# 6 CCR 1015-3: EMERGENCY MEDICAL SERVICES > Colorado · Regulations · In force URL: https://www.frixlaw.com/law-library/statutes/STATE_CO_CCR_6_CCR_1015_3 ## Section - **Citation:** 6 CCR 1015-3 - **Heading:** EMERGENCY MEDICAL SERVICES - **Jurisdiction:** Colorado - **Kind:** Regulations - **Status:** In force - **Text as of:** August 14, 2026 - **Source:** Compiled text - **Location:** 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 ## Text 1 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 CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 2 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. CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 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. CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 3 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. CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 4 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: CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 5 A) EMR education center B) EMR education group C) EMT education center D) EMT education group E) EMT-IV education group F) AEMT education center G) AEMT education group H) EMT-I education center I) EMT-I education group J) Paramedic education center K) 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 J) Paramedic education center K) 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: A) Completed application form provided by the Department; B) Personnel roster, to include a current resume for the program director and medical director; CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division aintain accreditation from CAAHEP. 3.1.9 Applicants for education program recognition shall submit the following documentation to the Department: A) Completed application form provided by the Department; B) Personnel roster, to include a current resume for the program director and medical director; CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 6 C) 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; D) Policies and procedures, which at a minimum shall address: 1) Admission requirements; 2) Attendance requirements; 3) Course schedule that lists as separate elements the didactic, lab, clinical, skills and written testing criteria of the education program; 4) Discipline/counseling of students; 5) Grievance procedures; 6) Successful course completion requirements; 7) Testing policies; 8) Tuition policy statement; 9) 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: A) Fulfillment of all application requirements; B) Demonstration of ability to conduct education, at the requested level, in compliance with the Department's education program standards; and CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 7 C) 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. CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 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. CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 8 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: A) EMT B) AEMT C) EMT-I D) Paramedic E) 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. A) 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: A) Evidence of compliance with criminal history record check requirements: CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 9 1) 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). 2) 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. 3) 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. 3) 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. B) Evidence of current and valid certification from the NREMT at or above the EMS Provider level being applied for. C) 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. D) 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. E) 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. F) In additional to Paragraphs C) and D) above, a P-CP applicant shall submit the following additional information: 1) Current and valid Community Paramedic certification issued by the IBSC. 2) Proof of completion of a course in community paramedicine from one of the following institutions: a) An accredited paramedic training program, b) A college accredited by an educational accrediting body, or c) A university accredited by an educational accrediting body. G) 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. G) 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). 1) The Department may require evidence of military status and appropriate orders in order to determine eligibility for this exemption. CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 10 5.3 Renewal of Certification or Licensure 5.3.1 General Requirements A) 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). B) Persons who have permitted their certification or license to expire: 1) Shall not, until such time as the Department has issued a new or renewed certification or license: a) 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, b) Offer or perform, whether or not for compensation, any services included in these rules, or c) Offer or perform, whether or not for compensation, any authorized acts permitted by the Rules Pertaining to EMS Practice and Medical Director Oversight; and 2) 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 3) 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 3) 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. C) All certificates or licenses renewed by the Department shall be valid for three (3) years from the date of issuance. D) 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. E) 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. F) 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: CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 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: CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 11 1) During the service, or 2) 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: A) 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; B) Submit to the Department with a completed application form all of the following: 1) Evidence of compliance with criminal history record check requirements: a) 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. b) 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). c) 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. d) 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. 2) Evidence of current and valid professional level Basic Cardiac Life Support (CPR) course completion from a national or local organization approved by the Department. 3) 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. CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division from a national or local organization approved by the Department. 3) 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. CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 12 4) 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. 5) 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. C) Complete one of the following: 1) 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. 2) 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. 3) 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. 3) 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 A) For renewal of a certificate or license without the use of a current and valid NREMT certification, the following education is required: 1) 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) 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 b) 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: i) 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. CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division nsisting of the following minimum content requirements on the EMT or AEMT level: i) 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. CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 13 iii) Two (2) hours of pediatric patient assessment and treatment. iv) Six (6) hours of trauma patient assessment and treatment. v) 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. 2) 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) 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. b) 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: i) 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. v) Four (4) hours of pediatric patient assessment and treatment el: No less than twenty-five (25) hours as described below: i) 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. v) 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. 3) Education cannot be used in lieu of a valid and current BCCTPC Critical Care or Flight Paramedic Certification to maintain the Critical Care endorsement. CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 14 4) 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. A) 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. A) 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: A) Submit one transcript establishing that the applicant has: 1) Completed a four-year bachelor’s degree program from an accredited college or university in a field related to the health sciences; or 2) 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. B) 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. C) 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: A) The successful completion of a four-year bachelor’s degree from an accredited college or university; and B) 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: 1) Chemistry; 2) Biology; 3) Physics; 4) Mathematics; 5) Sociology; 6) Psychology; CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division r’s degree from an accredited college or university; and B) 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: 1) Chemistry; 2) Biology; 3) Physics; 4) Mathematics; 5) Sociology; 6) Psychology; CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 15 7) Public health; 8) Anthropology; 9) 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 A) 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. B) 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. C) A provisional certification or license shall be valid for not more than ninety (90) days. D) 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. E) 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: A) 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: A) Submit to the Department a completed provisional certification or licensure application. B) 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. CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 16 C) Submit to the Department with a completed application form all of the following: 1) A fee in the amount of $23.00. 2) A name-based criminal history record check. a) 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. b) 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. c) 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. c) 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. A) Registration is not required to perform as an EMR. B) 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: A) Evidence of compliance with criminal history record check requirements: CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 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: A) Evidence of compliance with criminal history record check requirements: CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 17 1) 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. 2) 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. 3) 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. 4) 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. B) Proof of adequate training and education with a current and valid certification from the NREMT at the EMR level. C) 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 A) 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. C) 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 A) 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. B) Persons who have permitted their registration to expire: 1) 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 2) 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). C) All registrations renewed by the Department shall be valid for three (3) years from the date of registration. D) 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. CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 18 E) 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 18 E) 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: A) 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; B) Submit to the Department with a completed application form all of the following: 1) Evidence of compliance with criminal history record check requirements: a) 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. b) 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. c) 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. d) 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. d) 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. e) 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. 2) Evidence of current and valid professional level basic CPR course completion from a national or local organization approved by the Department. C) Complete one of the following training requirements: CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 19 1) Current and valid NREMT certification at the EMR level. 2) 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. 3) 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. 3) 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 A) For renewal of a registration without the use of a current and valid NREMT EMR certification, the following education is required: 1) 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) 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. b) 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: i) 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 v) 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 A) 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. CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division f childbirth and pediatric topics 6.4 Provisional Registration 6.4.1 General Requirements A) 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. CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 20 B) 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. C) A provisional registration shall be valid for not more than ninety (90) days. D) 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. E) 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: A) Submit to the Department a completed provisional registration application. B) 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: A) Submit to the Department a completed provisional registration application. B) 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. C) Submit to the Department with a completed application form, a fee in the amount of $23.00 and either: 1) 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 2) 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. D) 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: CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 21 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. CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 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. CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 22 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. CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 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. CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 23 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: A) Offenses under Article 3 - offenses against a person. B) Offenses under Article 4 - offenses against property. C) Offenses under Article 5 - offenses involving fraud. D) Offenses under Article 6 - offenses involving the family relations. E) Offenses under Article 6.5 - wrongs to at-risk adults. F) Offenses under Article 7 - offenses related to morals. G) Offenses under Article 8 - offenses - governmental operations. H) Offenses under Article 9 - offenses against public peace, order and decency. I) Offenses under Article 17 - Colorado Organized Crime Control Act. J) 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: A) 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; B) The relationship of the crime to the purposes of requiring a certificate, license, or registration; C) 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; B) The relationship of the crime to the purposes of requiring a certificate, license, or registration; C) 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 D) 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) A request for a hearing shall be submitted to the Department in writing within sixty (60) calendar days from the date of the notice. B) 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. CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 24 C) 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. A) 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. A) The certificate, license, or registration holder shall file a written answer within thirty (30) calendar days of the date of mailing of the notice. B) 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. C) 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. D) 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). ‘ CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 25 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 25 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 CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 26 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. CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 27 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. CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 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. CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 28 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. CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 29 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. CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 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. CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 30 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 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. 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. l 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. CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 31 3.2 The EMPAC shall consist of the following thirteen members: 3.2.1 Ten voting members appointed by the governor as follows: A) 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; B) Two physicians licensed in good standing in Colorado who are actively serving as EMS agency medical directors and are practicing in urban counties; C) One physician licensed in good standing in Colorado who is actively serving as an EMS agency medical director in any area of the state; D) One EMS provider certified or licensed at an advanced life support level who is actively involved in the provision of emergency medical services; E) One EMS provider certified or licensed at a basic life support level who is actively involved in the provision of emergency medical services; and F) One EMS provider certified or licensed at any level who is actively involved in the provision of emergency medical services; G) One clinical psychiatrist licensed in good standing in Colorado who is recommended by a statewide association of psychiatrists; H) 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; H) 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: A) The acts and medications that EMS providers are authorized to perform or administer under the direction of all medical directors. CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 32 B) Requests by medical directors for waivers to the scope of practice of EMS providers as established in these rules. C) Modifications to EMS provider certification or licensing levels and capabilities. D) 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. CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 33 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. CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 34 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. CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 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. CODE OF COLORADO REGULATIONS 6 CCR 1015-3 Health Facilities and Emergency Medical Services Division 35 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 med [Text truncated at 120,000 characters. The full text is on the page linked above.] ## Nearby sections - [6 CCR 1011-1 Chapter 22 CHAPTER 22 - BIRTH CENTERS](https://www.frixlaw.com/law-library/statutes/STATE_CO_CCR_6_CCR_1011_1_Chapter_22.md) - [6 CCR 1011-1 Chapter 24 CHAPTER 24 - MEDICATION ADMINISTRATION REGULATIONS](https://www.frixlaw.com/law-library/statutes/STATE_CO_CCR_6_CCR_1011_1_Chapter_24.md) - [6 CCR 1011-1 Chapter 25 CHAPTER 25 - RURAL PRIMARY CARE HOSPITALS [Repealed eff. 11/01/2004]](https://www.frixlaw.com/law-library/statutes/STATE_CO_CCR_6_CCR_1011_1_Chapter_25.md) - [6 CCR 1011-1 Chapter 26 CHAPTER 26 - HOME CARE AGENCIES](https://www.frixlaw.com/law-library/statutes/STATE_CO_CCR_6_CCR_1011_1_Chapter_26.md) - [6 CCR 1011-3 STANDARDS FOR COMMUNITY INTEGRATED HEALTH CARE SERVICE AGENCIES](https://www.frixlaw.com/law-library/statutes/STATE_CO_CCR_6_CCR_1011_3.md) - [6 CCR 1011-4 STANDARDS FOR SECURE TRANSPORTATION SERVICES](https://www.frixlaw.com/law-library/statutes/STATE_CO_CCR_6_CCR_1011_4.md) - [6 CCR 1015-1 EMERGENCY MEDICAL SERVICES ACCOUNT](https://www.frixlaw.com/law-library/statutes/STATE_CO_CCR_6_CCR_1015_1.md) - [6 CCR 1015-2 IMPLEMENTATION OF CARDIOPULMONARY RESUSCITATION (CPR) DIRECTIVES BY EMERGENCY MEDICAL SERVICE PROVIDERS](https://www.frixlaw.com/law-library/statutes/STATE_CO_CCR_6_CCR_1015_2.md) - [6 CCR 1015-3 EMERGENCY MEDICAL SERVICES](https://www.frixlaw.com/law-library/statutes/STATE_CO_CCR_6_CCR_1015_3.md) - [6 CCR 1015-4 STATEWIDE EMERGENCY MEDICAL AND TRAUMA CARE SYSTEM](https://www.frixlaw.com/law-library/statutes/STATE_CO_CCR_6_CCR_1015_4.md) --- Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_CO_CCR_6_CCR_1015_3. Check the current official text before relying on it. Not legal advice.