NON-NATIONALLY REGISTERED EMR, AFAA and EMT CONTINUING EDUCATION REPORT NORTH DAKOTA DEPARTMENT OF HEALTH DIVISION OF EMERGENCY MEDICAL SERVICES & TRAUMA SFN 59299 01/2016

This form is for the Emergency Medical Responder (EMR), AFAA, or Emergency Medical Technician (EMT) who is NOT Nationally Registered. In order to re-license with DEMST, you must complete this form and submit it with a current EMS Registration to DEMST. Hours submitted on this form are subject to audit. This form may be filled out electronically and saved on your computer. Forms submitted prior to January 1 of the year of expiration will not be accepted.

Name Six Digit State ID NREMT Number

Date Topic Method Hours Category

By signing this form you are affirming the information is true and correct to the best of your knowledge.

Signature Date

Instructions for completion of Continuing Education Report for Non-Nationally Registered EMS Providers at the Emergency Medical Responder, Advanced First Aid Ambulance and Emergency Medical Technician level.

Starting January 1 of the year of expiration this form may be completed and submitted with an EMS Registration form to DEMST for re-licensure. Below is a guideline of the educational topics and hours you must complete prior to submission. NOTE: This form is for non-Nationally Registered providers ONLY.

Emergency Medical Responder National Core Competency Requirements Topics and Minimum Hours

Airway, Respiration and VentilationVentilation - 1.0 hours

Oxygenation - 1.0 hours2

CardiovascularStroke - 1.0 hours

Cardiac Arrest - 0.5 hours 2Post Resuscitation Care - 0.5 hours

Note: The hours and topics listed are minimum amounts in each category. Any hours that are obtained beyond the minimum requirements may be used in the LCCR or ICCR categories. You must have at least three (3) different subject in the LCCR and ICCR categories. Other subject material related to EMS may be used in the LCCR and ICCR categories on an hour-for-hour basis.

TraumaCNS Injury - 0.5 hours

Tourniquets - 0.5 hours1

MedicalImmunological Diseases - 1.0 hours

Communicable Disease - 0.5 hours 3Psychiatric Emergencies - 1.5 hours

Required LCCR Hours

Required ICCR Hours

Total Amount of Hours Required

NCCR Total

4

4

16

8

Airway, Respiration and VentilationVentilation - 3.0 hours

Oxygenation - 1.0 hours4

AFAA & Emergency Medical Technician National Core Competency Requirements Topics and Minimum Hours

Cardiovascular

Post Resuscitation Care - 0.5 hours

Stroke - 1.0 hours

6Cardiac Arrest - 0.5 hours

Cardiac Rate Disturbance (Ped) - 1.0 hours

Pediatric Cardiac Arrest - 2.0 hours

Chest Pain from Card Disease - 1.0 hours

Operations

At-Risk Populations - 0.5 hours

Pediatric Transport - 0.5 hours 2Affective - 0.5 hours

Role of Research - 0.5 hours

Medical

Special Healthcare Needs - 1.0 hours

OB Emergencies - 1.0 hours

6Psychiatric Emergencies - 1.5 hours

Endocrine - 1.0 hours

Immunological Diseases - 1.0 hours

Communicable Disease - 0.5 hours

TraumaCNS Injury - 0.5 hours

Tourniquets - 0.5 hours 2

Note: The hours and topics listed are minimum amounts in each category. Any hours that are obtained beyond the minimum requirements may be used in the LCCR or ICCR categories. You must have at least three (3) different subject in the LCCR and ICCR categories. Other subject material related to EMS may be used in the LCCR and ICCR categories on an hour-for-hour basis.

Required LCCR Hours

Required ICCR Hours

Total Amount of Hours Required

NCCR Total

10

10

40

20

Field Triage - 1.0 hours

SFN 59299 (1-2016) Page 2 of 2

Note: Distributive Education Allowance is as follows: NCCR LCCR ICCR 1/3 of total 2/3 of total 3/3 (all) allowed