**APPENDIX G27. MEDICAL INSTRUMENT TECHNICIAN**

**QUALIFICATION STANDARD**

**GS-649**

**Veterans Health Administration**

**1. COVERAGE.** The following are requirements for appointment as a
Medical Instrument Technician (MIT) in the Veterans Health
Administration (VHA). This series includes positions that perform
diagnostic examinations or medical treatment procedures as part of the
diagnosis and treatment of patients. The work involves operating or
monitoring diagnostic and therapeutic medical instruments and equipment
associated with cardiac catheterization, pulmonary examinations and
evaluations, heart bypass surgery/heart-lung transplant surgery
(perfusion), electrocardiography, electroencephalography,
polysomnography, hemodialysis, ultrasonography, and vascular sonography.
Positions in this series require knowledge of the capabilities and
operating characteristics of one or more kinds of instruments and a
practical knowledge of human anatomy and physiology. Positions also
require a practical understanding of medical data generated by
patient/equipment connections. Some positions may also require a
practical knowledge of chemistry, pharmacology, physics, and
mathematics.

Coverage under this standard and assignment of individuals to this
occupation are restricted to the specific subspecialties identified
above and those DIRECTLY DERIVED from these current subspecialties. For
example, electroencephalography and polysomnography technicians perform
duties using the same types of equipment and measure brain waves, the
primary difference being the wake or sleep state of the patient. No
individual will be assigned to this series (GS-649) without an approved
parenthetical title.

Any additional parenthetical specialties developed as the result of new
technologies must be directly derived from current specialties and must
be approved by the Office of Human Resources Management & Labor
Relations, Compensation & Classification Service (055) in VA Central
Office (VACO). Only after a decision has been made to include the
identified new specialty in this qualification standard, and an approved
parenthetical title and code have been developed, will an individual be
assigned to this series.

**2. BASIC REQUIREMENTS**

a\. **Citizenship.** Citizenship of the United States. (Non-citizens may
be appointed when it is not possible to recruit qualified citizens in
accordance with chapter 3, section A, paragraph 3g, this part.)

b\. **Education.** There are no specific educational requirements for
this occupation. Education may be substituted for experience only at the
GS-4 and GS-5 levels. See the grade requirements part of this standard
for information regarding educational substitutions.

c\. **Licensure or Certification.** Licensure or Certification is not
required for this occupation; however, it is strongly desirable at GS-6
or above as evidence of possession of the essential knowledge, skills,
and abilities. For certain functional areas at the higher levels or
supervisory assignments, specific certifications appropriate to the
specialty are indicated in this standard under "Titles and
Certification/Registrations".

For all specialties identified in this standard, Basic and Advanced
Cardiac Life Support certifications are desirable. Training which does
not result in official certification does not meet this definition.

d\. **Grandfathering Provision.** The following is the standard
grandfathering policy for all Title 38 Hybrid qualification standards.
Some of these provisions may not apply to this occupation. Please

carefully review the qualification standard to determine the specific
education and/or licensure/certification/ registration requirements that
apply to this occupation.

[]{.mark}

All persons employed in VHA in this occupation on the effective date of
this qualification standard are considered to have met all qualification
requirements [for the title, series and grade held]{.underline},
including positive education and licensure/certification/registration
that are part of the basic requirements of the occupation. For employees
who do not meet all the basic requirements required in this standard,
but who met the qualifications applicable to the position at the time
they were appointed to it, the following provisions apply:

-   Such employees in an occupation that does not require a
    licensure/certification/registration, may be reassigned, promoted,
    or demoted within the occupation.

-   Such employees in an occupation that [requires]{.underline} a
    licensure/certification/registration, may be reassigned, promoted up
    to and including the full performance (journey) level, or demoted
    within the occupation, but [may not]{.underline} be promoted beyond
    the journey level or placed in supervisory or managerial positions.

-   Such employees in an occupation that requires a
    licensure/certification/registration only at higher grade levels
    must meet the licensure/certification/registration requirement
    before they can be promoted to those higher grade levels.

Employees who are appointed on a temporary basis prior to the effective
date of the qualification standard may not have their temporary
appointment extended or be reappointed, on a temporary or permanent
basis, until they fully meet the basic requirements of the standard.

Employees initially grandfathered into this occupation, who subsequently
obtain additional education and/or licensure/certification/registration
that meet all the basic requirements of this qualification standard must
maintain the required credentials as a condition of employment in the
occupation.

If an employee who was retained in an occupation listed in 38 U.S.C. §
7401(3) under this provision leaves that occupation, the employee loses
protected status and must meet the full VA qualification standard
requirements in effect at the time of reentry to the occupation.

e\. **Physical Requirements.** See VA Directive and Handbook 5019.

f\. **English Language Proficiency.** Medical Instrument Technicians
must be proficient in spoken and written English in accordance with
chapter 2, section D, paragraph 5a, this part.

**3. GRADE REQUIREMENTS**

a\. **Definitions:** For purposes of this qualification standard the
specialty areas of this occupation have been grouped into six functional
areas. These are:

-   Cardiovascular (Electrocardiograph Technician, Cardiac
    Catheterization Technician)

-   Medical (Hemodialysis Technician)

-   Surgical (Perfusion Technician, Anesthesia Technician)

-   Neurology (Electroencephalograph Technician, Polysomnography
    Technician)

-   Pulmonary (Pulmonary Function Technician), and

-   Imaging (Diagnostic Ultrasound Technician, Echocardiograph
    Technician, and Vascular Technician).

Medical Instrument Technicians at GS-6 and above will have a functional
assignment and reference should be made to the appropriate appendix for
qualifications evaluation.

Grade level criteria, KSAs (core competencies), and typical assignment
information for all GS-4 and GS-5 levels are defined generically in this
part of the qualification standard. For higher level positions where the
grade level/assignment is based on supervisory and/or managerial
responsibilities, criteria are also included in the general portion of
this qualification standard (for individuals in multiple function
assignments) and/or the specific appendices.

For non-supervisory positions at GS-6 and above and for supervisory
positions in a single specialty, the grade level criteria, KSAs, and
types of assignments are discussed in appendices matching the title
areas listed below. Reference should be made to the appropriate appendix
in evaluating the qualifications of individuals for this occupation.

\(1\) **[Titles and Certifications/Registrations:]{.underline}** All
individuals assigned to this occupation MUST have an approved
parenthetical title. For individuals at the GS-4 and GS-5 levels, the
approved title will be Medical Instrument Technician (Trainee). For
supervisory positions over two or more approved specialties, the
approved title will be Supervisory Medical Instrument Technician
(Multiple Function). Supervisors over a single specialty will have that
specialty as the parenthetical title; for example, Supervisory Medical
Instrument Technician (Cardiac Catheterization). Non-supervisory
individuals whose assignments involve two or more specialty areas will
be assigned the parenthetical title for the predominant specialty
considering both the intended function and qualifications background of
the individual.

\(a\) **Anesthesia Technicians** perform logistical and technical
support to anesthesiologists and nurse anesthetists. They maintain
anesthesiology supplies and equipment, set-up anesthetizing locations
and operate, monitor, and collect data from anesthesia related
equipment. In some cases Anesthesia Technicians will perform clinical
laboratory functions, equipment preventive maintenance/repair, and
specialized cardiac procedures such as cardiac output measurement,
intra-aortic balloon pumping, vessel cannulation, and autotransfusion
services. Certification at two distinct levels is offered by the
American Society of Anesthesia Technologists and Technicians (ASATT).
(See Appendix A)

\(b\) **Cardiac Catheterization** **Technicians** perform, under a
physician's direction, diagnostic tests, both invasive and noninvasive,
of the pulmonary system (lung) and the cardiovascular system (heart and
circulation). They operate, monitor, and collect data from instruments
used in procedures such as cardiac catheterization, angiography,
valvuloplasty, angioplasty, electrophysiology studies, cardiac pacing,
or cardiac pacemaker or leadwire insertion. Registration is offered by
Cardiovascular

Credentialing International (CCI) as a Registered Cardiovascular
Invasive Specialist (RCIS). (See Appendix B)

\(c\) **Diagnostic Ultrasound Technicians** operate diagnostic
ultrasonic scanning equipment to produce cross sectional and two
dimensional pictures of internal organs and body structures used to
diagnose diseases and other medical conditions. Registration is offered
by Cardiovascular Credentialing International (CCI) or by the American
Registry of Diagnostic Medical Sonographers (ARDMS). (See Appendix C)

Positions should be assigned to the Diagnostic Radiologic Technologist
(DRT), GS-647 series, when [both]{.underline} ultrasound and other
modalities which require the delivery of ionizing radiation are
performed. Positions in which ultrasound duties are performed
exclusively (no other modalities are performed), should be assigned to
the Medical Instrument Technician, GS-649 series, since ultrasound
duties solely do not require the delivery of ionizing radiation.

\(d\) **Echocardiography Technicians** operate diagnostic equipment to
graphically record the position and motion of the heart walls or the
internal structure of the heart and neighboring tissue by the echo
obtained from beams of ultrasonic waves directed through the chest wall.
Registration is offered by Cardiovascular Credentialing International
(CCI), as a Registered Cardiac Sonographer (RCS) or by the American
Registry of Diagnostic Medical Sonographers (ARDMS) as a Registered
Diagnostic Cardiac Sonographer (RDCS). (See Appendix D)

\(e\) **Electrocardiograph Technicians (EKG)** operate instruments used
to record electrocardiograms, exercise tolerance tests, 24-48 heart
monitoring and scanning, and pacemaker evaluations. Certification is
offered by Cardiovascular Credentialing International (CCI) as a
Certified Cardiographic Technician (CCT). (See Appendix E)

\(f\) **Electroencephalograph (EEG)** **Technicians** operate the
electroencephalograph and other devices such as evoked potential
equipment to record the electrical activity of the brain. Registration
is offered by the American Board of Registration of EEG, CNIM & EP
Technologists (ABRET) or the American Association of Electrodiagnostic
Techs (AAET). (See Appendix F)

\(g\) **Hemodialysis** **Technicians** operate and monitor kidney
dialysis instruments to provide dialysis treatment to patients with
kidney failure or to maintain patients with irreversible kidney
disorders. The agencies that offer national certification are Nephrology
Certification Commission (NNCC), Board of Nephrology Examiners, Inc.,
Nursing and Technology (BONENT), National Nephrology Certification
Organization (NNCO), and the International Certification Commission for
Clinical Engineering and Biomedical Technology (ICC) in conjunction with
the United States Certification Commission (USCC). (See Appendix G)

\(h\) **Perfusion** **Technicians** operate the heart-lung apparatus to
take over functions of the patient's heart and lungs during coronary
bypass surgery, heart and/or lung transplantation surgery, valve
replacement, or respiratory failure. Certification is offered by the
American Board of Cardiovascular Perfusion (ABCP). (See Appendix H)

\(i\) **Polysomnography** **Technicians** operate the
electroencephalograph and other devices to record the electrical
activity of the brain during sleep. Registration is offered by the Board
of Registered Polysomnographic Technologists (BRPT). (See Appendix I)

\(j\) **Pulmonary Function Technicians** operate instruments to perform
blood gas analysis; bronchoscopy with lung sampling; cardiopulmonary
exercise stress tests; lung volume tests including spirometry (both pre
and post medication); total lung capacity, functional residual capacity,
and flow volume loops. Certification (RPFT) is offered by the National
Board of Respiratory Care. (See Appendix J)

\(k\) **Vascular technicians** or **vascular sonographers** operate
diagnostic equipment using ultrasound to record vascular information
such as vascular blood flow, blood pressure, limb volume changes, oxygen
saturation, cerebral circulation, peripheral circulation, and abdominal
circulation. Registration is offered by Cardiovascular Credentialing
International, (CCI) as a Registered Vascular Specialist (RVS) or by the
American Registry of Diagnostic Medical Sonographers (ARDMS) as a
Registered Vascular Technologist (RVT). (See Appendix K)

\(2\) **Creditable Experience - Knowledge of Current Medical Instrument
Technician Practices.** To be creditable, the experience must have
required the use of knowledge, skills, abilities and other
characteristics associated with current Medical Instrument Technician
practice appropriate to the identified specialty area.

\(3\) **Quality of Experience.** Experience is only creditable if it is
equivalent to at least the next lower grade level and is directly
related to the position/specialty to be filled.

\(4\) **Part-time Experience**. Part time experience is credited
according to its relationship to a full time work week. For example, an
individual employed 20 hours per week, or on a ½ time basis would
receive one work week credit for each two weeks of service.

\(5\) **Fellowships. N/A**

\(6\) **Internships. N/A**

b\. **Grade Determinations.** In addition to the basic requirements for
employment, the criteria discussed in the applicable headings, or that
defined in the appendices, must be met when determining the grade of
candidates.

c\. **Education/Training.** To be creditable education must have been
gained in an accredited Community College, College, or University.

Foreign Education: To be creditable, education completed outside the
U.S. must have been submitted to a private organization that specializes
in the interpretation of foreign educational credentials and such
education must have been deemed at least equivalent to that gained in
conventional U.S. programs.

Completion of appropriate training such as in-service training programs,
on the job training, training acquired while in the Armed Forces,
government sponsored developmental training programs, and/or training
under physicians certified in the functional area will be allowed on a
month-for-month basis through the GS-5 level.

Specialized developmental experience obtained under supervision of
appropriately certified individuals may be credited at higher levels and
is addressed in individual appendices.

d\. **Basic Developmental Levels**

\(1\) **GS-4**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
position to be filled. Six months of this experience may have been in
medically related fields such as nursing assistant, practical nursing,
or similar fields. The remaining six months must have been in operating
diagnostic and therapeutic equipment covered by this occupation.
Experience gained in the operation of equipment for animal diagnosis or
treatment may be credited at this level. In addition, the candidate must
demonstrate the following KSAs:

**OR**

**Education.** Successful completion of two years of education above
high school or an associate's degree with a major field of study
directly related to the medical instrument technician occupation.

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1.]{.underline} Knowledge of basic medical terminology.

[2]{.underline}. Ability to learn the components, operating
characteristics, and settings of the equipment to be used.

[3.]{.underline} Ability to learn typical patient reactions to the basic
procedures involved and ability to recognize signs of distress.

[4.]{.underline} Ability to learn the standard positions for the
procedure being conducted.

[5.]{.underline} Ability to communicate orally and in writing.

\(c\) **Assignments.** At this level assignments are trainee in nature.
The medical instrument technician trainee is performing limited routine
assignments of a developmental nature under close supervision.

\(2\) **GS-5**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
position to be filled. This would be experience in operating equipment
related to the particular specialization for which application is made
or in related functional areas. Experience gained in the operation of
equipment for animal diagnosis or treatment may be credited through this
grade level. In addition, the candidate must demonstrate the following
KSAs:

OR

\(b\) **Education.** Successful completion of a bachelor's degree in a
major field of study appropriate to medical instrument technician
functions.

\(c\) **Demonstrated Knowledge, Skills, and Abilities**

[1.]{.underline} Knowledge of standard medical terminology to interpret
physician orders or instructions.

[2.]{.underline} Knowledge of common physical disabilities and ability
to position patients for the examination or treatment.

[3.]{.underline} Ability to learn the normal and abnormal results for
routine procedures to recognize and report obvious abnormalities.

[4.]{.underline} Ability to operate the equipment to administer
routine/standard diagnostic treatment or procedures.

[5.]{.underline} Ability to perform standard operator maintenance on the
equipment including the ability to disassemble, clean, reassemble, and
calibrate the machine.

\(d\) **Assignment.** Medical Instrument Technicians (Trainee) at this
level operate and monitor commonly used equipment performing routine
procedures under normal supervision. The technician functions somewhat
independently in carrying out these standardized procedures of limited
complexity. Deviations from regular procedures, unanticipated problems,
and unfamiliar situations are referred to the supervisor for a decision
or help. Some assignments at this level also include developmental
duties involving more complex procedures designed to prepare the
technician for promotion to higher grades in a functional area. Such
duties would be performed under closer supervision.

e\. **Non-Supervisory positions at GS-6 and above.** For medical
instrument technician positions with functional specialty titles, see
the appropriate appendix for creditable experience, KSAs, and assignment
definitions.

f\. **Supervisory Medical Instrument Technician.** Supervisory positions
in single specialties will be addressed in the applicable appendix, for
example supervisory medical instrument technician (cardiac
catheterization).

Typically, assignments for supervisory positions will be one grade
(first line supervisor) or two grade (second line supervisor) levels
above the full performance level of the employees supervised. The full
performance levels are clearly identified in the separate appendices.

Supervisory medical instrument technician positions having oversight for
two or more functional specialties will have "Multiple Function" as the
parenthetical title. Grade levels for these positions should be
determined by the full performance level of the positions supervised and
other program

management responsibilities. Individual appendices indicate the full
performance level of identified specialties. Levels and complexity of
supervisory positions are described below.

\(1\) **First Level Supervisor**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. This
experience must demonstrate possession of the knowledge required in
order to provide medical instrument technician services in the
functional specialties supervised. In addition, the candidate must
demonstrate the following technical KSAs and the potential to acquire
the assignment specific KSAs designated by an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1.]{.underline} Knowledge of the more complex examination and treatment
procedures and techniques.

\*[2.]{.underline} Ability to manage and supervise employees in two or
more functional specialties.

\*[3.]{.underline} Knowledge of Joint Commission on Accreditation of
Healthcare Organizations (JCAHO) and other regulatory requirements.

[4.]{.underline} Ability to communicate effectively and professionally
with employees at varying grade levels.

\*[5.]{.underline} Ability to provide, or provide for, staff development
and training.

\(c\) **Certification.** At this level, it is highly desirable that
supervisors possess certification in one or more appropriate functional
areas.

\(d\) **Assignment.** Typically these positions are established one
grade above the full performance level of the technicians supervised.
Individuals in this assignment assume full administrative and
professional responsibility for planning and directing the work of
subordinate technicians. Typically these duties include assigning and
evaluating the work of subordinate staff; providing Medical Instrument
Technician services in more complex cases; reviewing and making
recommendations regarding new and emerging procedures; providing
instruction and training to new staff; interviewing candidates for
positions; recommending selections, advancements, promotions; evaluating
performance; taking disciplinary action when necessary; and identifying
educational or training needs. For all assignments above the full
performance level, the higher-level duties must consist of significant
scope, complexity (difficulty), and range of variety, and be performed
by the incumbent at least 25% of the time.

\(2\) **Higher Level Supervisor**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. This
would be specialized experience as a first level supervisor which
demonstrates possession of the knowledge required to provide medical
instrument technician services in the functional specialties

supervised as well as supervisory knowledge, skills, and abilities. In
addition, the candidate must demonstrate the following technical KSAs
and the potential to acquire the assignment specific KSAs designated by
an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1.]{.underline} Advanced knowledge of complex and non-standard
treatment and examination procedures and techniques.

\*[2.]{.underline} Ability to plan and assist in the establishment of a
completely integrated treatment and examination program.

\*[3.]{.underline} Ability to evaluate new products and equipment and
make recommendations concerning developments which would improve
operations.

\*[4.]{.underline} Ability to manage the fiscal matters of the functions
supervised (which would include fund controls, contracts, and equipment
expenditures), forecast resource and equipment needs, and administer the
allocated budget.

\*[5.]{.underline} Knowledge of and ability to provide the full range of
supervisory duties which would include responsibility for assignment of
work to be performed; performance evaluation; selection of staff; and
recommendation of awards, advancements, and, when appropriate,
disciplinary actions.

\(c\) **Certification.** At this level, it is highly desirable that
supervisors possess certification in two or more functional specialties.
Participation in recognized professional organizations as a Board
examiner, in the development of curricula for training, or testing for
the Board is evidence of competence.

\(d\) **Assignment.** Individuals at this level plan and direct programs
at affiliated medical centers and their satellite outpatient clinics and
have full supervisory responsibility for a large staff of
non-supervisory personnel and at least one subordinate team leader or
supervisor. Typically these duties include assigning and evaluating the
work of subordinate staff resolving problems which may interfere with
patient examination or treatment; providing medical instrument
technician services in more complex and non-standard cases; evaluating
new products and equipment and making recommendations concerning
developments which would improve operations; participating as an
instructor in the facility's clinical training program; making final
decisions on selections based on recommendations from subordinate
supervisors or leads; evaluating performance; taking disciplinary action
when necessary; and identifying educational or training needs. For all
assignments above the full performance level, the higher-level duties
must consist of significant scope, complexity (difficulty), and range of
variety, and be performed by the incumbent at least 25% of the time.

**4. DEVIATIONS**

a\. The appointing official may, under unusual circumstances, approve
reasonable deviations to the grade determination requirements for
medical instrument technicians in VHA whose composite record of
accomplishments, performance, and qualifications, as well as current
assignments, warrant such action based on demonstrated competence to
meet the requirements of the proposed grade.

b\. There will be some positions which properly belong in this
occupational series but for which there have been no authorized
parenthetical specialty titles developed. Such positions may represent
specialties for which there are relatively few positions or may be the
result of new technologies. In either case the work of the position must
be directly derived from the specialties identified in the coverage
portion of this standard. Before any individual may be assigned to such
a position in this series, the proposed parenthetical title must be
approved by the Office of Human Resources Management & Labor Relations,
Compensation & Classification Service in VA Central Office.

c\. The placement of individuals in grade levels not described in this
standard must be approved by the Under Secretary for Health, or
designee, in VHA Central Office.

**Authority: 38 U.S.C. § 7304; 7402**

Appendix A -- Medical Instrument Technician (Anesthesia)

\(1\) GS-6

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. In addition, the candidate must demonstrate the
following KSAs:

\(b\) **Demonstrated Knowledge, Skills and Abilities**

[1.]{.underline} Knowledge of human anatomy and physiology (specifically
cardiac and pulmonary).

[2.]{.underline} Knowledge and application of safety and infection
control processes.

[3.]{.underline} Ability to serve as a circulating technician for
supplies and to assist with documentation of hemodynamic patient data.

[4.]{.underline} Knowledge of anesthesiology supplies and equipment
appropriate to less complex anesthetic procedures, such as those found
in Ambulatory Surgery.

\(c\) **Certification.** No certification is required; however, it is
desirable that employees at this level have Basic Cardiac Life Support
(BCLS) certification.

\(d\) **Assignment.** The anesthesia technician at this level aids
anesthesiologists and nurse anesthetists in less-complex anesthetic
procedures such as regional anesthesia (epidural and spinal), laryngeal
mask anesthesia, and monitored anesthesia care under close supervision.
Technicians will exercise minimal independent judgment in anesthesia
technology duties.

\(2\) **GS-7**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. In addition, the candidate must demonstrate the
following KSAs:

\(b\) **Demonstrated Knowledge, Skills and Abilities**

[1.]{.underline} Knowledge of the fundamentals of standard equipment
operation, calibration and function.

[2.]{.underline} Knowledge of correct use of non-invasive patient
monitoring equipment specific to anesthesiology.

[3.]{.underline} Ability to appropriately interact with patients during
anesthetic procedures.

[4.]{.underline} Knowledge of anesthesiology supplies and equipment
appropriate to routine anesthetic procedures, such as those found in
typical inpatient settings.

\(c\) **Certification.** No certification is required; however, it is
desirable that employees at this level have Basic Cardiac Life Support
(BCLS) certification.

\(d\) **Assignment.** The anesthesia technician at this level assists
anesthesiologists and nurse anesthetists in routine anesthetic
procedures under general supervision. The technician will connect and
operate non-invasive hemodynamic monitoring equipment, blood and fluid
warmers (e.g., Hot Line and Ranger) and patient warming devices (e.g.,
Bair Hugger). The technician will exercise moderate independent judgment
in anesthesia technology duties.

\(3\) **GS-8**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. In addition, the candidate must demonstrate the
following KSAs:

\(b\) **Demonstrated Knowledge, Skills and Abilities**

[1.]{.underline} Knowledge of the correct use of invasive patient
monitoring equipment specific to anesthesiology.

[2.]{.underline} Knowledge of basic electrocardiography (EKG).

[3.]{.underline} Skill and ability to troubleshoot equipment, often
while the patient is anesthetized.

[4.]{.underline} Skill and ability to maintain sterility during
procedures.

[5.]{.underline} Knowledge and understanding of arterial pressure line
wave forms including the ability to recognize and distinguish normal
from abnormal, artifact from abnormality, and forewarn the physician or
anesthetist of an impending life-threatening situation.

[6.]{.underline} Knowledge of anesthesiology supplies, medications, and
equipment appropriate to more difficult anesthetic procedures such as
those found in inpatient settings with more acutely ill patients.

\(c\) **Certification.** No certification is required; however, it is
desirable that employees at this level have Basic Cardiac Life Support
(BCLS) certification.

\(d\) **Assignment.** This represents the full performance level. The
anesthesia technician at this level assists anesthesiologists and nurse
anesthetists in difficult anesthetic procedures under minimal
supervision. The technician will connect and operate invasive
hemodynamic monitoring equipment (e.g., arterial pressure monitors),
anesthesia machines, ventilators, intubation bronchoscopes, and
ultrasonic scanning devices. Technicians prepare and administer
medications as directed by the attending physician. They mentor and
train lower graded technicians, nurses, medical students, and anesthesia
residents on anesthesia technology procedures and assist the
supervisor/manager with quality control and performance improvement
activities. The technician will exercise a high degree of independent
judgment in anesthesia technology duties.

\(4\) **GS-9.** In addition to the core competencies defined at the GS-8
full performance level, positions at this level may be lead,
supervisory, or non-supervisory with specialized advanced knowledge and
duties.

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. This
would include specialized experience as an anesthesia technician which
demonstrates possession of the knowledge, skills, and abilities required
to provide all aspects of anesthesia technician services including
specialized duties. In addition, the candidate must demonstrate the
following technical KSAs and the potential to acquire the assignment
specific KSAs designated by an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs 1 through
6 are appropriate for all positions at this level. KSAs 7 and 8 are to
be used in accordance with their appropriateness for the specific
assignment.

[1.]{.underline} Knowledge and comprehensive understanding of laboratory
testing procedures to include maintenance, calibration, and quality
control procedures. This includes the ability to perform these lab tests
accurately and correctly.

[2.]{.underline} Advanced knowledge of electronics and anesthesia
equipment with skill in repairing and maintaining this equipment and
repairing complex problems.

\*[3.]{.underline} Comprehensive knowledge of central venous and
pulmonary artery (Swan-Ganz) catheterization procedures including
measuring cardiac outputs and intra-aortic balloon counterpulsation
procedures (i.e., balloon pump).

[4.]{.underline} Knowledge and ability to assist with airway management
techniques.

\*[5.]{.underline} Knowledge of JCAHO and other regulatory requirements.

[6.]{.underline} Ability to communicate effectively and professionally
with employees at varying grade levels.

\*[7.]{.underline} Ability to manage and supervise employees.

\*[8.]{.underline} Ability to provide, or provide for, staff development
and training.

\(c\) **Certification.** Anesthesia technician certification through the
American Society of Anesthesia Technologists and Technicians (ASATT) is
highly desirable. Basic Cardiac Life Support (BCLS) and Advanced Cardiac
Life Support (ACLS) certifications are also desirable for employees at
this level.

\(d\) **Assignments** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

[1.]{.underline} **Special Assignments.** Perioperative programs at some
facilities require that anesthesia technicians perform duties that
exceed the full performance level. The anesthesia technician at this

level performs difficult and responsible anesthesia technology duties
with considerable latitude for the exercise of independent judgment. The
technician may perform clinical laboratory tests for the unit (i.e.,
blood gas, activated clotting time and glucose) or perform more
difficult equipment repairs. The technician may also participate in
large-vessel cannulations (with subsequent monitoring) characteristic of
open-heart, transplant and major vascular surgeries. These assignments
are expected to be relatively few in number ad must represent
substantial additional responsibility over the full performance level.

[2.]{.underline} **Lead Anesthesia Technician.** There may be some
perioperative programs that do not need a technician functioning at the
full supervisory level. However, daily guidance of the anesthesia
technicians may still be required and can be accomplished through a lead
technician. Typically, the lead technician will only have the
responsibility of seeing that the work flows smoothly, assuring coverage
if needed and assigning work. Authority to approve leave, take
disciplinary action, etc. will only be assigned to full supervisory
positions.

[3.]{.underline} **Supervisory Anesthesia Technician.** Individuals in
this assignment assume full administrative and professional
responsibility for planning and directing the work of subordinate
technicians. Typically these duties include assigning and evaluating the
work of subordinate staff; providing anesthesia technician services in
more complex cases; reviewing and making recommendations regarding new
and emerging procedures; providing instruction and training to new
staff; interviewing candidates for positions; recommending selections,
advancements, promotions; evaluating performance; taking disciplinary
action when necessary; and identifying educational or training needs.

\(5\) **GS-10.** In addition to the core competencies defined at the
GS-9 level, positions at this grade may be supervisory or
non-supervisory with specialized advanced knowledge and assignments.

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. In
addition, the candidate must demonstrate the following technical KSAs
and the potential to acquire the assignment specific KSAs designated by
an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs 1, 2, and
3 are appropriate for all positions at this level. KSAs 4 and 5 are to
be used in accordance with their appropriateness for the specific
assignment.

[1.]{.underline} Knowledge of the more complex procedures and techniques
in the practice of anesthesiology such as extracorporeal blood salvage,
washing and return to patient (also known as autotransfusion or cell
saving) and arterial and/or venous cannulation for the establishment of
arterial pressure monitoring or intravenous fluid/medication delivery.

\*[2.]{.underline} Ability to plan and assist in the establishment of a
completely integrated treatment and procedure program.

\*[3.]{.underline} Ability to evaluate new products and equipment and
make recommendations concerning developments which would improve
operations.

\*[4.]{.underline} Ability to manage the fiscal matters of the functions
supervised (which would include fund controls, contracts and equipment
expenditures), forecast resource and equipment needs and administer the
allocated budget.

\*[5.]{.underline} Knowledge of and ability to provide the full range of
supervisory duties which would include responsibility for assignment of
work to be performed; performance evaluation; selection of staff; and
recommendation of awards, advancements and, when appropriate,
disciplinary actions.

\(c\) **Certification.** Anesthesia technician certification through the
American Society of Anesthesia Technologists and Technicians (ASATT) is
highly desired. Basic Cardiac Life Support (BCLS) and Advanced Cardiac
Life Support (ACLS) certifications are also desirable for employees at
this level. Participation in recognized professional organizations as a
Board examiner, in the development of curricula for training, or testing
for the Board is evidence of competence.

\(d\) **Assignments.** In addition to the core competencies defined at
the GS-9 level, positions at this level may be supervisory or
non-supervisory with specialized advanced knowledge and duties. For all
assignments above the full performance level, the higher-level duties
must consist of significant scope, complexity (difficulty), and range of
variety, and be performed by the incumbent at least 25% of the time.

[1.]{.underline} **Special Assignments.** Perioperative programs at some
facilities require that anesthesia technicians perform duties that
exceed the full performance level. The anesthesia technician at this
level performs highly difficult and responsible anesthesia technology
duties with considerable latitude for the exercise of independent
judgment. The anesthesia technician may perform autotransfusion services
to ensure that the patient is receiving the safest possible blood
transfusion (his/her own blood) and that the regional blood bank supply
is not unnecessarily depleted. Additionally, the anesthesia technician
may be an integral part of the Anesthesia Care Team and prepare the
patients for surgery by establishing arterial or venous access for the
anesthesiologists and nurse anesthetists.

2\. **Supervisory Anesthesiology Technician.** Individuals at this level
plan and direct programs at affiliated medical centers and their
satellite outpatient clinics and have full supervisory responsibility
for a large staff of non-supervisory personnel and at least one
subordinate team leader or supervisor. Typically these duties include
assigning and evaluating the work of subordinate staff; resolving
problems which may interfere with patient examination or treatment;
providing anesthesia technician services in more complex and
non-standard cases; evaluating new products and equipment and making
recommendations concerning developments which would improve operations;
participating as an instructor in the facility's clinical training
program; making final decisions on selections based on recommendations
from subordinate supervisors or leads; evaluation performance; taking
disciplinary action when necessary; and identifying educational or
training needs.

Appendix B -- Medical Instrument (Cardiac Catheterization)

\(1\) GS-6

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. In addition, the candidate must demonstrate the
following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1.]{.underline} Knowledge of cardiac anatomy, physiology, and basic
electrocardiography.

[2.]{.underline} Knowledge of sterile techniques, catheterization
laboratory supplies, and equipment used in the procedures.

[3.]{.underline} Ability to circulate, assist, monitor, and document
hemodynamics and electrocardiograms during the procedure.

[4.]{.underline} Knowledge of and ability to prepare intra-aortic
balloon catheters.

\(c\) **Certification.** Basic Cardiac Life Support (BCLS) certification
is desirable.

\(d\) **Assignment.** The cardiac catheterization technician at this
level aids physicians in aspects of cardiac catheterization and related
invasive procedures such as coronary angioplasty, pulmonary angioplasty,
and intra-aortic balloon insertion. The technician must be able to
recognize cardiac arrhythmias and take appropriate action.

\(2\) **GS-7**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. In addition, the candidate must demonstrate the
following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1.]{.underline} Ability to assist with insertion of temporary
transvenous pacemaker catheters.

[2.]{.underline} Ability to maintain intra-aortic balloon pump equipment
during procedures.

[3.]{.underline} Ability to complete individual cases by pulling sheaths
and holding pressure to obtain hemostasis.

[4.]{.underline} Ability to assist with closure devices.

[5.]{.underline} Ability to appropriately educate patients and patient
families regarding procedures and post-catheterization care.

\(c\) **Certification.** Basic Cardiac Life Support (BCLS) and Advanced
Cardiac Life Support (ACLS) certifications are desirable.

\(d\) **Assignment.** Cardiac catheterization technicians at this level
aid physicians in all aspects of standard cardiac catheterization and
related invasive procedures such as coronary angioplasty, pulmonary
angioplasty, and intra-aortic balloon insertion. They select, set up,
and calibrate surgical instruments, catheters, radiographic contrast
injectors, and radiographic imaging devices. They prepare cardiac
medication for administration by the physician and must be able to
recognize cardiac arrhythmias and take appropriate action.

\(3\) **GS-8**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics of the positions to be filled. In
addition, the candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1.]{.underline} Ability to scrub, circulate, and monitor advanced
procedures (including electrophysiological) to include rotoblation,
intravascular ultrasound, RADI or wave-wire, angiojet, filter wires,
myocardial biopsies EPS, permanent pacemaker insertions, AICD
insertions, and biventricular pacemaker insertion.

[2.]{.underline} Advanced knowledge of equipment, medications, and
supplies used in the Cardiac Catheterization Laboratory and the ability
to set-up, calibrate, operate, and troubleshoot this equipment.

[3.]{.underline} Knowledge and understanding of wave forms from the
great vessels and all chambers of the heart including the ability to
recognize and distinguish normal from abnormal, artifact from
abnormality, and forewarn the physician of an impending life-threatening
situation.

[4.]{.underline} Knowledge of quality control and performance
improvement indicators for the Cardiac Catheterization Laboratory and
ability to prepare and analyze quality control of test results.

\(c\) **Certification.** Basic Cardiac Life Support (BCLS) and Advanced
Cardiac Life Support (ACLS) certifications are desirable.

\(d\) **Assignment.** This represents the full performance level.
Cardiac catheterization technicians at this level function as full
members of the Cardiac Catheterization Laboratory Team. They scrub,
circulate, operate equipment, etc., on the most complex examination and
treatment procedures including procedures such as endocardial biopsy,
radio frequency ablation procedures, and intra-aortic balloon pump
therapy for very critical patients. They prepare and administer cardiac
medications as directed by the attending physician. They mentor and
train lower graded technicians, nurses, nursing students, and
cardiopulmonary technology students on cardiac catheterization
laboratory procedures and assist the supervisor/manager with quality
control and performance improvement activities.

\(4\) **GS-9.** In addition to the core competencies defined at the GS-8
full performance level, positions at this grade may be lead,
supervisory, or non-supervisory with specialized advanced knowledge and
assignments.

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. This
would be experience which demonstrates possession of the knowledge
required in order to provide all aspects of cardiac catheterization
technician services. In addition, the candidate must demonstrate the
following technical KSAs and the potential to acquire the assignment
specific KSAs designated by an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs 1, 2, and
3 are appropriate for all positions at this level. KSAs 4 and 5 are to
be used in accordance with their appropriateness for the specific
assignment.

[1.]{.underline} Knowledge of the more complex examination and treatment
procedures and techniques in order to provide training and supervision
in these procedures, to evaluate and initiate performance improvement
projects, and to write policies, procedures, and protocols, that pertain
to the Cardiac Catheterization Laboratory.

\*[2.]{.underline} Knowledge of JCAHO and other regulatory requirements.

[3.]{.underline} Ability to communicate effectively and professionally
with employees at varying grade levels.

\*[4.]{.underline} Ability to manage and supervise employees.

\*[5.]{.underline} Ability to provide, or provide for, staff development
and training.

\(c\) **Certification.** Registration by Cardiovascular Credentialing
International (CCI) as a registered Cardiovascular Invasive Specialist
(RCIS) is highly desirable. Basic Cardiac Life Support (BCLS) and
Advanced Cardiac Life Support (ACLS) certifications are also desirable
for employees at this level.

\(d\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

[1.]{.underline} **Special Assignments.** Non-supervisory medical
instrument technician (cardiac catheterization) may have assignments
that because of their nature substantially exceed the full performance
level. The Professional Standards Board will review proposed
non-supervisory special assignments for the GS-9 level and make a
determination regarding their appropriateness. These assignments are
expected to be relatively few in number and must represent substantial
additional responsibility over the full performance level.

[2.]{.underline} **Lead Medical Instrument Technician (Cardiac
Catheterization)**. In certain programs, either because of their size
and scope or because of a lack of specific supervisory positions, lead
positions may be appropriate.

[3.]{.underline} **Supervisory Cardiac Catheterization Technician.**
Individuals in this assignment assume full administrative and
professional responsibility for planning and directing the work of
subordinate technicians. Typically these duties include assigning and
evaluating the work of subordinate staff; providing cardiac
catheterization technician services in more complex cases; reviewing and
making recommendations regarding new and emerging procedures; providing
instruction and training to new staff; interviewing candidates for
positions; recommending selections, advancements, promotions; evaluating
performance; taking disciplinary action when necessary; and identifying
educational or training needs.

\(5\) **GS-10.** In addition to the core competencies defined at the
GS-9 level, positions at this grade may be supervisory or
non-supervisory with specialized advanced knowledge and assignments.

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. This
would be experience that demonstrates possession of the knowledge
required to provide the most complex cardiac catheterization technician
services and/or supervisory knowledge, skills, and abilities. In
addition, the candidate must demonstrate the following technical KSAs
and the potential to acquire the assignment specific KSAs designated by
an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs 1, 2, and
3 are appropriate for all positions at this level. KSAs 4 and 5 are to
be used in accordance with their appropriateness for the specific
assignment.

[1.]{.underline} Advanced knowledge of complex and non-standard
treatment and examination procedures and techniques.

\*[2.]{.underline} Ability to plan and assist in the establishment of a
completely integrated treatment and examination program.

\*[3.]{.underline} Ability to evaluate new products and equipment and
make recommendations concerning developments which would improve
operations.

\*[4.]{.underline} Ability to manage the fiscal matters of the functions
supervised (which would include fund controls, contracts, and equipment
expenditures), forecast resource and equipment needs, and administer the
allocated budget.

\*[5.]{.underline} Knowledge of and ability to provide the full range of
supervisory duties which would include responsibility for assignment of
work to be performed; performance evaluation; selection of staff; and
recommendation of awards, advancements, and, when appropriate,
disciplinary actions.

\(c\) **Certification.** Registration by Cardiovascular Credentialing
International (CCI) as a registered Cardiovascular Invasive Specialist
(RCIS) is highly desirable. Basic Cardiac Life Support (BCLS) and
Advanced Cardiac Life Support (ACLS) certifications are also desirable
for employees at this level.

\(d\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

1\. **Special Assignments.** There may be a rare non-supervisory
position supporting this grade level. Such a position would typically
include maintaining all data and research protocols for cardiac
procedures and investigations as well as writing policies, procedures,
and protocols for a cardiac catheterization laboratory.

2\. **Supervisory Cardiac Catheterization Technician.** Individuals at
this level plan and direct programs at affiliated medical centers and
satellite outpatient clinics and have full supervisory responsibility
for a large staff of non-supervisory personnel and at least one
subordinate team leader or supervisor. Typically these duties include
assigning and evaluating the work of subordinate staff resolving
problems which may interfere with patient examination or treatment;
providing cardiac catheterization technician services in more complex
and non-standard cases; evaluating new products and equipment and making
recommendations concerning developments which would improve operations;
participating as an instructor in the facility's clinical training
program; making final decisions on selections based on recommendations
from subordinate supervisors or leads; evaluating performance; taking
disciplinary action when necessary; and identifying educational or
training needs.

**Appendix C -- Medical Instrument Technician (Diagnostic Ultrasound)**

NOTE: Positions should be assigned to the DRT, GS-647 series, when
[both]{.underline} ultrasound and other modalities which require the
delivery of ionizing radiation are performed. Positions in which
ultrasound duties are performed exclusively (no other modalities are
performed), should be assigned to the Medical Instrument Technician,
GS-649 series, since ultrasound duties solely do not require the
delivery of ionizing radiation.

\(1\) **GS-6**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. In addition, the candidate must demonstrate the
following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1.]{.underline} Knowledge of medical terminology and human anatomy in
order to receive and interpret physician requests for routine,
standardized ultrasonography procedures.

[2.]{.underline} Knowledge of tissue harmonics and soundwave propagation
within the body to adjust TGC (Time Gain Compensation) for optimal image
quality.

[3.]{.underline} Knowledge of the physics of velocity, frequency of
soundwaves, and their physical properties.

[4.]{.underline} Ability to set up and adjust the ultrasound equipment
to meet the conditions of the examination and the patient and to operate
the equipment for standardized, routine procedures.

[5.]{.underline} Ability to interact with patients explaining procedures
and positioning the patient for the procedure.

\(c\) **Certification.** Basic Cardiac Life Support (BCLS) certification
is desirable.

\(d\) **Assignment.** At this level, medical instrument technicians
(diagnostic ultrasound) perform examinations which are routine and
standardized in nature. They position the patient as needed for the best
test results, set up and adjust the ultrasound equipment to meet the
condition of the examination and patient, move and adjust depths and
types of scan in accordance with procedures, perform operator preventive
maintenance and care of equipment, and assist higher graded technicians
in performing more complicated examinations.

\(2\) **GS-7**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. This would be experience which provided the
individual with the knowledge, skills, and abilities to independently
conduct difficult but standardized diagnostic ultrasonography
examinations. In addition, the candidate must demonstrate the following
KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1.]{.underline} Ability to set up and adjust the ultrasound equipment
to meet the conditions of the examination and the patient and to operate
the equipment for more complex, but standardized procedures.

[2.]{.underline} Knowledge of zoom, expansion, prospectus, color
Doppler, and pulsed echo Doppler.

[3.]{.underline} Knowledge of the digital transmission of images.

[4.]{.underline} Ability to alter standard, but complex procedures and
protocols to meet patient needs and physical limitations.

\(c\) **Certification.** Basic Cardiac Life Support (BCLS) and Advanced
Cardiac Life Support (ACLS) certifications are desirable.

\(d\) **Experience.** At this level the medical instrument technician
(diagnostic ultrasound) performs complex, standardized procedures
independently. They have the knowledge to alter procedures, equipment
settings, transducers used, etc., to accommodate patient needs and still
produce a quality image for diagnostic purposes. They will also be
required to assist with the performance of more complicated procedures
and non-standardized procedures in a developmental capacity.

\(3\) **GS-8**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. This would be experience which provided the
overall knowledge, skills, and abilities to conduct diagnostic
ultrasound examinations in complex and unusual cases. In addition, the
candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1.]{.underline} Ability to perform diagnostic ultrasound examination on
multiple areas of the body, including, but not limited to, the abdomen,
pelvis, transvaginal, chest, small parts, thyroid, breast, and scrotum.

[2.]{.underline} Ability to perform vascular studies such as vertebral,
renal artery, aortic aneurysm, portal-systemic shunts, etc.

[3.]{.underline} Ability to assist radiologists with biopsy procedures
determining the location, depth, and required needle angle for the
lesion to be sampled.

[4.]{.underline} Ability to assist in surgical procedures and fluid
aspirations.

\(c\) **Certification.** Basic Cardiac Life Support (BCLS) and Advanced
Cardiac Life Support (ACLS) certifications are desirable.

\(d\) **Assignment.** This represents the full performance level for
medical instrument technician (diagnostic ultrasound). At this level the
technician is required to perform a full range of procedures including
special complicated examinations for which there are no standard
instructions or procedures. They perform independent portable ultrasound
examinations in the intensive care units, emergency room, surgery, and
throughout the Medical Center when required. They also work
independently on evenings, nights, and weekend tours of duty as
scheduled and/or when on call.

\(4\) **GS-9.** In addition to the core competencies defined at the GS-8
full performance level, positions at this grade may be lead,
supervisory, or non-supervisory with specialized advanced knowledge and
assignments.

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. This
would be specialized experience which demonstrates possession of the
knowledge required in order to provide all aspects of diagnostic
ultrasonography services. In addition, the candidate must demonstrate
the following technical KSAs and the potential to acquire the assignment
specific KSAs designated by an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs 1, 2, and
3 are appropriate for all positions at this level. KSAs 4 and 5 are to
be used in accordance with their appropriateness for the specific
assignment.

[1.]{.underline} Knowledge of the more complex examination and treatment
procedures and techniques in order to provide training and supervision
in these procedures, to evaluate and initiate performance improvement
projects, and to write policies, procedures, and protocols that pertain
to diagnostic ultrasonography.

\*[2.]{.underline} Knowledge of JCAHO and other regulatory requirements.

[3.]{.underline} Ability to communicate effectively and professionally
with employees at varying grade levels.

\*[4.]{.underline} Ability to manage and supervise employees.

\*[5.]{.underline} Ability to provide, or provide for, staff development
and training.

\(c\) **Certification.** Registration by Cardiovascular Credentialing
International (CCI) or by the American Registry of Diagnostic Medical
Sonographers (ARDMS) is highly desirable. Basic Cardiac Life Support
(BCLS) and Advanced Cardiac Life Support (ACLS) certifications are also
desirable.

\(d\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

[1.]{.underline} **Special Assignments.** Non-supervisory diagnostic
ultrasound technicians may have assignments that because of their nature
substantially exceed the full performance level. The Professional
Standards Board will review proposed non-supervisory special assignments
for the GS-9 level and make a determination regarding their
appropriateness. These assignments are expected to be relatively few in
number and must represent substantial additional responsibility over the
full performance level.

[2.]{.underline} **Lead Diagnostic Ultrasound Technician.** In certain
programs, either because of their size and scope or because of a lack of
specific supervisory positions, lead positions may be appropriate.

[3.]{.underline} **Supervisory Diagnostic Ultrasound Technician.**
Individuals in this assignment assume full administrative and
professional responsibility for planning and directing the work of
subordinate technicians. Typically these duties include assigning and
evaluating the work of subordinate staff; providing diagnostic
ultrasound technician services in more complex cases; reviewing and
making recommendations regarding new and emerging procedures; providing
instruction and training to new staff; interviewing candidates for
positions; recommending selections, advancements, promotions; evaluating
performance; taking disciplinary action when necessary; and identifying
educational or training needs.

\(5\) **GS-10.** In addition to the core competencies defined at the
GS-9 level, positions at this grade may be supervisory or
non-supervisory with specialized advanced knowledge and assignments.

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. In
addition, the candidate must demonstrate the following technical KSAs
and the potential to acquire the assignment specific KSAs designated by
an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs 1, 2, and
3 are appropriate for all positions at this level. KSAs 4 and 5 are to
be used in accordance with their appropriateness for the specific
assignment.

[1.]{.underline} Advanced knowledge of complex and non-standard
treatment and examination procedures and techniques.

\*[2.]{.underline} Ability to plan and assist in the establishment of a
completely integrated treatment and examination program.

\*[3.]{.underline} Ability to evaluate new products and equipment and
make recommendations concerning developments which would improve
operations.

\*[4.]{.underline} Ability to manage the fiscal matters of the functions
supervised (which would include fund controls, contracts, and equipment
expenditures), forecast resource and equipment needs, and administer the
allocated budget.

\*[5.]{.underline} Knowledge of and ability to provide the full range of
supervisory duties which would include responsibility for assignment of
work to be performed; performance evaluation; selection of staff; and
recommendation of awards, advancements, and, when appropriate,
disciplinary actions.

\(c\) **Certification.** Registration by Cardiovascular Credentialing
International (CCI) or by the American Registry of Diagnostic Medical
Sonographers (ARDMS) is highly desirable. Basic Cardiac Life Support
(BCLS) and Advanced Cardiac Life Support (ACLS) certifications are also
desirable.

\(d\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

[1.]{.underline} **Special Assignments.** There may be a rare
non-supervisory position supporting this grade level. Such a position
would typically include knowledge of standards of medical practice in
applicable medico-legal responsibilities in diagnostic ultrasound
procedures; developing protocols and clinical research projects;
developing and updating technical policy and procedure manuals; as well
as teaching the correct methodology of diagnostic ultrasound procedures,
theory of operations, and theory of interpretation of results to
trainees.

[2.]{.underline} **Supervisory Diagnostic Ultrasound Technician.**
Individuals at this level plan and direct programs at affiliated medical
centers and their satellite outpatient clinics and have full supervisory
responsibility for a large staff of non-supervisory personnel and at
least one subordinate team leader or supervisor. Typically these duties
include assigning and evaluating the work of subordinate staff resolving
problems which may interfere with patient examination or treatment;
providing diagnostic ultrasonography technician services in more complex
and non-standard cases; evaluating new products and equipment and making
recommendations concerning developments which would improve operations;
participating as an instructor in the facility's clinical training
program; making final decisions on selections based on recommendations
from subordinate supervisors or leads; evaluating performance; taking
disciplinary action when necessary; and identifying educational or
training needs.

**Appendix D -- Medical Instrument Technician (Echocardiography)**

\(1\) **GS-6**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. In addition, the candidate must demonstrate the
following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1.]{.underline} Knowledge of the anatomy and physiology of the heart
and great vessels.

[2.]{.underline} Knowledge of cardiac arrhythmias and their relationship
to hemodynamic conditions of the cardiac cycle.

[3.]{.underline} Knowledge of basic cardiac ultrasound physics and the
acoustic mechanisms by which high quality cardiac images are obtained.

[4.]{.underline} Ability to set up and adjust the ultrasound equipment
to meet the conditions of the examination and the patient and to operate
the equipment for standardized, routine procedures.

[5.]{.underline} Ability to interact with patients explaining procedures
and positioning the patient for the procedure.

\(c\) **Certification.** Basic Cardiac Life Support (BCLS) certification
is desirable.

\(d\) **Assignment.** Echocardiography technician assignments at this
level involve performing routine, standardized cardiac ultrasound
examinations under the supervision of a fully qualified cardiac
sonographer. The work involves generating adequate gray scale images to
define cardiac borders and learning to perform Doppler integration of
cardiac valves for determination of flow velocities.

\(2\) **GS-7**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. This would be experience which provided the
individual with the knowledge, skills, and abilities to independently
conduct difficult but standardized echocardiographic examinations. In
addition, the candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1.]{.underline} Ability to scan transthoracic echocardiograms in all
views with colorflow and some Doppler.

[2.]{.underline} Ability to conduct cardiac testing to determine the
severity and variety of cardiac problems, i.e., valvular dysfunction,
myocardial wall kinesia, effusions, endocardial lesions, etc.

[3.]{.underline} Knowledge of the set-up for transesophageal
echocardiograms.

[4.]{.underline} Ability to set up and adjust the ultrasound equipment
to meet the conditions of the examination and the patient and to operate
the equipment for more complex, but standardized procedures.

\(c\) **Certification.** Basic Cardiac Life Support (BCLS) and Advanced
Cardiac Life Support (ACLS) certifications are desirable.

\(d\) **Assignment.** At this level, medical instrument technicians
(echocardiography) perform a range of standard, but complex,
echocardiographic examinations with responsibility for calibrating all
instruments prior to the procedure. They are expected to keep an
accurate record of tests, daily logs, and videotapes. They maintain
cidex logs.

\(3\) **GS-8**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. This would be experience which provided the
overall knowledge, skills, and abilities to conduct diagnostic
echocardiography examinations in complex and unusual cases. In addition,
the candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills and Abilities**

[1.]{.underline} Ability to produce diagnostic quality images and
Doppler frequency shift recordings using M-mode, two-dimensional, pulsed
and continuous wave Doppler spectral display, and colorflow Doppler
imaging.

[2.]{.underline} Knowledge of normal echocardiographic findings and
deviations produced by a wide variety of cardiovascular diseases.

[3.]{.underline} Ability to perform complex procedures such as cardiac
studies of the four chambers of the heart and valves using sector
scanning techniques to detect stenotic and incompetent valves, chamber
enlargement, and pericardial effusion and cardiovascular studies
deriving pressure gradients across obstructed valves, etc.

[4.]{.underline} Ability to perform complementary ultrasonic
examinations (including noninvasive) transthoracic, Bubble studies and
contrast echocardiography, (invasive) stress echocardiography, and
transesophageal echocardiography.

[5.]{.underline} Ability to adapt transducer positioning, instrument
controls, and examination techniques to the individual patient being
studied and the problem being evaluated including recognizing pertinent
abnormalities and documenting abnormal findings.

\(c\) **Certification.** Basic Cardiac Life Support (BCLS) and Advanced
Cardiac Life Support (ACLS) certifications are desirable.

\(d\) **Assignment.** This represents the full performance level.
Echocardiography technicians at this level identify and record anomalies
indicative of disease, injury, or other medically significant condition
from ultrasound imaging and simultaneous recordings of the Doppler. They
incorporate the causes and results of a variety of symptoms and
conditions into a plan of ultrasonic diagnostic examination. They change
and develop sounding techniques to accommodate such variables as limited
patient mobility, variation in physical condition or dimension of the
patient, presence of prosthesis or foreign objects, and ultrasonic
response of different body parts. They produce diagnostic quality images
and Doppler frequency recordings using M-mode, two-dimensional, and
Doppler ultrasound.

\(4\) **GS-9.** In addition to the core competencies defined at the GS-8
full performance level, positions at this grade may be lead,
supervisory, or non-supervisory with specialized advanced knowledge and
assignments.

\(a\) **Experience.** At least 1 year experience comparable to the next
lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. This
would be experience which demonstrates possession of the knowledge
required in order to provide all aspects of echocardiography services.
In addition, the candidate must demonstrate the following technical KSAs
and the potential to acquire the assignment specific KSAs designated by
an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs 1, 2, and
3 are appropriate for all positions at this level. KSAs 4 and 5 are to
be used in accordance with their appropriateness for the specific
assignment.

[1.]{.underline} Knowledge of the more complex examination and treatment
procedures and techniques in order to provide training and supervision
in these procedures, to evaluate and initiate performance improvement
projects, and to write policies, procedures, and protocols, that pertain
to Echocardiography.

\*[2.]{.underline} Knowledge of JCAHO and other regulatory requirements.

[3.]{.underline} Ability to communicate effectively and professionally
with employees at varying grade levels.

\*[4.]{.underline} Ability to manage and supervise employees.

\*[5.]{.underline} Ability to provide, or provide for, staff development
and training.

\(c\) **Certification.** Registration by Cardiovascular Credentialing
International (CCI) as a Registered Cardiac Sonographer (RCS) or by the
American Registry of Diagnostic Medical Sonographers (ARDMS) as a
Registered Diagnostic Cardiac Sonographer (RDCS) is highly desirable.
Basic Cardiac Life Support (BCLS) and Advanced Cardiac Life Support
(ACLS) certifications are also desirable.

\(d\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

[1.]{.underline} **Special Assignments.** Non-supervisory
echocardiography technicians may have assignments that because of their
nature substantially exceed the full performance level. The Professional
Standards Board will review proposed non-supervisory special assignments
for the GS-9 level and make a determination regarding their
appropriateness. These assignments are expected to be relatively few in
number and must represent substantial additional responsibility over the
full performance level.

[2.]{.underline} **Lead Echocardiography Technician.** In certain
programs, either because of their size and scope or because of a lack of
specific supervisory positions, lead positions may be appropriate.

3\. **Supervisory Echocardiography Technician.** Individuals in this
assignment assume full administrative and professional responsibility
for planning and directing the work of subordinate technicians.
Typically these duties include assigning and evaluating the work of
subordinate staff; providing Echocardiography Technician services in
more complex cases; reviewing and making recommendations regarding new
and emerging procedures; providing instruction and training to new
staff; interviewing candidates for positions; recommending selections,
advancements, promotions; evaluating performance; taking disciplinary
action when necessary; and identifying educational or training needs.

\(5\) **GS-10.** In addition to the core competencies defined at the
GS-9 level, positions at this grade may be supervisory or
non-supervisory with specialized advanced knowledge and assignments.

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. In
addition, the candidate must demonstrate the following technical KSAs
and the potential to acquire the assignment specific KSAs designated by
an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs 1, 2, and
3 are appropriate for all positions at this level. KSAs 4 and 5 are to
be used in accordance with their appropriateness for the specific
assignment.

[1.]{.underline} Advanced knowledge of complex and non-standard
treatment and examination procedures and techniques.

\*[2.]{.underline} Ability to plan and assist in the establishment of a
completely integrated treatment and examination program.

\*[3.]{.underline} Ability to evaluate new products and equipment and
make recommendations concerning developments which would improve
operations.

\*[4.]{.underline} Ability to manage the fiscal matters of the functions
supervised (which would include fund controls, contracts, and equipment
expenditures), forecast resource and equipment needs, and administer the
allocated budget.

\*[5.]{.underline} Knowledge of and ability to provide the full range of
supervisory duties which would include responsibility for assignment of
work to be performed; performance evaluation; selection of staff; and
recommendation of awards, advancements, and, when appropriate,
disciplinary actions.

\(c\) **Certification.** Registration by Cardiovascular Credentialing
International (CCI) as a Registered Cardiac Sonographer (RCS) or by the
American Registry of Diagnostic Medical Sonographers (ARDMS) as a
Registered Diagnostic Cardiac Sonographer (RDCS) is highly desirable.
Basic Cardiac Life Support (BCLS) and Advanced Cardiac Life Support
(ACLS) certifications are also desirable.

\(d\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

[1.]{.underline} **Special Assignments.** There may be a rare
non-supervisory position supporting this grade level. Such a position
would typically include independently carrying out the most complex
laboratory procedures such as real-time 3D cardiac ultrasounds utilizing
on-line and off line computer enhancement and reconstruction technology
and 3D reconstruction using off-line computers for rendering real-time
3D images to specified parameters as well as teaching the correct
methodology of echocardiography procedures, theory of operations, and
theory of interpretation of results to trainees.

[2.]{.underline} **Supervisory Echocardiography Technician.**
Individuals at this level plan and direct programs at affiliated medical
centers and satellite outpatient clinics and have full supervisory
responsibility for a large staff of non-supervisory personnel and at
least one subordinate team leader or supervisor. Typically these duties
include assigning and evaluating the work of subordinate staff resolving
problems which may interfere with patient examination or treatment;
providing echocardiography technician services in more complex and
non-standard cases; evaluating new products and equipment and making
recommendations concerning developments which would improve operations;
participating as an instructor in the facility's clinical training
program; making final decisions on selections based on recommendations
from subordinate supervisors or leads; evaluating performance; taking
disciplinary action when necessary; and identifying educational or
training needs.

Appendix E -- Electrocardiograph Technician (EKG)

\(1\) GS-6

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. In addition, the candidate must demonstrate the
following KSAs:

\(b\) **Demonstrated Knowledge, Skills and Abilities**

[1.]{.underline} Ability to recognize special patient needs such as
disabilities, impaired mobility, and complicating medical conditions in
order to prepare and position the patient for the prescribed procedure.

[2.]{.underline} Knowledge of the specialized equipment and accessories
appropriate to Holter monitoring and ability to perform such tests.

[3.]{.underline} Knowledge of universal precautions and sterilization
techniques and ability to follow CDC guidelines in cleaning equipment.

[4.]{.underline} Ability to monitor the patient for adverse reactions
and take appropriate action.

[5.]{.underline} Ability to operate the equipment to perform standard
and routine highly specialized procedures including exercise stress
testing.

\(c\) **Certification.** No certification is required; however, it is
desirable that employees at this level have BCLS (Basic Cardiac Life
Support) certification.

\(d\) **Assignment.** Medical instrument technicians (EKG) at this level
receive and interpret physician's requests for diagnostic procedures
and/or treatments; explain the procedure to the patient to secure the
patient's confidence and cooperation; document the patient's record;
independently perform standardized testing monitoring the patient for
adverse reactions; and operate, calibrate, and clean and/or sterilize
commonly used equipment. Assignments at this level require knowledge of
standard medical terminology as well as common diseases and their
specific affects.

\(2\) **GS-7**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. This would be experience which provided
knowledge of the equipment, standard tests and procedures, and typical
readings including arrhythmias and abnormalities. In addition, the
candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1.]{.underline} Knowledge of typical patient reactions and signs of
distress including the ability to recognize, report and treat
potentially lethal arrhythmias.

[2]{.underline}. Knowledge of common equipment settings and standardized
procedures plus knowledge of common errors and corrective measures.

[3.]{.underline} Ability to modify procedures/positions to obtain the
correct results with patients with complicating conditions such as
amputations, Parkinson's disease, structural defects, and scar tissue.

[4.]{.underline} Ability to act as a mentor or preceptor to lower graded
technicians.

[5.]{.underline} Ability to conduct in-service training on the EKG
equipment and related instrumentation.

\(c\) **Certification.** No certification is required; however, it is
desirable that employees at this level have BCLS (Basic Cardiac Life
Support) and ACLS (Advanced Cardiac Life Support) certifications.

\(d\) **Assignment.** This represents the full performance level.
Medical instrument technicians (EKG) at this level operate and monitor
electrocardiographic equipment to perform specialized examinations and
studies involving exercise stress testing, ambulatory monitoring of
arrhythmias, and indirect carotid pulse tracings on chronic patients.
They monitor tracings to identify arrhythmias and when gross
abnormalities appear, when to repeat certain procedures, when to stop
test procedures, and when to get the immediate attention of a physician.
They evaluate test results to determine appropriate machine adjustments
and use alternative techniques and procedures when established
procedures do not accomplish acceptable results. This includes adapting
equipment and accessories to yield the best results during the
examination. They edit and select an appropriate sample portion of the
tracing for further interpretation by the physician.

\(3\) **GS-8.** In addition to the core competencies defined at the GS-7
full performance level, positions at this grade may be lead,
supervisory, or non-supervisory with specialized advanced knowledge and
assignments.

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. This
would be experience which provided knowledge of advanced specialized
procedures, the pharmacology related to this occupation, and knowledge
of related acute disorders and diseases and their effects on organs and
methods of treatment. In addition, the candidate must demonstrate the
following technical KSAs and the potential to acquire the assignment
specific KSAs designated by an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs 1, 2, 3,
and 4 are appropriate for all positions at this level. KSAs 5 and 6 are
to be used in accordance with their appropriateness for the specific
assignment**.**

[1.]{.underline} Knowledge of pharmacology related to specialized
procedures.

[2.]{.underline} Ability to provide briefings and orientations to
hospital staff including physicians.

[3.]{.underline} Knowledge of a variety of related acute disorders and
diseases, their effects on organs, and methods of treatment.

[4.]{.underline} Ability to perform more complex procedures such as
SAECG (Signal Averaged ECG), Tilt table monitoring, electrophysiology
monitoring, and event monitoring.

\*[5.]{.underline} Ability to provide, or provide for, staff development
and training.

\*[6.]{.underline} Ability to manage and supervise employees.

\(c\) **Certification.** No certification is required; however, it is
desirable that employees at this level have BCLS (Basic Cardiac Life
Support) and ACLS (Advanced Cardiac Life Support) certifications.

\(d\) **Assignments.** Medical instrument technicians (EKG) at this
level perform complicated examinations or treatments for which there are
no standard instructions or procedures. They utilize knowledge of
anatomy and physiology including an in depth understanding of the
functioning of the major systems and internal organs to interpret
requests and to recognize the need for additional tests or a different
position. Knowledge of pharmacology including the classification and
administration of drugs, patient responses, and common dosages as
related to this specialty is required. The technician has the ability to
perform Signal Averaged ECG, Tilt table monitoring, electrophysiology
monitoring, and event monitoring. For all assignments above the full
performance level, the higher-level duties must consist of significant
scope, complexity (difficulty), and range of variety, and be performed
by the incumbent at least 25% of the time.

1\. **Special Assignments.** Non-supervisory medical instrument
technician (EKG) may have assignments that because of their nature
substantially exceed the full performance level. The Professional
Standards Board will review proposed non-supervisory special assignments
for the GS-8 level and make a determination regarding their
appropriateness. These assignments are expected to be relatively few in
number and must represent substantial additional responsibility over the
full performance level.

[2.]{.underline} **Lead Medical Instrument Technician (EKG).** In
certain programs, either because of their size and scope or because of a
lack of specific supervisory positions, lead positions may be
appropriate.

3\. **Supervisory Medical Instrument Technician (EKG).** Individuals in
this assignment assume full administrative and professional
responsibility for planning and directing the work of subordinate
technicians. Typically these duties include assigning and evaluating the
work of subordinate staff; providing medical instrument technician (EKG)
services in more complex cases; reviewing and making recommendations
regarding new and emerging procedures; providing instruction and
training to new staff; interviewing candidates for positions;
recommending selections, advancements, promotions; evaluating
performance; taking disciplinary action when necessary; and identifying
educational or training needs.

\(4\) **GS-9.** In addition to the core competencies defined at the GS-8
level, positions at this grade may be lead, supervisory, or
non-supervisory with specialized advanced knowledge and assignments.

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. In
addition, the candidate must demonstrate the following technical KSAs
and the potential to acquire the assignment specific KSAs designated by
an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs 1, 2, and
3 are appropriate for all positions at this level. KSAs 4 and 5 are to
be used in accordance with their appropriateness for the specific
assignment.

[1.]{.underline} Knowledge of the more complex examination and treatment
procedures and techniques such as SAECG, ETT, Tilt table monitoring,
electrophysiology monitoring, and event monitoring in order to provide
training and supervision in these procedures, to develop analysis
interpretation formats, and to receive inquiries concerning results.

\*[2.]{.underline} Knowledge of JCAHO and other regulatory requirements.

[3.]{.underline} Ability to communicate effectively and professionally
with employees at varying grade levels.

\*[4.]{.underline} Ability to provide, or provide for, staff development
and training.

\*[5.]{.underline} Ability to manage and supervise employees.

\(c\) **Certification.** Certification by Cardiovascular Credentialing
International (CCI) as a Certified Cardiographic Technician (CCT) is
highly desirable at this level. Basic Cardiac Life Support (BCLS) and
Advanced Cardiac Life Support (ACLS) certifications are also desirable
for employees at this level.

\(d\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

[1.]{.underline} **Special Assignments.** Non-supervisory medical
instrument technician (EKG) may have assignments that because of their
nature substantially exceed the GS-8 level. The Professional Standards
Board will review proposed non-supervisory special assignments for the
GS-9 level and make a determination regarding their appropriateness.
These assignments are expected to be few in number and must represent
substantial additional responsibility.

[2.]{.underline} **Lead Medical Instrument Technician (EKG).** In
certain programs, either because of their size and scope or because of a
lack of specific supervisory positions, lead positions may be
appropriate.

3\. **Supervisory Medical Instrument Technician (EKG).** Individuals in
this assignment assume full administrative and professional
responsibility for planning and directing the work of subordinate
technicians. Typically these duties include assigning and evaluating the
work of subordinate staff; providing medical instrument technician (EKG)
services in more complex cases; reviewing and making

recommendations regarding new and emerging procedures; providing
instruction and training to new staff; interviewing candidates for
positions; recommending selections, advancements, promotions; evaluating
performance; taking disciplinary action when necessary; and identifying
educational or training needs.

**Appendix F -- Medical Instrument Technician (Electroencephalography)**

\(1\) **GS-6**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. In addition, the candidate must demonstrate the
following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1.]{.underline} Knowledge of basic medical terminology, neuroanatomy,
neurophysiology, and EEG interpretation.

[2.]{.underline} Ability to position patients for the examination or
treatment including using standard alternate positions for patient with
common physical disabilities.

[3.]{.underline} Ability to operate the appropriate EEG equipment to
administer routine, standardized diagnostic or treatment procedures.

4\. Knowledge of normal and abnormal results to recognize and report
obvious abnormalities during procedures.

[5.]{.underline} Knowledge of universal precautions and basic
sterilization methods to clean instruments to prevent the spread of
infectious diseases.

[6.]{.underline} Knowledge of EEG and peripheral equipment to conduct
routine maintenance and adjustment checks.

\(c\) **Certification.** No certification or registration is required;
however, it is desirable that employees at this level have BCLS (Basic
Cardiac Life Support) certification.

\(d\) **Assignment.** Operates and monitors EEG equipment in the EEG
Lab, intensive care units, operating room, and the patient's bedside.
Performs a full range of standard, routine EEG examinations including
routine awake and sleep recordings, electrocerebral silence recordings,
multiple sleep latency recordings, intraoperative monitoring,
electrocorticography. Performs nerve conduction studies using
electromyography equipment. Prepares recordings for interpretation and
performs a preliminary review and interpretation of the recordings.

\(2\) **GS-7**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the positions to be
filled. This would be experience which provided the individual with the
knowledge, skills, and abilities to independently conduct difficult but
standardized electroencephalography examinations. In addition, the
candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1.]{.underline} Ability to perform more complex electroencephalography
studies such as evoked potential (visual, auditory, somatosensory) and
transcranial Doppler studies.

[2.]{.underline} Knowledge of medication effects related to
electroencephalography studies and clinical situations requiring
medication.

[3.]{.underline} Knowledge of life threatening or medically emergent
testing or patient situations.

[4.]{.underline} Ability to recognize artifacts (patient or
environmental) and document, eliminate, or take proper measures to
monitor the artifact.

\(c\) **Certification.** No certification or registration is required;
however, it is desirable that employees at this level have BCLS (Basic
Cardiac Life Support) and ACLS (Advanced Cardiac Life Support)
certifications.

\(d\) **Assignment.** At this level, the medical instrument technician
(EEG) independently performs routine but complex procedures and has
advanced knowledge in certain areas. They are able to deal with
difficult or more complex patients. They are able to identify and
correct most artifacts. Procedures are fully explained to the patient
and family members to set them at ease. Interpretative skills are
sufficient to allow identification of more serious conditions requiring
rapid intervention.

\(3\) **GS-8**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. This would be experience which provided
knowledge of the more complex procedures, the pharmacology related to
this occupation, and knowledge of related acute disorders and diseases
and their effects on organs and methods of treatment. In addition, the
candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1.]{.underline} Ability to interpret testing data to evaluate critical
information for surgeons and other medical staff during testing
procedures.

[2.]{.underline} Knowledge of anatomy and physiology of the nervous
system and the ability to understand the relationship of EEG and evoked
potential testing in detecting states of disease and health.

[3.]{.underline} Knowledge of behavior assessment during seizure attacks
in order to insure adequacy of recordings during seizure discharges.

[4.]{.underline} Knowledge of a variety of advanced EEG equipment and
peripheral equipment such as equipment for brain mapping, video EEG
telemetry systems with seizure detection computers, and spike analysis
software.

[5.]{.underline} Knowledge of anticonvulsant medications and their
effects on the EEG as well as other frequently used pharmaceuticals.

[6.]{.underline} Ability to adapt neurodiagnostic devices, parameters,
and procedures to complex, unusual, and often critical situations.

\(c\) **Certification.** No certification or registration is required;
however, it is desirable that employees at this level have BCLS (Basic
Cardiac Life Support) and ACLS (Advanced Cardiac Life Support)
certifications.

\(d\) **Assignment.** This represents the full performance level.
Medical instrument technicians (EEG) at this level are expected to
provide independent performance of a full range of procedures. The
technician consistently delivers high quality studies for the most
complex and non-routine procedures in difficult or demanding
environments such as research, intraoperative monitoring, or intensive
care monitoring. Procedures are tailored to clinical questions to be
answered and may require additional monitors, electrodes, or other
devices as clinically indicated. The technician interprets study results
and brings to the attention of the physician or supervisor more subtle
abnormalities that may require intervention. The technician will
highlight portions of recordings of clinical importance for review by
the clinical neurophysiologist and will accurately describe the
concurrent behavior of the patient. Positive interaction with other
health care staff to inform them of the indications for testing; the
value, possible outcomes, and limitations of testing; and the policies
of the laboratory are expected.

\(4\) **GS-9.** In addition to the core competencies defined at the GS-8
full performance level, positions at this grade may be lead,
supervisory, or non-supervisory with specialized advanced knowledge and
assignments.

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. In
addition, the candidate must demonstrate the following technical KSAs
and the potential to acquire the assignment specific KSAs designated by
an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs 1, 2, and
3 are appropriate for all positions at this level. KSAs 4 and 5 are to
be used in accordance with their appropriateness for the specific
assignment.

[1.]{.underline} Knowledge of the more complex examination and treatment
procedures and techniques in order to provide training and supervision
in these procedures.

\*[2.]{.underline} Knowledge of JCAHO and other regulatory requirements.

[3.]{.underline} Ability to communicate effectively and professionally
with employees at varying grade levels.

\*[4.]{.underline} Ability to manage and supervise employees.

\*[5.]{.underline} Ability to provide, or provide for, staff development
and training.

\(c\) **Certification.** Registration by the American Board of
Registration of EEG, CNIM &EP Technologists (ABRET) or the American
Association of Electrodiagnostic Technologists (AEET) is highly
desirable. Basic Cardiac Life Support (BCLS) and Advanced Cardiac Life
Support (ACLS) certifications are also desirable for employees at this
level.

\(d\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

[1.]{.underline} **Special Assignments.** Non-supervisory
Electroencephalography Technicians may have assignments that because of
their nature substantially exceed the full performance level. The
Professional Standards Board will review proposed non-supervisory
special assignments for the GS-9 level and make a determination
regarding their appropriateness. These assignments are expected to be
relatively few in number and must represent substantial additional
responsibility over the full performance level.

[2.]{.underline} **Lead Electroencephalograpy Technicians.** In certain
programs, either because of their size and scope or because of a lack of
specific supervisory positions, lead positions may be appropriate.

[3.]{.underline} **Supervisory Electroencephalography Technician.**
Individuals in this assignment assume full administrative and
professional responsibility for planning and directing the work of
subordinate technicians. Typically these duties include assigning and
evaluating the work of subordinate staff; providing medical instrument
technician (EEG) services in more complex cases; reviewing and making
recommendations regarding new and emerging procedures; providing
instruction and training to new staff; interviewing candidates for
positions; recommending selections, advancements, promotions; evaluating
performance; taking disciplinary action when necessary; and identifying
educational or training needs.

\(5\) **GS-10.** In addition to the core competencies defined at the
GS-9 level, positions at this grade may be supervisory or
non-supervisory with specialized advanced knowledge and assignments.

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. This
would be experience which demonstrates possession of the knowledge
required to provide the most complex EEG Technician services and/or
supervisory knowledge, skills, and abilities. Participation in
recognized professional organizations as a Board examiner, in the
development of curricula for training, or testing for the Board is
evidence of competence. In addition, the candidate must demonstrate the
following technical KSAs and the potential to acquire the assignment
specific KSAs designated by an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs 1, 2, and
3 are appropriate for all positions at this level. KSAs 4 and 5 are to
be used in accordance with their appropriateness for the specific
assignment.

[1.]{.underline} Advanced knowledge of the most complex and non-standard
treatment and examination procedures and techniques.

\*[2.]{.underline} Ability to plan and assist in the establishment of a
completely integrated treatment and examination program.

\*[3.]{.underline} Ability to evaluate new products and equipment and
make recommendations concerning developments which would improve
operations.

\*[4.]{.underline} Ability to manage the fiscal matters of the functions
supervised (which would include fund controls, contracts, and equipment
expenditures), forecast resource and equipment needs, and administer the
allocated budget.

\*[5.]{.underline} Knowledge of and ability to provide the full range of
supervisory duties which would include responsibility for assignment of
work to be performed; performance evaluation; selection of staff; and
recommendation of awards, advancements, and, when appropriate,
disciplinary actions.

\(c\) **Certification.** Registration by the American Board of
Registration of EEG, CNIM &EP Technologists (ABRET) or the American
Association of Electrodiagnostic Technologists (AEET) is highly
desirable. Basic Cardiac Life Support (BCLS) and Advanced Cardiac Life
Support (ACLS) certifications are also desirable for employees at this
level.

\(d\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

[1.]{.underline} **Special Assignments.** There may be a rare
non-supervisory position supporting this grade level. Such a position
would typically include carrying out laboratory procedures independently
in complex environments such as the operating room, monitoring suites,
and clinical research laboratories as well as teaching the correct
methodology of neurodiagnostic procedures, theory of operations, and
theory of interpretation of results to trainees.

[2.]{.underline} **Supervisory Electroencephalography Technician.**
Individuals at this level plan and direct programs at affiliated medical
centers and satellite outpatient clinics and have full supervisory
responsibility for a large staff of non-supervisory personnel and at
least one subordinate team leader or supervisor. Typically these duties
include assigning and evaluating the work of subordinate staff resolving
problems which may interfere with patient examination or treatment;
providing Medical Instrument Technician (EEG) services in more complex
and non-standard cases; evaluating new products and equipment and making
recommendations concerning developments which would improve operations;
participating as an instructor in the facility's clinical training
program; making final decisions on selections based on recommendations
from subordinate supervisors or leads; evaluating performance; taking
disciplinary action when necessary; and identifying educational or
training needs.

Appendix G -- Medical Instrument Technician (Hemodialysis)

\(1\) **GS-6**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. In addition, the candidate must demonstrate the
following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1.]{.underline} Skill in setting up, operating, and performing
calibrations as required on a variety of dialysis equipment.

[2.]{.underline} Skill in performing and interpreting test results
(dialysate chemistries, water treatment testing for contaminates, etc.)
including the ability to analyze deviations from the expected norm and
responding appropriately.

[3.]{.underline} Knowledge of American Association of Medical
Instrumentation (AMMI) standards and unit policies as they relate to
water treatment.

[4.]{.underline} Knowledge of physiological and psychological changes
and conditions related to end stage renal disease.

[5.]{.underline} Ability to calculate dialysis baths according to the
physician's orders per patient by mixing critical concentrates, i.e.,
calcium, potassium, and bicarbonate.

[6.]{.underline} Knowledge of Basic Cardiac Life Support (BCLS).

\(c\) **Certification.** No certification is required; however, it is
desirable that employees at this level have BCLS (Basic Cardiac Life
Support) certification.

\(d\) **Assignment.** Hemodialysis Technicians at this level operate and
monitor dialysis systems for chronic patients; check patient condition
and determine the proper treatment procedures, technique, and machine
adjustments; understand medical treatment for patients with renal
failure; administer prescribed medication and observe the patient for
desired action or adverse reaction; and recognize and react to signs and
symptoms that signal the onset of complications of dialysis including
hypotension, disequilibrium, seizures, and arrhythmias.

\(2\) **GS-7**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. This would be experience which provided
knowledge the equipment, standard procedures, and typical machine
problems and/or patient reactions to treatment. In addition, the
candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1.]{.underline} Ability to assist the physician in more complex
procedures such as central venous catheter insertion.

[2.]{.underline} Ability to assist in training patients in
home/self-care by teaching components of machine operation including
water treatment and monitoring patients for compliance.

[3.]{.underline} Ability to act as a mentor or preceptor to lower graded
technicians.

[4.]{.underline} Ability to analyze deviations from the expected,
determine whether the deviations are machine or patient related, and
respond according to the findings.

\(c\) **Certification.** No certification is required; however, it is
desirable that employees at this level have BCLS (Basic Cardiac Life
Support) and ACLS (Advanced Cardiac Life Support) certifications.

\(d\) **Assignment.** At this level in addition to providing
hemodialysis for chronic patients, hemodialysis technicians assist the
physician during central venous catheter insertion, assist in the
training of patients for home dialysis/self-care, and act as a mentor or
preceptor to lower graded hemodialysis technicians. At this level, the
technician accepts responsibility and accountability for his/her own
actions.

\(3\) **GS-8**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. This would be experience which provided
knowledge of the more complex procedures, the pharmacology related to
this occupation, and knowledge of related acute disorders and diseases
and their effects on organs and methods of treatment. In addition, the
candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1.]{.underline} Knowledge of the hemodialysis process and equipment
needed for home/self care including knowledge of common machine problems
and repairs to such equipment.

[2.]{.underline} Knowledge of the equipment and procedures for
peritoneal dialysis.

[3.]{.underline} Ability to assist the physician with percutaneous renal
biopsies and peritoneal catheter insertion.

[4.]{.underline} Ability to provide instruction to dialysis patients in
home/self care and in the maintenance of the equipment.

[5.]{.underline} Ability to provide instruction for physicians, nurses,
and other personnel in dialysis procedures, equipment operation and
maintenance, etc.

\(c\) **Certification.** No certification is required; however, it is
desirable that employees at this level have BCLS (Basic Cardiac Life
Support) and ACLS (Advanced Cardiac Life Support) certifications.

\(d\) **Assignment.** This represents the full performance level. At
this level the hemodialysis technician serves as a member of a dialysis
team performing dialysis on acutely ill patients including those within
an intensive care setting. Assignments involve performing both
peritoneal and hemodialysis procedures. The dialysis technician may
participate in percutaneous renal biopsies, watching the patient during
the procedure and properly processing the specimen. Assists the
physician in peritoneal catheter insertions and observes the patient for
vital signs and provides post operative care. Provides instruction and
monitors patients for home dialysis. Performs training of physicians,
nurses, and technicians on hemodialysis and peritoneal dialysis
techniques.

\(4\) **GS-9.** In addition to the core competencies defined at the GS-8
full performance level, positions at this grade may be lead,
supervisory, or non-supervisory with specialized advanced knowledge and
assignments.

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. In
addition, the candidate must demonstrate the following technical KSAs
and the potential to acquire the assignment specific KSAs designated by
an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs 1, 2, and
3 are appropriate for all positions at this level. KSAs 4 and 5 are to
be used in accordance with their appropriateness for the specific
assignment.

[1.]{.underline} Knowledge of the more complex examination and treatment
procedures and techniques such as those provided for acutely ill
patients and peritoneal dialysis in order to provide training and
supervision in these procedures.

\*[2.]{.underline} Knowledge of JCAHO and other regulatory requirements.

[3.]{.underline} Ability to communicate effectively and professionally
with employees at varying grade levels.

\*[4.]{.underline} Ability to manage and supervise employees.

\*[5.]{.underline} Ability to provide, or provide for, staff development
and training.

\(c\) **Certification.** Certification by one of the following
organizations is highly desirable at this level: Nephrology
Certification Commission (NNCC), Board of Nephrology Examiners, Inc.,
Nursing and Technology (BONENT), National Nephrology Certification
Organization (NNCO), and the International Certification Commission for
Clinical Engineering and Biomedical Technology (ICC) in conjunction with
the United States Certification Commission (USCC). Basic Cardiac Life
Support (BCLS) and Advanced Cardiac Life Support (ACLS) certifications
are also desirable for employees at this level.

\(d\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

[1.]{.underline} **Special Assignments.** Non-supervisory hemodialysis
technicians may have assignments that because of their nature
substantially exceed the full performance level. The Professional
Standards Board will review proposed non-supervisory special assignments
for the GS-9 level and make a determination regarding their
appropriateness. These assignments are expected to be relatively few in
number and must represent substantial additional responsibility over the
full performance level.

[2.]{.underline} **Lead Hemodialysis Technician**. In certain programs,
either because of their size and scope or because of a lack of specific
supervisory positions, lead positions may be appropriate.

[3.]{.underline} **Supervisory Hemodialysis Technician.** Individuals in
this assignment assume full administrative and professional
responsibility for planning and directing the work of subordinate
technicians. Typically these duties include assigning and evaluating the
work of subordinate staff; providing dialysis technician services in
more complex cases; reviewing and making recommendations regarding new
and emerging procedures; providing instruction and training to new
staff; interviewing candidates for positions; recommending selections,
advancements, promotions; evaluating performance; taking disciplinary
action when necessary; and identifying educational or training needs.

\(5\) **GS-10.** In addition to the core competencies defined at the
GS-9 level, positions at this grade may be supervisory or
non-supervisory with specialized advanced knowledge and assignments.

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. In
addition, the candidate must demonstrate the following technical KSAs
and the potential to acquire the assignment specific KSAs designated by
an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1.]{.underline} Advanced knowledge of the most complex and non-standard
treatment and examination procedures and techniques.

\*[2.]{.underline} Ability to plan and assist in the establishment of a
completely integrated treatment and examination program.

\*[3.]{.underline} Ability to evaluate new products and equipment and
make recommendations concerning developments which would improve
operations.

\*[4.]{.underline} Ability to manage the fiscal matters of the functions
supervised (which would include fund controls, contracts, and equipment
expenditures), forecast resource and equipment needs, and administer the
allocated budget.

\*[5.]{.underline} Knowledge of and ability to provide the full range of
supervisory duties which would include responsibility for assignment of
work to be performed; performance evaluation; selection of staff; and
recommendation of awards, advancements, and, when appropriate,
disciplinary actions.

\(c\) **Certification.** Certification by one of the following
organizations is highly desirable at this level: Nephrology
Certification Commission (NNCC), Board of Nephrology Examiners, Inc.,
Nursing and Technology (BONENT), National Nephrology Certification
Organization (NNCO), and the International Certification Commission for
Clinical Engineering and Biomedical Technology (ICC) in conjunction with
the United States Certification Commission (USCC). Basic Cardiac Life
Support (BCLS) and Advanced Cardiac Life Support (ACLS) certifications
are also desirable for employees at this level.

\(d\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

[1.]{.underline} **Special Assignments.** There may be a rare
non-supervisory position supporting this grade level. Such a position
would typically include advising physicians on the creation of dialysate
formulations not commercially available, determining contract
requirements for all dialysis equipment, and evaluating the home
environment and coordinating the modifications necessary for home
dialysis.

[2.]{.underline} **Supervisory Hemodialysis Technician**. Individuals at
this level plan and direct programs at affiliated medical centers and
their satellite outpatient clinics and have full supervisory
responsibility for a large staff of non-supervisory personnel and at
least one subordinate team leader or supervisor. Typically these duties
include assigning and evaluating the work of subordinate staff resolving
problems which may interfere with patient examination or treatment;
providing dialysis technician services in more complex and non-standard
cases; evaluating new products and equipment and making recommendations
concerning developments which would improve operations; participating as
an instructor in the facility's clinical training program; making final
decisions on selections based on recommendations from subordinate
supervisors or leads; evaluating performance; taking disciplinary action
when necessary; and identifying educational or training needs.

**Appendix H -- Medical Instrument Technician (Perfusion)**

\(1\) **GS-9**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. This represents the entry level for medical
instrument technician (perfusion) positions. Applicants must demonstrate
experience, education, or training which provided the basic knowledge,
skills, and abilities to maintain extracorporeal circulation during
heart surgery. This may evidenced by certification by the American Board
of Cardiovascular Perfusion (ABCP) as a Certified Clinical Perfusionist.
In addition, the candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1.]{.underline} Knowledge of the equipment and supplies needed for safe
conduct of cardiopulmonary by-pass.

[2]{.underline}. Knowledge of counter pulsation life support and
insertion, maintenance, and removal of the intra-aortic balloon pump.

[3.]{.underline} Knowledge of blood sparing equipment (its uses,
indications, and contraindications), blood banking procedures, blood
storage and administration, and blood components (including platelet gel
and sequestration).

[4.]{.underline} Ability to operate ventricular assist devices (VAD) and
assist with implantation, transportation, and removal of the device.

[5.]{.underline} Knowledge of blood gases (using alpha stat or ph stat
measures) and ability to analyze and apply lab results to patients under
direct care on by-pass or VAD.

\(c\) **Certification.** Certification by the American Board of
Cardiovascular Perfusion (ABCP) as a Certified Cardiovascular
Perfusionist (CCP) is highly desirable.

\(d\) **Assignment.** Medical instrument technicians (perfusion) at this
level operate the heart-lung machine, intra-aortic balloon pump, cell
saver and blood salvaging equipment, and ventricular assist devices
during open heart and coronary by-pass surgery. They analyze blood
gasses and laboratory results in preparation for cardiopulmonary by-pass
or while conducting cardiopulmonary by-pass.

\(2\) **GS-10**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the positions being
filled. This would be experience as a clinical perfusionist which
provided the knowledge, skills, and abilities to function as a full
member of the surgical team on the most critical and complex cases. In
addition, the candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1.]{.underline} Knowledge of occupation specific pharmacology and
ability to give drug therapy and medications as necessary to maintain
homeostasis.

[2.]{.underline} Ability to maintain intra-operative and initial
post-operative files of extracorporeal circulation data records and
patient response postoperatively.

[3.]{.underline} Ability to provide instruction for physicians, nurses,
residents, medical and nursing students, and other personnel in
perfusion procedures, equipment operation and maintenance, etc.

\(c\) **Certification.** Certification by the American Board of
Cardiovascular Perfusion (ABCP) as a Certified Cardiovascular
Perfusionist (CCP) is highly desirable.

\(d\) **Assignment.** This represents the full performance level.
Medical instrument technicians (perfusion) at this level operate the
heart-lung machine, intra-aortic balloon pump, cell saver and blood
salvaging equipment, and ventricular assist devices during open heart
and coronary by-pass surgery for patients representing the most complex
and critical cases. They analyze blood gasses and laboratory results in
preparation for cardiopulmonary by-pass or while conducting
cardiopulmonary by-pass. They may also operate the equipment during
heart transplantation. This could include participating as part of the
team for retrieval and transportation of the donor heart. They also
provide training to lower grade perfusion technicians, cardiac
catheterization technicians, and ICU staff regarding all aspects of
perfusion services.

\(3\) **GS-11**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the position to be
filled, and must fully meet the KSAs at that level. This would be
experience as a clinical perfusionist which provided the knowledge,
skills, and abilities to function as a chief technician and/or program
manager. In addition, the candidate must demonstrate the following
technical KSAs and the potential to acquire the assignment specific KSAs
designated by an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

\*[1.]{.underline} Knowledge of quality assurance and performance
improvement measures for perfusion programs.

\*[2.]{.underline} Ability to identify training needs for lower graded
staff and provide, or provide for this training.

\(c\) **Certification.** Certification by the American Board of
Cardiovascular Perfusion (ABCP) as a Certified Cardiovascular
Perfusionist (CCP) is highly desirable.

\(d\) **Assignment.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

Medical Instrument Technicians (Perfusion) at this level function as
Chief Technicians and/or program directors for the perfusion program.
They are responsible for evaluating quality control and developing
performance improvement programs for the program. They provide
administrative oversight for lower graded Perfusion Technicians and for
other personnel assigned to the program

**Appendix I -- Medical Instrument Technician (Polysomnography)**

\(1\) **GS-6**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. In addition, the candidate must demonstrate the
following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1.]{.underline} Knowledge of standard, computerized polysomnographs for
recording continuous all night physiological data including EEG, EOG,
EKG, EMG and respiratory parameters.

[2.]{.underline} Knowledge of standard devices such as oximeters,
respiratory effort devices, nasal pressure devices, thermistors,
thermocouples, continuous positive airway pressure (CPAP) machines, and
laboratory computers including the ability to calibrate and operate the
equipment and recognize and eliminate recording artifacts.

[3.]{.underline} Knowledge of medical terminology and medical record
organization to review medical records, sleep study orders, consent
forms, medical charts, etc.

[4.]{.underline} Knowledge of polysmnographic procedural protocols
(including overnight sleep studies, MSLT, MWT, PAP, etc.).

[5.]{.underline} Knowledge of basic anatomy and physiology and the
international 10-20 electrode placement system in order to conduct the
sleep studies.

\(c\) **Certification.** No certification or registration is required at
this level. Basic Cardiac Life Support (BCLS) certification is
desirable.

\(d\) **Assignment.** Polysomnography (PSG) Technicians at this level
perform a full range of standard, routine examinations including
overnight sleep studies, MSLT (Multiple Sleep Latency Test), MWT
(Maintenance of Wakefulness Test), and PAP (Positive Airway Pressure
Titration).

\(2\) **GS-7**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. This would be experience which provided the
individual with the knowledge, skills, and abilities to independently
conduct difficult but standardized polysomnography examinations. In
addition, the candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1.]{.underline} Knowledge of CPAP function and operation to select and
fit appropriate PAP patient interface devices.

[2.]{.underline} Ability to independently titrate and document PAP level
to achieve therapeutic goals.

[3.]{.underline} Knowledge of indications, complications, and
contraindications of CPAP therapy.

[4.]{.underline} Knowledge of BiLevel pressure titrations.

5\. Ability to recognize changes seen during the PSG tracing and
identify all stages of sleep. This includes the ability to score and
analyze sleep stages in clinical polysomnography recordings.

\(c\) **Certification.** No certification or registration is required.
Basic Cardiac Life Support (BCLS) certification is desirable.

\(d\) **Assignment.** At this level the Polysomnography Technician
performs a full range of standard, but complex, polysomnography
examinations with responsibility for properly and accurately calibrating
all instruments prior to the beginning of the PSG tracing and selection
of appropriate electrode montages and sensitivity and filter settings to
elicit the best possible tracings. They independently determine the need
for CPAP during all night sleep studies for sleep apnea. They may
administer nerve conduction velocity tests.

\(3\) **GS-8**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. This would be experience which provided a
knowledge of the more complex procedures as well as knowledge of the
uncommon and/or rare sleep disorders. In addition, the candidate must
demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1.]{.underline} Advanced knowledge or the International Classification
of Sleep Disorders and the ability to recognize uncommon and/or rare
sleep disorders.

[2.]{.underline} Ability to summarize and report polysomnographic data
in narrative form.

[3.]{.underline} Knowledge of event characteristics (e.g., respiratory,
cardiac, sleep stage, seizures, etc.) and ability to take appropriate
action.

[4.]{.underline} Ability to provide briefings and orientation to
hospital staff including physicians.

\(c\) **Certification.** No certification or registration is required.
Basic Cardiac Life Support (BCLS) and Advanced Cardiac Life Support
(ACLS) certifications are also desirable for employees at this level.

\(d\) **Assignment.** This represents the full performance level. At
this level Polysomnographic Technicians are able to interact fully with
the patient and physician to diagnose sleep disorders including those
that are uncommon or rare. They are able to conduct full sleep studies
including overnight studies and evaluate the relationship of events,
sleep stages, and possible medical conditions which influence or

result from events occurring during sleep. They anticipate problems
likely to occur during the sleep study and prepare for such situations,
make changes in established procedures, or recommend alternative courses
of action. They are able to mentor lower graded technicians.

\(4\) **GS-9.** In addition to the core competencies defined at the GS-8
level, positions at this grade may be lead, supervisory, or
non-supervisory with specialized advanced knowledge and assignments.

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. This
would be experience which demonstrates possession of the knowledge
required to provide all aspects of polysomnography services. In
addition, the candidate must demonstrate the following technical KSAs
and the potential to acquire the assignment specific KSAs designated by
an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs 1, 2, and
3 are appropriate for all positions at this level. KSAs 4 and 5 are to
be used in accordance with their appropriateness for the specific
assignment.

[1.]{.underline} Knowledge of the more complex examination and treatment
procedures and techniques in order to provide training and supervision
in these procedures, to evaluate and initiate performance improvement
projects, and to write policies, procedures, and protocols, that pertain
to Polysomnography.

\*[2.]{.underline} Knowledge of JCAHO and other regulatory requirements.

[3.]{.underline} Ability to communicate effectively and professionally
with employees at varying grade levels.

\*[4.]{.underline} Ability to manage and supervise employees.

\*[5.]{.underline} Ability to provide, or provide for, staff development
and training.

\(c\) **Certification.** Registration by the Board of Registered
Polysomnographic Technologists (BRPT) is highly desirable. Basic Cardiac
Life Support (BCLS) and Advanced Cardiac Life Support (ACLS)
certifications are also desirable for employees at this level.

\(d\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

[1.]{.underline} **Special Assignments.** Non-supervisory
polysomnography technicians may have assignments that because of their
nature substantially exceed the full performance level. The Professional
Standards Board will review proposed non-supervisory special assignments
for the GS-9 level and make a determination regarding their
appropriateness. These assignments are expected to be relatively few in
number and must represent substantial additional responsibility over the
full performance level.

[2.]{.underline} **Lead Polysomnography Technician.** In certain
programs, either because of their size and scope or because of a lack of
specific supervisory positions, lead positions may be appropriate.

3\. **Supervisory Polysomnography Technician.** Individuals in this
assignment assume full administrative and professional responsibility
for planning and directing the work of subordinate technicians.
Typically these duties include assigning and evaluating the work of
subordinate staff; providing polysomnography technician services in more
complex cases; reviewing and making recommendations regarding new and
emerging procedures; providing instruction and training to new staff;
interviewing candidates for positions; recommending selections,
advancements, promotions; evaluating performance; taking disciplinary
action when necessary; and identifying educational or training needs.

\(5\) **GS-10.** In addition to the core competencies defined at the
GS-9 level, positions at this grade may be supervisory or
non-supervisory with specialized advanced knowledge and assignments.

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. This
would be experience which demonstrates possession of the knowledge
required to provide the most complex polysomnography technician
services. In addition, the candidate must demonstrate the following
technical KSAs and the potential to acquire the assignment specific KSAs
designated by an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs 1, 2, and
3 are appropriate for all positions at this level. KSAs 4 and 5 are to
be used in accordance with their appropriateness for the specific
assignment.

[1.]{.underline} Advanced knowledge of complex and non-standard
treatment and examination procedures and techniques.

\*[2.]{.underline} Ability to plan and assist in the establishment of a
completely integrated treatment and examination program.

\*[3.]{.underline} Ability to evaluate new products and equipment and
make recommendations concerning developments which would improve
operations.

\*[4.]{.underline} Ability to manage the fiscal matters of the functions
supervised (which would include fund controls, contracts, and equipment
expenditures), forecast resource and equipment needs, and administer the
allocated budget.

\*[5.]{.underline} Knowledge of and ability to provide the full range of
supervisory duties which would include responsibility for assignment of
work to be performed; performance evaluation; selection of staff; and
recommendation of awards, advancements, and, when appropriate,
disciplinary actions.

\(c\) **Certification.** Registration by the Board of Polysomnographic
Technologists (BRPT) is highly desirable. Basic Cardiac Life Support
(BCLS) and Advanced Cardiac Life Support (ACLS) certifications are also
desirable for employees at this level.

\(d\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

[1.]{.underline} **Special Assignments.** There may be a rare
non-supervisory position supporting this grade level. Such a position
would typically include producing preliminary polysomnographic
interpretations and recommendations for presentations at case
conferences as well as developing, updating, and annually reviewing all
sleep laboratory policies and procedures to assure that the laboratory
operates according to national standards of practice.

[2.]{.underline} **Supervisory Polysomnographic Technician.**
Individuals at this level plan and direct programs at affiliated medical
centers and satellite outpatient clinics and have full supervisory
responsibility for a large staff of non-supervisory personnel and at
least one subordinate team leader or supervisor. Typically these duties
include assigning and evaluating the work of subordinate staff resolving
problems which may interfere with patient examination or treatment;
providing polysomnography technician services in more complex and
non-standard cases; evaluating new products and equipment and making
recommendations concerning developments which would improve operations;
participating as an instructor in the facility's clinical training
program; making final decisions on selections based on recommendations
from subordinate supervisors or leads; evaluating performance; taking
disciplinary action when necessary; and identifying educational or
training needs.

**Appendix J -- Medical Instrument Technician (Pulmonary Function)**

\(1\) **GS-6**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. In addition, the candidate must demonstrate the
following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1.]{.underline} Knowledge of proper administration of metered dose
inhalers and the various medications associated with bronchodilation
including understanding of the contraindications and dangers of such
pharmaceutical agents.

[2.]{.underline} Knowledge of the proper use and placement of pulse
oximetry equipment and sensors.

[3.]{.underline} Knowledge of universal precautions and aseptic
techniques for cleaning equipment to provide a safe environment for
performing tests.

[4.]{.underline} Ability to perform routine, standardized pulmonary
function tests.

[5.]{.underline} Ability to recognize adverse reactions to treatment
that may indicate the need to terminate procedures and to call the
physician's attention to unusual reactions to administered medications.

\(c\) **Certification.** No certification or registration is required;
however it is desirable that technicians at this level have Basic
Cardiac Life Support (BCLS) certification.

\(d\) **Assignment.** Technicians at this level perform routine
pulmonary function tests in a hospital or clinic. They administer
inhaled medications for the purpose of bronchodilator response. They
operate, calibrate, and maintain commonly used instruments such as blood
gas analyzers, oximeters, and gas nebulizers. They conduct standardized
tests such as forced and slow vital capacity, blood gas analysis, and
flow volume loops. They instruct patients when and how to perform
breathing exercises. They calculate and measure blood gas values. They
use aseptic methods to draw blood samples from patients and properly use
and clean equipment.

\(2\) **GS-7**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. This would be experience which provided
knowledge the equipment, standard tests and procedures, and typical
readings. In addition, the candidate must demonstrate the following
KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1.]{.underline} Ability to perform arterial punctures, analyze blood
gases, and interpret blood gas measurements including the ability to
determine if the sample is accurate for reporting, assess for
inaccuracy, and correct inaccurate samples.

[2.]{.underline} Knowledge of lung mechanics and ability to perform a
variety of spiromety and complex pulmonary function tests on both
ambulatory and non-ambulatory patients.

[3.]{.underline} Ability to determine the order of priority for
administering multiple pulmonary function tests, choose the most
appropriate equipment and techniques for the type of ventilatory
problem, and determine the proper sequence of steps to complete the
testing.

[4.]{.underline} Ability to measure the pulmonary function of patients
for the purpose of diagnosing disease, determining responsiveness to
treatment, and assessing disability.

\(c\) **Certification.** No certification or registration is required;
however, Basic Cardiac Life Support (BCLS) and Advanced Cardiac Life
Support (ACLS) certifications are desirable for employees at this level.

\(d\) **Assignment.** Assignments at this level require the technician
to have knowledge of the basic principles of pulmonary physiology
sufficient to understand impairment of lung function and to be able to
utilize that information in the design of individualized tests to help
solve specific problems. They perform complex but standardized tests and
procedures. They fully explain procedures to the patient and are aware
of possible complications and adverse reactions to the performance of
pulmonary function testing.

\(3\) **GS-8**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. This would be experience which provided
knowledge of the more complex procedures, the pharmacology related to
this occupation, and knowledge of related acute disorders and diseases
and their effects on organs and methods of treatment. In addition, the
candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1.]{.underline} Ability to perform special procedures pulmonary
function testing which may include cardiopulmonary exercise testing,
exercise induced asthma testing, Shunt testing, and/or P-100 testing.

[2.]{.underline} Knowledge of airway management, pulmonary pharmacology,
CPR, and oxygen administration.

[3.]{.underline} Knowledge of bio-testing procedures, syringe quality
control procedures, and ability to analyze results for compliance.

[4.]{.underline} Ability to perform quality control on blood gas
analyzers as required by accrediting bodies.

[5.]{.underline} Ability to provide training to lower graded pulmonary
function technicians and students including teaching the correct
methodology of pulmonary function procedures and theory of
interpretation of results.

\(c\) **Certification.** No certification or registration is required;
however, Basic Cardiac Life Support (BCLS) and Advanced Cardiac Life
Support (ACLS) certifications are desirable for employees at this level.

\(d\) **Assignment.** This represents the full performance level. At
this level assignments are characterized by performance of the complex,
non-routine Pulmonary Function tests and procedures. Technicians are
expected to provide emergency airway management when patients
deteriorate in the Laboratory including bronchodilator nebulization,
provision of supplemental oxygen, bag-and-mask ventilation,
cardio-pulmonary resuscitation and to assist with or perform airway
intubation and defibrillation.

\(4\) **GS-9.** In addition to the core competencies defined at the GS-8
full performance level, positions at this grade may be lead,
supervisory, or non-supervisory with specialized advanced knowledge and
assignments.

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. In
addition, the candidate must demonstrate the following technical KSAs
and the potential to acquire the assignment specific KSAs designated by
an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs 1, 2, and
3 are appropriate for all positions at this level. KSAs 4 and 5 are to
be used in accordance with their appropriateness for the specific
assignment.

[1.]{.underline} Knowledge of the more complex examination and treatment
procedures and techniques such as cardiopulmonary pulmonary exercise
testing, exercise induced asthma testing, Shunt testing, and/or P-100
testing in order to provide training and supervision in these
procedures, to develop analysis interpretation formats, and to receive
inquiries concerning results.

\*[2.]{.underline} Knowledge of JCAHO and other regulatory requirements.

[3.]{.underline} Ability to communicate effectively and professionally
with employees at varying grade levels.

\*[4.]{.underline} Ability to manage and supervise employees.

\*[5.]{.underline} Ability to provide, or provide for, staff development
and training.

\(c\) **Certification.** Certification by the National Board of
Respiratory Care as a Certified Pulmonary Function Technologist (CPFT)
is highly desirable. Basic Cardiac Life Support (BCLS) and Advanced
Cardiac Life Support (ACLS) certifications are also desirable for
employees at this level.

\(d\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

[1.]{.underline} **Special Assignments.** Non-supervisory pulmonary
function technicians may have assignments that because of their nature
substantially exceed the full performance level. The Professional
Standards Board will review proposed non-supervisory special assignments
for the GS-9 level and make a determination regarding their
appropriateness. These assignments are expected to be relatively few in
number and must represent substantial additional responsibility over the
full performance level.

[2.]{.underline} **Lead Pulmonary Function Technician**. In certain
programs, either because of their size and scope or because of a lack of
specific supervisory positions, lead positions may be appropriate.

[3.]{.underline} **Supervisory Pulmonary Function Technician.**
Individuals in this assignment assume full administrative and
professional responsibility for planning and directing the work of
subordinate technicians. Typically these duties include assigning and
evaluating the work of subordinate staff; providing pulmonary function
technician services in more complex cases; reviewing and making
recommendations regarding new and emerging procedures; providing
instruction and training to new staff; interviewing candidates for
positions; recommending selections, advancements, promotions; evaluating
performance; taking disciplinary action when necessary; and identifying
educational or training needs.

\(5\) **GS-10.** In addition to the core competencies defined at the
GS-9 level, positions at this grade may be supervisory or
non-supervisory with specialized advanced knowledge and assignments.

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. In
addition, the candidate must demonstrate the following technical KSAs
and the potential to acquire the assignment specific KSAs designated by
an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs 1, 2, and
3 are appropriate for all positions at this level. KSAs 4 and 5 are to
be used in accordance with their appropriateness for the specific
assignment.

[1.]{.underline} Advanced knowledge of complex and non-standard
treatment and examination procedures and techniques.

\*[2.]{.underline} Ability to plan and assist in the establishment of a
completely integrated treatment and examination program.

\*[3.]{.underline} Ability to evaluate new products and equipment and
make recommendations concerning developments which would improve
operations.

\*[4.]{.underline} Ability to manage the fiscal matters of the functions
supervised (which would include fund controls, contracts, and equipment
expenditures), forecast resource and equipment needs, and administer the
allocated budget.

\*[5.]{.underline} Knowledge of and ability to provide the full range of
supervisory duties which would include responsibility for assignment of
work to be performed; performance evaluation; selection of staff; and
recommendation of awards, advancements, and, when appropriate,
disciplinary actions.

\(c\) **Certification.** Certification by the National Board of
Respiratory Care as a Certified Pulmonary Function Technologist (CPFT)
is highly desirable. Basic Cardiac Life Support (BCLS) and Advanced
Cardiac Life Support (ACLS) certifications are also desirable for
employees at this level.

\(d\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

**Supervisory Pulmonary Function Technician.** Individuals at this level
plan and direct programs at affiliated medical centers and satellite
outpatient clinics and have full supervisory responsibility for a large
staff of non-supervisory personnel and at least one subordinate team
leader or supervisor. Typically these duties include assigning and
evaluating the work of subordinate staff resolving problems which may
interfere with patient examination or treatment; providing pulmonary
function technician services in more complex and non-standard cases;
evaluating new products and equipment and making recommendations
concerning developments which would improve operations; participating as
an instructor in the facility's clinical training program; making final
decisions on selections based on recommendations from subordinate
supervisors or leads; evaluating performance; taking disciplinary action
when necessary; and identifying educational or training needs.

**Appendix K -- Medical Instrument Technician (Vascular)**

\(1\) **GS-6**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
position to be filled. This would be experience which demonstrates the
knowledge, skills, and abilities to perform routine, standardized
vascular ultrasound procedures where the technician is not expected to
deviate from established procedures. In addition, the candidate must
demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1.]{.underline} Ability to perform standardized, routine vascular
ultrasound procedures and/or examinations of upper and lower extremity,
abdominal, and extra-cranial cerebrovascular vessels.

[2.]{.underline} Knowledge of anatomy and physiology including location
and function of major body organs and structures as they relate to
vascular ultrasonography.

[3.]{.underline} Ability to prepare preliminary reports from the
examination including documentation of procedural difficulties in the
medical record.

\(c\) **Certification.** Basic Cardiac Life Support (BCLS) certification
is desirable.

\(d\) **Assignment.** Assignments at this level are characterized by the
performance of routine, standardized vascular ultrasound procedures and
techniques in accordance with instructions.

\(2\) **GS-7**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. This would be experience which demonstrates that
the technician has the knowledge, skills, and abilities to perform
complex procedures requiring the ability to select appropriate equipment
based on symptomology and the objective of the examination and the
ability to adapt procedures and techniques to enhance diagnostic
results. In addition, the candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1.]{.underline} Ability to perform noninvasive vascular ultrasound
procedures or examinations of upper and lower extremity, abdominal, and
extra-cranial cerebrovascular vessels which require adaptation of
procedures or instruments.

[2.]{.underline} Knowledge of anatomy and physiology including location
and function of major body organs and structures as they relate to
vascular ultrasonography. This would also include knowledge of
physiological influences on the hemodynamics of blood flow.

[3.]{.underline} Knowledge of pharmacology and chemistry to understand
drug reactions, action, effects, and method of administration
specifically related to vascular ultrasonography.

[4.]{.underline} Knowledge of disease entities that impact the vascular
system and their influence on the test results to select the appropriate
procedures.

[5.]{.underline} Ability to obtain a patient history and perform and
appropriate physical assessment based on patient presentation and type
of exam to include observation, inspection, auscultation, and palpation.

\(c\) **Certification.** Basic Cardiac Life Support (BCLS) and Advanced
Cardiac Life Support (ACLS) certifications are desirable.

\(d\) **Assignment.** At the GS-7 level the medical instrument
technician (vascular) is expected to perform complex noninvasive
vascular testing for diagnostic purposes. These procedures are performed
with a variety of testing equipment and modalities to include B mode
scanning, duplex imaging, Doppler spectral analysis,
photoplethysmography, and upper and lower extremity, digit, and pensile
blood pressures. The technician must be able to deviate from normal
technique when necessary.

\(3\) **GS-8**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
position to be filled. This would be experience which demonstrates the
knowledge, skills, and abilities to perform noninvasive vascular
ultrasound procedures as a senior technician. In addition, the candidate
must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1.]{.underline} Knowledge of cross-sectional and longitudinal vascular
anatomy in normal and abnormal vessels, anatomical planes and tissue
structures, physiologic effects of disease entities that impact the
vascular system, signs and symptoms of acute and chronic vascular
disease, and the characteristic appearance of aneurysms,
pseudoaneurysms, thromboses, stenoses, occlusions, AV fistulae, and
morphology of atherosclerotic plaque formulation.

[2.]{.underline} Ability to provide Doppler information of peripheral
vessels; demonstrate characteristic differences related to the organs
they supply; accurately quantify carotid artery stenoses; and identify
and correlate specific waveform analysis, plethysmographic tracings,
velocity changes, and pressure gradients characteristic of normal,
obstructed, or occluded vessels or grafts.

[3.]{.underline} Ability to perform intracranial (transcranial) vascular
examinations.

[4.]{.underline} Ability to operate the instruments to extract the
highest quality image utilizing the appropriate transducer frequency,
Doppler angle, focal zones, gain, depth, color map, wall filter, and
sample volume.

[5.]{.underline} Ability to provide objective data to document
progression or regression of disease.

\(c\) **Certification.** Basic Cardiac Life Support (BCLS) and Advanced
Cardiac Life Support (ACLS) certifications are desirable.

\(d\) **Assignment.** This represents the full performance level. At the
GS-8 level the medical instrument technician (vascular) functions as a
senior technician. They are expected to perform the full range of
vascular ultrasound procedures including the most complex and
non-routine and to make appropriate adjustments in established
procedures and techniques to obtain the results required for clinical
diagnosis and documentation. At this level the technician would also
have the ability to perform intracranial (transcranial) vascular
examinations.

\(4\) **GS-9.** In addition to the core competencies defined at the GS-8
full performance level, positions at this grade may be lead,
supervisory, or non-supervisory with specialized advanced knowledge and
assignments.

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. This
would be experience which demonstrates the knowledge, skills, and
abilities to fully perform all vascular ultrasound tests and
examinations and to function as a technical director of the vascular
laboratory and provide oversight and/or guidance to other technicians.
In addition, the candidate must demonstrate the following technical KSAs
and the potential to acquire the assignment specific KSAs designated by
an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs 1, 2, and
3 are appropriate for all positions at this level. KSAs 4 and 5 are to
be used in accordance with their appropriateness for the specific
assignment.

[1.]{.underline} Knowledge of the more complex examination and treatment
procedures and techniques in order to provide training and supervision
in these procedures, to evaluate and initiate performance improvement
projects, and to write policies, procedures, and protocols, that pertain
to vascular ultrasonography.

\*[2.]{.underline} Knowledge of JCAHO and other regulatory requirements.

[3.]{.underline} Ability to communicate effectively and professionally
with employees at varying grade levels.

\*[4.]{.underline} Ability to manage and supervise employees.

\*[5.]{.underline} Ability to provide, or provide for, staff development
and training.

\(c\) **Certification.** Registration by Cardiovascular Credentialing
International (CCI) as a Registered Vascular Sonographer (RVS) or by the
American Registry of Diagnostic Medical Sonographers (ARDMS) as a
Registered Vascular Technologist (RVT) is highly desirable. Basic
Cardiac Life Support (BCLS) and Advanced Cardiac Life Support (ACLS)
certifications are also desirable.

\(d\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

[1.]{.underline} **Special Assignments.** Non-supervisory vascular
technicians may have assignments that because of their nature
substantially exceed the full performance level. The Professional
Standards Board will review proposed non-supervisory special assignments
for the GS-9 level and make a determination regarding their
appropriateness. These assignments are expected to be relatively few in
number and must represent substantial additional responsibility over the
full performance level.

[2.]{.underline} **Lead Vascular Technician.** In certain programs,
either because of their size and scope or because of a lack of specific
supervisory positions, lead positions may be appropriate.

[3.]{.underline} **Supervisory Vascular Technician.** Individuals in
this assignment assume full administrative and professional
responsibility for planning and directing the work of subordinate
technicians. Typically these duties include assigning and evaluating the
work of subordinate staff; providing Vascular Sonography services in
more complex cases; reviewing and making recommendations regarding new
and emerging procedures; providing instruction and training to new
staff; interviewing candidates for positions; recommending selections,
advancements, promotions; evaluating performance; taking disciplinary
action when necessary; and identifying educational or training needs.

\(5\) **GS-10.** In addition to the core competencies defined at the
GS-9 level, positions at this grade may be supervisory or
non-supervisory with specialized advanced knowledge and assignments.

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. In
addition, the candidate must demonstrate the following technical KSAs
and the potential to acquire the assignment specific KSAs designated by
an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs 1, 2, and
3 are appropriate for all positions at this level. KSAs 4 and 5 are to
be used in accordance with their appropriateness for the specific
assignment.

[1.]{.underline} Advanced knowledge of the most complex and non-standard
treatment and examination procedures and techniques.

\*[2.]{.underline} Ability to plan and assist in the establishment of a
completely integrated treatment and examination program.

\*[3.]{.underline} Ability to evaluate new products and equipment and
make recommendations concerning developments which would improve
operations.

\*[4.]{.underline} Ability to manage the fiscal matters of the functions
supervised (which would include fund controls, contracts, and equipment
expenditures), forecast resource and equipment needs, and administer the
allocated budget.

\*[5.]{.underline} Knowledge of and ability to provide the full range of
supervisory duties which would include responsibility for assignment of
work to be performed; performance evaluation; selection of staff; and
recommendation of awards, advancements, and, when appropriate,
disciplinary actions.

\(c\) **Certification.** Registration by Cardiovascular Credentialing
International (CCI) as a Registered Vascular Sonographer (RVS) or by the
American Registry of Diagnostic Medical Sonographers (ARDMS) as a
Registered Vascular Technologist (RVT) is highly desirable. Basic
Cardiac Life Support (BCLS) and Advanced Cardiac Life Support (ACLS)
certifications are desirable.

\(d\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

[1.]{.underline} **Special Assignments.** There may be a rare
non-supervisory position supporting this grade level. Such a position
would typically include knowledge of standards of medical practice in
applicable medico-legal responsibilities in vascular ultrasound
procedures as well as teaching the correct methodology of vascular
ultrasound procedures, theory of operations, and theory of
interpretation of results to trainees.

[2.]{.underline} **Supervisory Vascular Technician.** Individuals at
this level plan and direct programs at affiliated medical centers and
their satellite outpatient clinics and have full supervisory
responsibility for a large staff of non-supervisory personnel and at
least one subordinate team leader or supervisor. Typically these duties
include assigning and evaluating the work of subordinate staff resolving
problems which may interfere with patient examination or treatment;
providing vascular sonography services in more complex and non-standard
cases; evaluating new products and equipment and making recommendations
concerning developments which would improve operations; participating as
an instructor in the facility's clinical training program; making final
decisions on selections based on recommendations from subordinate
supervisors or leads; evaluating performance; taking disciplinary action
when necessary; and identifying educational or training needs.

**Authority: 38 U.S.C. §§ 7402, 7403.**