medical director, administer and monitor medications and

classes of medications defined in Appendices B and D for a Paramedic.

9.3

Paramedics may carry out a physician order for a mental health hold as set forth in Section 27-

65-105(1), C.R.S. Such physician order may be a direct verbal order or by electronic

communications.

9.4

Any Paramedic who is a member or employee of an EMS service agency and who performs

medical acts in a prehospital setting must have the authorization of and be supervised by an EMS

agency medical director to perform medical acts.

9.5

Any Paramedic who performs medical acts in a clinical setting must have the authorization of a

clinical medical director and be supervised by a medical supervisor to perform medical acts

a member or employee of an EMS service agency and who performs

medical acts in a prehospital setting must have the authorization of and be supervised by an EMS

agency medical director to perform medical acts.

9.5

Any Paramedic who performs medical acts in a clinical setting must have the authorization of a

clinical medical director and be supervised by a medical supervisor to perform medical acts.

9.6

In addition to the acts of a Paramedic, a P-CC may, under the supervision and authorization of an

EMS agency medical director or under the authorization of a clinical medical director and

supervision of a medical supervisor perform advanced medical acts consistent with and not to

exceed those authorized in Appendix E of these rules for Critical Care.

9.7

In addition to the medications a Paramedic is allowed to administer and monitor, a P-CC may,

under the authorization of an EMS or clinical medical director, administer and monitor

medications defined in Appendix F of these rules for Critical Care.

9.8

In addition to the acts of a Paramedic, a P-CP may, under the supervision and authorization of a

CIHCS Agency medical director or under the authorization of a clinical medical director and

supervision of a medical supervisor perform out-of-hospital medical services and medical acts

consistent with and not to exceed those authorized in Appendix G of these rules for Community

Paramedics.

9.9

In addition to the medications a Paramedic is allowed to administer and monitor, a P-CP may,

under the supervision and authorization of a CIHCS Agency medical director or under the

authorization of a clinical medical director, administer and monitor medications defined in

Appendix G of these rules for Community Paramedics.

9.10

Any P-CP who is a member or employee of an CIHCS Agency and who performs medical acts in

an out-of-hospital setting must have authorization and be supervised by a CIHCS Agency medical

director to perform medical acts

ency medical director or under the

authorization of a clinical medical director, administer and monitor medications defined in

Appendix G of these rules for Community Paramedics.

9.10

Any P-CP who is a member or employee of an CIHCS Agency and who performs medical acts in

an out-of-hospital setting must have authorization and be supervised by a CIHCS Agency medical

director to perform medical acts.

9.11

Any P-CP who performs medical acts in a clinical setting must have the authorization of a clinical

medical director and be supervised by a medical supervisor to perform medical acts.

9.12

In the event of a governor-declared disaster or public health emergency, the Chief Medical Officer

for the Department or designee may temporarily authorize the performance of additional medical

acts, such as the administration of other immunizations, vaccines, biologicals, or tests not listed in

these rules.

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SECTION 10 – Graduate Advanced EMTs and Graduate Paramedics

Medical directors may supervise Graduate AEMTs and Paramedics acting as AEMTs or Paramedics for a

period of no more than six months following successful completion of an appropriate Department-

recognized initial course. Upon expiration of this six month period, such Graduate AEMTs and Graduate

Paramedics must successfully complete certification or licensing requirements, as specified in Rules

Pertaining to EMS and EMR Education, EMS Certification or Licensure, and EMR Registration 6 CCR

1015-3, Chapter One, to continue to function under the provisions of these rules.

SECTION 11 – General Acts Allowed

11.1

Any EMS provider working for an EMS service agency shall be supervised by an EMS agency

medical director who complies with the requirements in these rules.

11.2

EMS providers who are providing medical care in a clinical setting must function under the

authority of a clinical medical director and under the medical supervision of a medical supervisor

ese rules.

SECTION 11 – General Acts Allowed

11.1

Any EMS provider working for an EMS service agency shall be supervised by an EMS agency

medical director who complies with the requirements in these rules.

11.2

EMS providers who are providing medical care in a clinical setting must function under the

authority of a clinical medical director and under the medical supervision of a medical supervisor.

11.3

An EMS agency medical director, CIHCS agency medical director, or clinical medical director

may limit the scope of practice of any EMS provider over whom they provide medical direction.

11.4

In a prehospital setting, the gathering of laboratory and/or other diagnostic data for the sole

purpose of providing information to another health care provider does not require a waiver

provided:

11.4.1 The method by which the data is gathered is within the scope of practice of the EMS

provider as contained in these rules;

11.4.2 The collection method and analysis of the information collected is done in accordance

with applicable regulations including, but not limited to, the Clinical Laboratory

Improvement Amendments (CLIA) and FDA requirements; and,

11.4.3 Unless otherwise allowed in Table A.6, the information obtained will not be used to alter

the prehospital treatment or destination of the patient without a direct verbal order.

11.4.4 A medical director shall obtain a waiver as set forth in Section 12 of these rules for any

other data gathering activities that do not meet the provisions listed above.

11.5

EMS providers who are providing out-of-hospital medical services, as specifically defined in

Section 2.36 of these rules, for a CIHCS agency or in a clinical setting must obtain a Community

Paramedic endorsement.

11.5.1 An endorsed Community Paramedic may provide out-of-hospital medical services as

defined in these rules while employed by or contracting with a CIHCS agency

sions listed above.

11.5

EMS providers who are providing out-of-hospital medical services, as specifically defined in

Section 2.36 of these rules, for a CIHCS agency or in a clinical setting must obtain a Community

Paramedic endorsement.

11.5.1 An endorsed Community Paramedic may provide out-of-hospital medical services as

defined in these rules while employed by or contracting with a CIHCS agency.

11.5.2 Paramedics with a Community Paramedic endorsement working in a CIHCS agency can

perform and interpret POCT, excluding imaging procedures that are not performed by the

P-CP in real time, as defined in Appendix G.

A P-CP may interpret POCT for clinical decision making based on the protocols

and procedures of the CIHCS agency medical director.

A P-CP may interpret laboratory studies outside of POCT if part of a prescribed

service plan approved by the CIHCS agency medical director.

CODE OF COLORADO REGULATIONS

6 CCR 1015-3

Health Facilities and Emergency Medical Services Division

11.5.3 An endorsed Community Paramedic may provide out-of-hospital medical services in the

clinical setting pursuant to the provisions set forth in Section 9 of these rules.

11.6

EMS providers may not practice in camps in a nursing capacity including the dispensing of

medications.

SECTION 12 – Waivers to Scope of Practice for EMS Providers in Prehospital Settings

12.1

Any EMS agency medical director may apply to the Department for a waiver to the scope of

practice set forth in these rules for EMS providers under his or her supervision in specific

circumstances, based on established need, provided that on-going quality assurance of each

EMS provider’s competency is maintained by the medical director. Waivers to scope of practice

are limited to prehospital settings.

12.2

A waiver is not necessary for the allowed medical acts listed in Appendices A, B, C, or D of this

rule.

12.2.1 In addition to the medical acts allowed in Section12.2, a P-CC does not require a waiver

for the allowed medical acts listed in Appendices E and F

f each

EMS provider’s competency is maintained by the medical director. Waivers to scope of practice

are limited to prehospital settings.

12.2

A waiver is not necessary for the allowed medical acts listed in Appendices A, B, C, or D of this

rule.

12.2.1 In addition to the medical acts allowed in Section12.2, a P-CC does not require a waiver

for the allowed medical acts listed in Appendices E and F.

12.2.2 In addition to the medical acts allowed in Section 12.2, a P-CP does not require a waiver

for the allowed out-of-hospital medical services listed in Appendix G when providing

medical services in a CIHCS agency setting.

12.3

All levels of EMS provider may, under the supervision and authorization of an EMS agency

medical director, perform specific skills or administer specific medications not listed in

Appendices A, B, C, D, E, or F of this rule, only if the EMS agency medical director has been

granted a waiver from the Department for that specific skill or medication.

12.3.1 Waivered skills or medication administration may be authorized by the EMS agency

medical director under standing orders or direct verbal orders of a physician, including by

electronic communications.

12.3.2 No EMS provider shall function beyond the scope of practice identified in these rules for

their level until their EMS agency medical director has received official written

confirmation of the waiver being granted by the Department.

12.4

EMS agency medical directors seeking a waiver shall submit a completed application to the

Department in a form and manner determined by the Department.

12.4.1 The application shall include, but not be limited to, a description of the act or medication

to be waived, information regarding the justification for the waiver, the proposed

education, training, and quality assurance process, literature review, and copies of the

applicable protocols. The forms and affidavit required by Section 5 of these rules shall

also be included

ned by the Department.

12.4.1 The application shall include, but not be limited to, a description of the act or medication

to be waived, information regarding the justification for the waiver, the proposed

education, training, and quality assurance process, literature review, and copies of the

applicable protocols. The forms and affidavit required by Section 5 of these rules shall

also be included.

12.4.2 The Department may require the applicant to provide additional information if the initial

application is determined to be insufficient.

12.4.3 An application shall not be considered complete until the required information is

submitted.

12.4.4 The completed waiver application shall be submitted to the Department in a timely

fashion as specified by the Department.

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6 CCR 1015-3

Health Facilities and Emergency Medical Services Division

12.4.5 The application shall be a matter of public record and is subject to disclosure

requirements under the Colorado Open Records Act (Section 24-72-200.1 et seq.,

C.R.S.).

12.5

The EMPAC shall review waiver requests and make recommendations to the Department. The

EMPAC may make recommendations, including but not limited to: deny, approve, table, request

more information from the EMS agency medical director, or impose special conditions on the

waiver.

12.6

After receiving recommendations from the EMPAC, the Department shall make a decision on the

waiver request and send notice of that decision to the EMS agency medical director within thirty

Department. The

EMPAC may make recommendations, including but not limited to: deny, approve, table, request

more information from the EMS agency medical director, or impose special conditions on the

waiver.

12.6

After receiving recommendations from the EMPAC, the Department shall make a decision on the

waiver request and send notice of that decision to the EMS agency medical director within thirty

(30) calendar days of the recommendation. If granted, the notice shall include the effective date

and expiration date of the waiver.

12.6.1 If the waiver is granted, the Department may:

Specify the terms and conditions of the waiver.

Specify the duration of the waiver.

Specify any reporting requirements.

12.6.2 The Department may require the submission of data or other information regarding

waivers.

Unless otherwise specified by the Department, any data or information submitted

to the Department shall not contain patient-identifying information.

If the Department requires submission of data or reports containing patient-

identifying information for purposes of overseeing a statewide continuing quality

improvement system, that information shall be kept confidential pursuant to

Section 25-3.5-704(2)(h)(I)(E), C.R.S.

If the Department requires submission of data, information, records, or reports

related to the identification of individual patient’s, provider’s, or facility’s care

outcomes for purposes of overseeing a statewide continuing quality improvement

system, that information shall be kept confidential pursuant to Section 25-3.5-

704(2)(h)(II), C.R.S.

12.6.3 The Department may deny, revoke, or suspend a waiver if it determines:

That its approval or continuation jeopardizes the health, safety, and/or welfare of

patients.

The EMS agency medical director has provided false or misleading information in

the waiver application.

The EMS agency medical director has failed to comply with conditions or

reporting on an approved waiver

II), C.R.S.

12.6.3 The Department may deny, revoke, or suspend a waiver if it determines:

That its approval or continuation jeopardizes the health, safety, and/or welfare of

patients.

The EMS agency medical director has provided false or misleading information in

the waiver application.

The EMS agency medical director has failed to comply with conditions or

reporting on an approved waiver.

That a change in federal or state law prohibits continuation of the waiver.

CODE OF COLORADO REGULATIONS

6 CCR 1015-3

Health Facilities and Emergency Medical Services Division

12.7

If the Department denies a waiver application or revokes or suspends a waiver, it shall provide

the EMS agency medical director with a notice explaining the basis for the action. The notice shall

also inform the EMS agency medical director of his or her right to appeal and the procedure for

appealing the action.

12.8

Appeals of Departmental actions shall be conducted in accordance with the State Administrative

Procedure Act, Section 24-4-101, et seq., C.R.S.

12.9

If the rule pertaining to a waived medical act is amended or repealed obviating the need for the

waiver, the waiver shall expire on the effective date of the rule change.

12.10

If an EMS agency medical director has made timely and sufficient application for renewal of a

waiver and the Department fails to take action on the application prior to the waiver’s expiration

date, the existing waiver shall not expire until the Department acts upon the application. The

Department, in its sole discretion, shall determine whether the application was timely and

sufficient.

12.11

In the case of exigent circumstances, including but not limited to the death or incapacitation of an

EMS agency medical director or the termination of the relationship between a EMS agency

medical director and an EMS service agency, the Department may transfer waivers upon request

by a replacement EMS agency medical director for a period not to exceed six (6) months

as timely and

sufficient.

12.11

In the case of exigent circumstances, including but not limited to the death or incapacitation of an

EMS agency medical director or the termination of the relationship between a EMS agency

medical director and an EMS service agency, the Department may transfer waivers upon request

by a replacement EMS agency medical director for a period not to exceed six (6) months. The

EMS agency medical director shall then apply for new waiver(s) for consideration and

Department action within sixty (60) days of the transfer.

SECTION 13 – Technology and Pharmacology Dependent Patients in Prehospital Settings

The transport of patients with continuously administered medications, continuous technology support, and

nutritional support, previously prescribed by licensed health care workers and typically managed day-to-

day at their residence by either the patient or caretakers, shall be allowed. The EMS provider is not

authorized to discontinue, interfere with, alter, or otherwise manage these patient medication/nutrition

systems except by direct verbal order or where cessation and/or continuation of medication pose a threat

to the safety of the patient.

SECTION 14 – Combination Benzodiazepine and Opiate Therapy

14.1

The administration of a combination of benzodiazepines and opiates, for the purpose of pain

management, anxiolysis, and/or muscle relaxation is permitted. Safeguards shall be taken to

maximize patient safety including but not limited to the patient’s ability to:

14.1.1 Independently maintain an open airway and normal breathing pattern,

14.1.2 Maintain normal hemodynamics, and

14.1.3 Respond appropriately to physical stimulation and verbal commands.

14.2

The administration of combination therapy requires appropriate monitoring and care including, but

not limited to: IV or IO access, continuous waveform capnography, pulse oximetry, ECG

monitoring, blood pressure monitoring, and administration of supplemental oxygen

athing pattern,

14.1.2 Maintain normal hemodynamics, and

14.1.3 Respond appropriately to physical stimulation and verbal commands.

14.2

The administration of combination therapy requires appropriate monitoring and care including, but

not limited to: IV or IO access, continuous waveform capnography, pulse oximetry, ECG

monitoring, blood pressure monitoring, and administration of supplemental oxygen.

SECTION 15 – Scope of Practice

15.1

All of the following appendices define the maximum medical acts an EMT, EMT-IV, AEMT, EMT-I,

and Paramedic may be authorized to perform under appropriate medical direction by the

applicable medical director for each setting.

CODE OF COLORADO REGULATIONS

6 CCR 1015-3

Health Facilities and Emergency Medical Services Division

15.2

A medical director may establish the methods by which an EMS provider obtains authorization in

the prehospital or clinical setting to perform any medical acts contained in these rules including,

but not limited to: advanced standing orders that are written or electronically conveyed,

contemporaneous orders that are direct verbal orders, or written orders that are conveyed in real-

time.

15.3

As used in all of the Appendices, the following terms are defined to mean:

15.3.1 “Y” = YES: May be performed or administered by EMS providers with supervision as

described in these rules.

15.3.2 “VO” = Verbal Order: Indicates a category of medical acts or medications that EMS

providers may only perform or administer within their scopes of practice after receiving

authorization from a physician. Such authorization shall be communicated by direct

verbal or written order received from a physician contemporaneous to when patient is

receiving treatment, unless specific exception criteria are established by the applicable

medical director

medical acts or medications that EMS

providers may only perform or administer within their scopes of practice after receiving

authorization from a physician. Such authorization shall be communicated by direct

verbal or written order received from a physician contemporaneous to when patient is

receiving treatment, unless specific exception criteria are established by the applicable

medical director.

In a clinical setting, a medical supervisor may instruct EMS providers to perform

a medical act or administer a medication that requires a physician’s authorization

only if the physician has contemporaneously communicated the direct verbal or

written order to the medical supervisor.

Exception criteria may include, but are not limited to cardiac arrest, behavioral

management, or communications failure.

Medical Directors shall not develop exception criteria that merely waive all direct

verbal order requirements.

15.3.3 “N” = NO: May not be performed or administered by EMS providers except with an

approved waiver as described in Section 12 of these rules.

15.3.4 “EMT” = Medical acts that may be performed or administered by an EMT with appropriate

medical director authorization and training recognized by the Department.

15.3.5 “EMT-IV” = Medical acts that may be performed or administered by an EMT-IV with

appropriate medical director authorization and training recognized by the Department.

15.3.6 “AEMT” = Medical acts that may be performed or administered by an AEMT with

appropriate medical director authorization and training recognized by the Department.

15.3.7 “EMT-I” = Medical acts that may be performed or administered by an EMT-I with

appropriate medical director authorization and training recognized by the Department.

15.3.8 “P” = Medical acts that may be performed or administered by a Paramedic with

appropriate medical director authorization and training recognized by the Department.

Note: Section 16 – INTERFACILITY TRANSPORT begins following APPENDIX B

-I” = Medical acts that may be performed or administered by an EMT-I with

appropriate medical director authorization and training recognized by the Department.

15.3.8 “P” = Medical acts that may be performed or administered by a Paramedic with

appropriate medical director authorization and training recognized by the Department.

Note: Section 16 – INTERFACILITY TRANSPORT begins following APPENDIX B.

Note: Section 17 – CRITICAL CARE begins following APPENDIX D.

Note: Section 18 – COMMUNITY PARAMEDIC begins following APPENDIX F.

Note: Section 19 – CLINICAL SETTING begins following APPENDIX G.

CODE OF COLORADO REGULATIONS

6 CCR 1015-3

Health Facilities and Emergency Medical Services Division

APPENDIX A

MEDICAL ACTS ALLOWED

A.1.1

In the prehospital setting, additions to these medical acts are not allowed unless a waiver has

been granted as described in Section 12 of these rules. A waiver may not be granted for medical

acts in the out-of-hospital or clinical settings.

A.1.2

Not all medical acts allowed are included in initial education for various EMS provider levels. All

medical directors subject to these rules shall ensure providers are appropriately trained as noted

in Sections 5.1.8 and 5.1.9, Sections 18 (CIHCS) and 19 (Clinical Settings).

A.1.3

In addition to the medical acts allowed in Appendix A, EMS providers may provide services

allowable under the Community Assistance Referral and Education Services (CARES) Program,

as set forth in Section 25-3.5-1203(3), C.R.S

directors subject to these rules shall ensure providers are appropriately trained as noted

in Sections 5.1.8 and 5.1.9, Sections 18 (CIHCS) and 19 (Clinical Settings).

A.1.3

In addition to the medical acts allowed in Appendix A, EMS providers may provide services

allowable under the Community Assistance Referral and Education Services (CARES) Program,

as set forth in Section 25-3.5-1203(3), C.R.S.

TABLE A.1 – AIRWAY/VENTILATION/OXYGEN

Skill

EMT

EMT-IV

AEMT

EMT-I

Airway – Supraglottic

Airway – Nasal

Airway – Oral

Bag – Valve – Mask (BVM)

Carbon Monoxide Monitoring

Chest Decompression – Needle

Chest Tube Insertion

CPAP

PEEP

Cricoid Pressure – Sellick’s Maneuver

Cricothyroidotomy – Needle

Cricothyroidotomy – Surgical

End Tidal CO2 Monitoring/Capnometry/ Capnography

Flow Restrictive Oxygen Powered Ventilatory Device

Gastric Decompression – NG/OG Tube Insertion

Inspiratory Impedence Threshold Device

Intubation – Digital

Intubation – Bougie Style Introducer

Intubation – Lighted Stylet

Intubation – Medication Assisted (non-paralytic)

Intubation – Medication Assisted (paralytics) (RSI)

Intubation – Maintenance with paralytics

Intubation – Nasotracheal

Intubation – Orotracheal

Intubation – Retrograde

Extubation

Obstruction – Direct Laryngoscopy

Oxygen Therapy – Humidifiers

Oxygen Therapy – Nasal Cannula

Oxygen Therapy – Non-rebreather Mask

Oxygen Therapy – Simple Face Mask

Oxygen Therapy – Venturi Mask

Peak Expiratory Flow Testing

Pulse Oximetry

Suctioning – Tracheobronchial

Suctioning – Upper Airway

CODE OF COLORADO REGULATIONS

6 CCR 1015-3

Health Facilities and Emergency Medical Services Division

py – Nasal Cannula

Oxygen Therapy – Non-rebreather Mask

Oxygen Therapy – Simple Face Mask

Oxygen Therapy – Venturi Mask

Peak Expiratory Flow Testing

Pulse Oximetry

Suctioning – Tracheobronchial

Suctioning – Upper Airway

CODE OF COLORADO REGULATIONS

6 CCR 1015-3

Health Facilities and Emergency Medical Services Division

Skill

EMT

EMT-IV

AEMT

EMT-I

Tracheostomy Maintenance – Airway management only

Tracheostomy Maintenance – Includes replacement

Ventilators – Automated Transport (ATV)1

1 Use of automated transport ventilators (ATVs) is restricted to the manipulation of tidal volume (TV or VT), respiratory rate (RR),

fraction of inspired oxygen (FIO2), and positive end expiratory pressure (PEEP). Manipulation of any other parameters of

mechanical ventilation devices by EMS providers requires a waiver to these rules.

TABLE A.2 – CARDIOVASCULAR/CIRCULATORY SUPPORT

Skill

EMT

EMT-IV

AEMT

EMT-I

Cardiac Monitoring – Application of electrodes and data

transmission

Cardiac Monitoring – Rhythm and diagnostic EKG

interpretation

Cardiopulmonary Resuscitation (CPR)

Cardioversion – Electrical

Carotid Massage

Defibrillation – Automated/Semi-Automated (AED)

Defibrillation – Manual

External Pelvic Compression

Hemorrhage Control – Direct Pressure

Hemorrhage Control – Pressure Point

Hemorrhage Control – Tourniquet

Implantable cardioverter/defibrillator magnet use

Mechanical CPR Device

Transcutaneous Pacing

Transvenous Pacing – Maintenance

Targeted Temperature Management2

Arterial Blood Pressure Indwelling Catheter – Maintenance

Invasive Intracardiac Catheters – Maintenance

Central Venous Catheter Insertion

Central Venous Catheter Maintenance/Patency/Use

Percutaneous Pericardiocentesis

2 Targeted Temperature Mana

Pacing

Transvenous Pacing – Maintenance

Targeted Temperature Management2

Arterial Blood Pressure Indwelling Catheter – Maintenance

Invasive Intracardiac Catheters – Maintenance

Central Venous Catheter Insertion

Central Venous Catheter Maintenance/Patency/Use

Percutaneous Pericardiocentesis

2 Targeted Temperature Management (TTM)

Approved methods of cooling include:

Surface cooling methods including ice packs, evaporative cooling, and surface cooling blankets or

surface heat-exchange devices.

Internal cooling with the intravenous administration of cold crystalloids (4°C / 39°F)

Esophageal temperature probe allowed for monitoring core temperatures in patients undergoing TTM.

The medical director should work with the hospital systems to which their agencies transport in setting up a

“systems” approach to the institution of TTM. Medical directors should not institute TTM without having receiving facilities

that also have TTM programs to which to transport these patients.

CODE OF COLORADO REGULATIONS

6 CCR 1015-3

Health Facilities and Emergency Medical Services Division

TABLE A.3 – IMMOBILIZATION

Skill

EMT

EMT-IV

AEMT

EMT-I

Spinal Immobilization – Cervical Collar

Spinal Immobilization – Long Board

Spinal Immobilization – Manual Stabilization

Spinal Immobilization – Seated Patient

Splinting – Manual

Splinting – Rigid

Splinting – Soft

Splinting – Traction

Splinting – Vacuum

TABLE A.4 – INTRAVENOUS CANNULATION / FLUID ADMINISTRATION / FLUID MAINTENANCE

Skill

EMT

EMT-IV

AEMT

EMT-I

Blood/Blood By-Products Initiation (out of facility initiation)

Colloids – (Albumin, Dextran) – Initiation

Crystalloids (D5W, LR, NS) – Initiation/Maintenance

Intraosseous – Initiation

Intraosseous Initiation – In Extremis

Medicated IV Fluids Maintenance – As Authorized in

Appendix B

Peripheral

ID MAINTENANCE

Skill

EMT

EMT-IV

AEMT

EMT-I

Blood/Blood By-Products Initiation (out of facility initiation)

Colloids – (Albumin, Dextran) – Initiation

Crystalloids (D5W, LR, NS) – Initiation/Maintenance

Intraosseous – Initiation

Intraosseous Initiation – In Extremis

Medicated IV Fluids Maintenance – As Authorized in

Appendix B

Peripheral – Excluding External Jugular – Initiation

Peripheral – Including External Jugular – Initiation

Use of Peripheral indwelling Catheter for IV medications

(Does not include PICC)

TABLE A.5 – MEDICATION ADMINISTRATION ROUTES

Skill

EMT

EMT-IV

AEMT

EMT-I

Aerosolized

Atomized

Auto-Injector

Buccal

Endotracheal Tube (ET)

Extra-abdominal umbilical vein

Intradermal

Intramuscular (IM)

Intranasal (IN)

Intraosseous

Intravenous (IV) Piggyback

Intravenous (IV) Push

Nasogastric

Nebulized

Ophthalmic

Oral

Rectal

Subcutaneous

Sublingual

Sublingual (nitroglycerin)

Topical

Use of Mechanical Infusion Pumps

3AEMTs may not employ the rectal administration route in any situation except for the one exception set out in Table B.10,

“Benzodiazepine –Diazepam rectal administration.”

CODE OF COLORADO REGULATIONS

6 CCR 1015-3

Health Facilities and Emergency Medical Services Division

Sublingual

Sublingual (nitroglycerin)

Topical

Use of Mechanical Infusion Pumps

3AEMTs may not employ the rectal administration route in any situation except for the one exception set out in Table B.10,

“Benzodiazepine –Diazepam rectal administration.”

CODE OF COLORADO REGULATIONS

6 CCR 1015-3

Health Facilities and Emergency Medical Services Division

TABLE A.6 – MISCELLANEOUS

Skill

EMT

EMT-IV

AEMT

EMT-I

Aortic Balloon Pump Monitoring

Assisted Delivery

Capillary Blood Sampling

Diagnostic Interpretation – Blood Glucose4

Diagnostic Interpretation – Blood Lactate4

Dressing/Bandaging

Esophageal Temperature Probe for TTM

Eye Irrigation Noninvasive

Eye Irrigation Morgan Lens

Maintenance of Intracranial Monitoring Lines

Physical examination

Public Health Related-Oral/Nasal Swab Sample Collection

Restraints – Verbal

Restraints – Physical

Restraints – Chemical

Urinary Catheterization – Initiation

Urinary Catheterization – Maintenance

Venous Blood Sampling – Obtaining

4 See also Section 11.4

APPENDIX B

FORMULARY OF MEDICATIONS ALLOWED

B.1.1

In prehospital settings, additions to this medication formulary are not allowed unless a waiver has

been granted as described in Section 12 of these rules.

B.1.2

Not all medical acts allow

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