Emergency Medical Services (EMS) Working Group

JOB TITLES
The EMS Working Group determined the following job titles to be the most commonly requested EMS personnel in an interstate, mutual aid-based response:

EMS Job Title 1:     Air Medical Transport Manager	        5
EMS Job Title 2:     Air Medical Transport Mechanic	        7
EMS Job Title 3:     Air Medical Transport Medical Director	9
EMS Job Title 4:     Air Medical Transport Paramedic	       11
EMS Job Title 5:     Air Medical Transport Pilot	4
EMS Job Title 6:     Air Medical Transport Registered Nurse	4
EMS Job Title 7:     Emergency Medical Responder	4
EMS Job Title 8:     Emergency Medical Technician (EMT)	4
EMS Job Title 9:     Emergency Vehicle Operator	21
EMS Job Title 10:   Emergency Vehicle Operator-Heavy	23
EMS Job Title 11:   EMS Physician	4
EMS Job Title 12:   EMS Transportation Group Supervisor	27
EMS Job Title 13:   EMS Transportation Unit Leader	29
EMS Job Title 14:   EMS Treatment Unit Leader	31
EMS Job Title 15:   EMS Triage Unit Leader	33
EMS Job Title 16:   Medical Branch Director	35
EMS Job Title 17:   Medical Group Supervisor	37
EMS Job Title 18:   Medical Supply Coordinator	39
EMS Job Title 19:   Paramedic	4

REQUISITE AND RECOMMENDED CRITERIA
Considering existing, nationally-accepted standards, the Emergency Medical Services (EMS) Working Group extracted relevant education, training, experience, physical/medical fitness, certification, and licensing criteria to define the baseline criteria for each job title listed above.  These baseline criteria represent the minimum requirements for EMS personnel to participate in the National Incident Management System (NIMS) Integration Centers National Emergency Responder Credentialing System.
The EMS Working Group identified additional recommended criteria relating to education, training, certification, experience, and physical/ medical fitness where it believed standards and baseline criteria did not exist or were deemed insufficient.  These recommended criteria are not required and represent the EMS Working Groups recommendations for EMS personnel to participate in the NIMS Integration Centers National Emergency Responder Credentialing System.

The categories used in Designing a National Emergency Responder Credentialing System are defined as follows:

Education
Formalinstruction based on a curriculumthat prepares an individual with the core knowledge andskill for entry into a discipline and for performing a job function 
Training1
Instruction and/or activities that enhancean individuals core knowledge,increase a skill set and proficiency, andstrengthen and augment abilities 
Experience
Time required functioning in a job titlefor an individual toattain proficiency in applyingknowledge, skills, and abilities
Physical/ Medical Fitness
Physical andmedicalconsiderations that when applied,helpto ensure safeperformancein risky environments
Certification
Designation granted by Authority Having Jurisdiction (AHJ) thatan individual has met requirements and achievedspecific knowledge, skills, and abilities
Licensing
Legal designation granted by AHJ thatan individual has metthe necessary legal requirements to function in a job title
Where requisite and/or recommended criteria do not apply, that category will not be listed.

EMS ACRONYM LIST

ADM 		Aeronautical Decision Making
AHJ		Authority Having Jurisdiction
AMPA		Air Medical Physician Association
AMRM		Air Medical Resource Management
AMT		Air Medical Technician
ATP		Airline Transport Pilot
CAMTS		Commission on Accreditation of 	Medical Transport Systems 
CBRNE		Chemical, Biological, Radiological, Nuclear, and High-Yield Explosives
CCRN		Critical Care Registered Nurse
CEN		Certified Emergency Nurse
CEVO		Emergency Vehicle Operators Course
CFRN		Certified Flight Registered Nurse
CTRN		Certified Transport Registered Nurse
CRM		Crew Resource Management	
DDC		Defensive Driving Course
DEA		Drug Enforcement Administration
EMR		Emergency Medical Responder
EMS		Emergency Medical Services
EMT		Emergency Medical Technician
EVO		Emergency Vehicle Operator
FAA		Federal Aviation Administration
FP-C		Certified Flight Paramedic
GED		General Equivalency Diploma
GVW		Gross Vehicle Weight	
HazMat		Hazardous Materials
IAP		Incident Action Plan
ICS		Incident Command System
IS		Independent Study
MCI		Mass Casualty Incident
NHTSA		National Highway Transportation Safety Administration
NIMS		National Incident Management System
NREMT		National Registry of Emergency 	Medical Technicians
NRP		Neonatal Resuscitation Program
OSHA		Occupational Safety and Health 	Administration
PIC		Pilot in Charge
Td		Tetanus and Diphtheria
Tdap		Tetanus, Diphtheria, and Pertussis

EMS Job Title 1:   Air Medical Transport Manager
Description: The primary focus of an Air Medical Transport Manager or administrator is patient and air medical crew safety through the coordination of patient transportation and the maintenance of records relating to patient identification, condition, and destination via rotor-wing or fixed-wing air ambulance.   The Air Medical Transport Manager assists in the identification and allocation of resources to support all air medical missions and may facilitate the communication of information between the scene and sending/receiving facilities in conjunction with the Air Medical Transport Medical Director.  The Air Medical Transport Manager coordinates aviation activities with the Aviation Coordinator and other transportation team leaders.  

REQUISITE CRITERIA
The table below lists minimum requisite criteria, based on existing protocols and standards, for an Air Medical Transport Manager to participate in NIMS Integration Centers National Emergency Responder Credentialing System.

Category
Criteria
Training2
Completion of the following courses/ curricula:
1. Incident Command System (ICS)-100:  Introduction to ICS     
2. ICS-200:  Basic ICS
3. Federal Emergency Management Agency (FEMA) Independent Study (IS)-700:  An Introduction to the National Incident Management System (NIMS)     
4. Occupational Safety and Health Administration (OSHA) 1910.120 Hazardous Materials (HazMat) Awareness Training or equivalent basic instruction on responding to and operating in a chemical, biological, radiological nuclear, and high-yield explosives (CBRNE) mass casualty incident (MCI)
Experience
Ongoing involvement with an established air medical transport service
EMS Job Title 1:   Air Medical Transport Manager

RECOMMENDED CRITERIA
The recommended criteria that follow are intended to supplement previously listed requisite criteria for the NIMS Integration Centers consideration and referral to organizations, as appropriate. 
The table below lists the EMS Working Groups recommended criteria for an Air Medical Transport Manager to participate in the NIMS Integration Centers National Emergency Responder Credentialing System. These criteria incorporate and/or modify existing protocols and standards and/or propose their development where they do not exist. 

Category
Criteria
Training
Ongoing training in operations and management and care of patients involved in MCIs
Experience
1. Minimum of 2 years of supervisory, management, or administrative experience
2. Knowledge of Commission on Accreditation of Medical Transport Systems (CAMTS) accreditation standards for patients requiring air medical transport
3. Medical Transport Leadership Institute or equivalent
Certification
1. Certified Medical Transport Executive or equivalent college-level education
Physical/ Medical Fitness
1. Individuals must be healthy enough to function under field conditions, which may include all or some of the following: 
* 12-hour shifts, austere conditions (possibly no showers, housing in tents, portable toilets)
* Extreme weather conditions (long exposure to heat and humidity, lack of air conditioning, extreme cold, or wet environments)
* Long periods of standing
2. Individuals should not require personal medications that require refrigeration of any kind
3. Individuals should not have any physical conditions, impairments, or restrictions that would preclude them from participating in the moving and lifting of patients and/or equipment and supplies
4. Immunizations:
* Tetanus and diphtheria (Td) toxoid or Tetanus, diphtheria, and pertussis (Tdap.) Receipt of primary series and booster within 10 years
* Documentation of Hepatitis B Vaccination Series and documentation of a positive titer (antibody to HBsAg) OR completion of a waiver of liability
EMS Job Title 2:   Air Medical Transport Mechanic
Description:  The primary focus of an Air Medical Transport Mechanic is to ensure that aircraft used for medical missions are maintained to airworthiness standards prescribed by applicable regulations. The Air Medical Transport Mechanic is responsible for the direct operation and administration of avionics maintenance and support. The Air Medical Transport Mechanic will ensure compliance with Federal Aviation Administration (FAA) and other related regulations; that aircraft avionics and avionics-related equipment inspection and maintenance records are originated and retained for review as needed; that specific equipment and special tools are made available to accomplish the inspection, maintenance, and repair of avionics-related components on any aircraft in use; and that all appropriate entries have been made and/or transcribed to the aircraft journal and technical logs with respect to the avionics maintenance function and airworthiness status of the aircraft. 

REQUISITE CRITERIA
The table below lists minimum requisite criteria, based on existing protocols and standards, for an Air Medical Transport Mechanic to participate in the NIMS Integration Centers National Emergency Responder Credentialing System.

Category
Criteria
Education
High school diploma or General Equivalency Diploma (GED)
Training
Completion of  FAA-certified mechanic school or equivalent on-the-job training
Certification
Completion of Airframe &  Powerplant Certification
Licensing
Valid drivers license
EMS Job Title 2:   Air Medical Transport Mechanic

RECOMMENDED CRITERIA
The recommended criteria that follow are intended to supplement previously listed requisite criteria for the NIMS Integration Centers consideration and referral to organizations, as appropriate. 
The table below lists the EMS Working Groups recommended criteria for an Air Medical Transport Mechanic to participate in the NIMS Integration Centers National Emergency Responder Credentialing System. These criteria incorporate and/or modify existing protocols and standards and/or propose their development where they do not exist. 

Category
Criteria
Training
Completion of the following courses and/or curricula:
1. OSHA 1910.120 HazMat Awareness Training or equivalent basic instruction on responding to and operating in a CBRNE MCI
Experience
Minimum of 2 years of experience working as an aviation mechanic
Physical/ Medical Fitness
1. Individuals must be healthy enough to function under field conditions, which may include all or some of the following: 
* 12-hour shifts, austere conditions (possibly no showers, housing in tents, portable toilets)
* Extreme weather conditions (long exposure to heat and humidity, lack of air conditioning, extreme cold, or wet environments)
* Long periods of standing
2. Individuals should not require personal medications that need refrigeration of any kind
3. Individuals should not have any physical conditions, impairments, or restrictions that would preclude them from participating in the moving and lifting of patients and/or equipment and supplies
4. Immunizations:
* Td toxoid or Tdap. Receipt of primary series and booster within 10 years.
* Documentation of Hepatitis B Vaccination Series and documentation of a positive titer (antibody to HBsAg) OR completion of a waiver of liability
EMS Job Title 3:   Air Medical Transport Medical Director
Description:  The primary focus of an Air Medical Transport Medical Director is to oversee the care that the air medical transport crew delivers to the patient from the point of initial contact throughout the entire transport and appropriate disposition of the patient to the point of definitive care.  The Air Medical Transport Medical Director is a licensed physician with education and experience in areas of medicine and pre-hospital care commensurate with the patient care mission.  The Air Medical Transport Medical Director serves as a clinical resource to the air medical transport crew and has the authority over all patient care and clinical aspects of the air medical transport service.  

REQUISITE CRITERIA
The table below lists minimum requisite criteria, based on existing protocols and standards, for an Air Medical Transport Medical Director to participate in the NIMS Integration Centers National Emergency Responder Credentialing System.

Category
Criteria
Education
Graduate of an accredited medical school and completion of an accredited residency program
Training3
Completion of the following courses/ curricula:
1. ICS-100:  Introduction to ICS    
2. ICS-200:  Basic ICS
3. FEMA IS-700:  NIMS, An Introduction
4. OSHA 1910.120 HazMat Awareness Training or equivalent basic instruction on responding to and operating in a CBRNE MCI
5. Air Medical Physician Associations (AMPA) Medical Directors Core Curriculum or equivalent basic training as an aviation medical technician (AMT) medical director
Experience
Ongoing involvement with an established air medical transport service
Certification
Completion of the following:
1. Board certification or board-eligible in emergency medicine (or other comparable specialty)  
2. Current Drug Enforcement Administration (DEA) Registration
Licensing
Active status of legal authority to function as a physician granted by a state, the District of Columbia, or U.S. territory
EMS Job Title 3:   Air Medical Transport Medical Director 

RECOMMENDED CRITERIA
The recommended criteria that follow are intended to supplement previously listed requisite criteria for the NIMS Integration Centers consideration and referral to organizations, as appropriate. 
The table below lists the EMS Working Groups recommended criteria for an Air Medical Transport Medical Director to participate in the NIMS Integration Centers National Emergency Responder Credentialing System. These criteria incorporate and/or modify existing protocols and standards and/or propose their development where they do not exist. 

Category
Criteria
Experience
1. Active involvement in the care of critically ill/injured patients
2. Knowledge of CAMTS Accreditation Standards for patients requiring air medical transport
Physical/ Medical Fitness
1. Individuals must be healthy enough to function under field conditions, which may include all or some of the following: 
* 12-hour shifts, austere conditions (possibly no showers, housing in tents, portable toilets)
* Extreme weather conditions (long exposure to heat and humidity, lack of air conditioning, extreme cold, or wet environments)
* Long periods of standing
2. Individuals should not require personal medications that need refrigeration of any kind
3. Individuals should not have any physical conditions, impairments, or restrictions that would preclude them from participating in the moving and lifting of patients and/or equipment and supplies
4. Immunizations:
* Td toxoid or Tdap. Receipt of primary series and booster within 10 years.
* Documentation of Hepatitis B Vaccination Series and documentation of a positive titer (antibody to HBsAg) OR completion of a waiver of liability
EMS Job Title 4:   Air Medical Transport Paramedic
Description:  The primary focus of an Air Medical Transport Paramedic is the acute management and transportation of the broad range of patients who access the emergency medical system.  The Air Medical Transport Paramedic possesses basic and advanced skills to include invasive and pharmacological interventions to reduce the morbidity and mortality associated with acute out-of-hospital medical and traumatic emergencies. Emergency care is based on an advanced assessment and the formulation of a field impression. The Air Medical Transport Paramedic has education and experience in areas of patient care commensurate with the patient care mission.  The Air Medical Transport Paramedic provides care designed to minimize secondary injury and provide comfort to the patient and family while transporting the patient to an appropriate health care facility. 
Paramedic is the minimum licensure level for patients requiring the full range of advanced out-of-hospital care.

REQUISITE CRITERIA
The table below lists minimum requisite criteria, based on existing protocols and standards, for an Air Medical Transport Paramedic to participate in the NIMS Integration Centers National Emergency Responder Credentialing System.

Category
Criteria
Education
Completion of a state-recognized paramedic program (based on the National Highway Transportation Safety Administrations [NHTSAs] National Standard Curriculum)
Training4
Completion of the following courses/ curricula:
1. ICS-100:  Introduction to ICS    
2. ICS-200:  Basic ICS
3. FEMA IS-700:  NIMS, An Introduction
4. OSHA 1910.120 HazMat Awareness Training or equivalent basic instruction on responding to and operating in a CBRBNE MCI
Experience
Ongoing involvement with an established air medical transport service
Certification
Successful completion of a state-approved program at this level or NREMT certification at this level
Licensing
Active status of legal authority to function as a paramedic granted by a state, the District of Columbia, or U.S. territory
EMS Job Title 4:   Air Medical Transport Paramedic

RECOMMENDED CRITERIA
The recommended criteria that follow are intended to supplement previously listed requisite criteria for the NIMS Integration Centers consideration and referral to organizations, as appropriate. 
The table below lists the EMS Working Groups recommended criteria for an Air Medical Transport Paramedic to participate in the NIMS Integration Centers National Emergency Responder Credentialing System. These criteria incorporate and/or modify existing protocols and standards and/or propose their development where they do not exist. 

Category
Criteria
Education
Successful completion of the minimum terminal learning objectives for Paramedic as defined by NHTSAs National EMS education standards.5 
Training
Completion of the following courses and/or curricula:
1. Ongoing training in the management and care of patients involved in MCIs
2. Neonatal Resuscitation Program (NRP) or equivalent, if expected to transport high-risk OB or neonatal patients
Experience
1. Minimum of 2 years of emergency and critical care paramedic experience
2. Knowledge of CAMTS Accreditation Standards for patients requiring air medical transport
Physical/Medical Fitness
1. Individuals must be healthy enough to function under field conditions, which may include all or some of the following: 
* 12-hour shifts, austere conditions (possibly no showers, housing in tents, portable toilets)
* Extreme weather conditions (long exposure to heat and humidity, lack of air conditioning, extreme cold, or wet environments)
* Long periods of standing
2. Individuals should not require personal medications that need refrigeration of any kind
3. Individuals should not have any physical conditions, impairments, or restrictions that would preclude them from participating in the moving and lifting of patients and/or equipment and supplies
4. Immunizations:
* Td toxoid or Tdap. Receipt of primary series and booster within 10 years.
* Documentation of Hepatitis B Vaccination Series and documentation of a positive titer (antibody to HBsAg) OR completion of a waiver of liability
Certification
Certified Flight Paramedic (FP-C)
EMS Job Title 5:   Air Medical Transport Pilot
Description: The primary focus of an Air Medical Transport Pilot is the safe, coordinated transport of air medical personnel and equipment to the location of an incident and subsequent provision of  safe, coordinated transport of injured victims to an appropriate destination.   The Air Medical Transport Pilot has  authority for acceptance of specific missions and will make all decisions concerning suitability of weather conditions, landing areas, condition of the aircraft for flight, loading of the aircraft, and other factors affecting flight safety.

REQUISITE CRITERIA
The table below lists minimum requisite criteria, based on existing protocols and standards, for an Air Medical Transport Pilot to participate in the NIMS Integration Centers National Emergency Responder Credentialing System.

Category
Criteria
Education
Completion of required ground school on aeronautical knowledge; pass the required knowledge and practical test that applies to the aircraft type and class certificate sought
Training6
Completion of the following courses/ curricula:
1. ICS-100:  Introduction to ICS
2. ICS-200:  Basic ICS
3. FEMA IS-700:  NIMS, An Introduction
4. Instrument Flight Training7 
5. OSHA 1910.120 HazMat Awareness Training or equivalent basic instruction on responding to and operating in a CBRNE MCI
6. Risk assessment training and hazard mitigation
7. Air Medical Resource Management/Aeronautical Decision Making (ADM)/Crew Resource Management 
Experience
Pilot is current in aircraft type and pilot rating as determined by the AHJ

Completion of the following: 
1. 2000 hours of pilot-in-command time (in helicopters for rotorcraft operations)
2. 250 hours of unaided night time
3. 300 hours of turbine time
4. 100 hours of EMS time
5. Fixed wing operations: Pilot in Command (PIC) must be ATP rated, 2000 airplane flight hours with 1000 as PIC, 500 hours multi-engine time as PIC (not required of single-engine turbine aircraft), 100 nighttime hours as PIC
Physical/Medical Fitness
Completion of the following:
1. Annual flight physical with medical class certificate that corresponds with the pilot certificate/rating
Certification
1. Commercial Pilot Certificate with Instrument Rating preferred (Rotor). Military or Public Use pilot equivalent training, documented to the same standard or higher.
EMS Job Title 5:   Air Medical Transport Pilot

RECOMMENDED CRITERIA
The recommended criteria that follow are intended to supplement previously listed requisite criteria for the NIMS Integration Centers consideration and referral to organizations, as appropriate. 
The table below lists the EMS Working Groups recommended criteria for an Air Medical Transport Pilot to participate in the NIMS Integration Centers National Emergency Responder Credentialing System. These criteria incorporate and/or modify existing protocols and standards and/or propose their development where they do not exist. 

Category
Criteria
Training
1. Ongoing training in operations of management and care of patients involved in MCI incidents.
2. 100 hours night-vision goggles
3. Hoist operations, rappelling operations, mountain operations, desert      operations, and over-water operations as applicable to the mission the pilot will be asked to perform
Physical/ Medical Fitness
1. Individuals must be healthy enough to function under field conditions, which may include all or some of the following: 
* 12-hour shifts, austere conditions (possibly no showers, housing in tents, portable toilets)
* Extreme weather conditions (long exposure to heat and humidity, lack of air conditioning, extreme cold, or wet environments)
* Long periods of standing
2. Individuals should not require personal medications that need refrigeration of any kind
3. Individuals should not have any physical conditions, impairments, or restrictions that would preclude them from participating in the moving and lifting of patients and/or equipment and supplies
4. Immunizations:
* Td toxoid or Tdap. Receipt of primary series and booster within 10 years.
* Documentation of Hepatitis B Vaccination Series and documentation of a positive titer (antibody to HBsAg) OR completion of a waiver of liability
EMS Job Title 6:   Air Medical Transport Registered Nurse
Description: The primary focus of an Air Medical Transport Registered Nurse is to provide direct care and transportation of critical and emergent patients who access the EMS scene or inter-facility health care system.  The Air Medical Transport Registered Nurse possesses the education and experience in areas of patient care commensurate with the patient care mission.  The Air Medical Transport Registered Nurse will serve as a functional member of the air medical transport crew, providing critical assessment, treatment, and transportation of patients via rotor-wing or fixed-wing air ambulance.

REQUISITE CRITERIA
The table below lists minimum requisite criteria, based on existing protocols and standards, for an Air Medical Transport Registered Nurse to participate in the NIMS Integration Centers National Emergency Responder Credentialing System.

Category
Criteria
Education
Graduate of an accredited nursing program
Training8
Completion of the following courses/ curricula:
1. ICS-100:  Introduction to ICS   
2. ICS-200:  Basic ICS
3. FEMA IS-700:  NIMS, An Introduction
4. OSHA 1910.120 HazMat Awareness Training or equivalent basic instruction on responding to and operating in a CBRNE MCI
Experience
Ongoing involvement with an established air medical transport service
Licensing
Active status of legal authority to function as a registered nurse granted by a state, the District of Columbia, or U.S. territory
EMS Job Title 6:   Air Medical Transport Registered Nurse

RECOMMENDED CRITERIA
The recommended criteria that follow are intended to supplement previously listed requisite criteria for the NIMS Integration Centers consideration and referral to organizations, as appropriate. 
The table below lists the EMS Working Groups recommended criteria for an Air Medical Transport Registered Nurse to participate in the NIMS Integration Centers National Emergency Responder Credentialing System. These criteria incorporate and/or modify existing protocols and standards and/or propose their development where they do not exist. 

Category
Criteria
Training
Completion of the following courses and/or curricula:
1. Ongoing training in the management and care of patients involved in MCIs
2. Neonatal Resuscitation Program (NRP) or equivalent, if expected to transport high risk OB or neonatal patients
Experience
1. Minimum of 2 years of emergency and critical care nursing experience
2. Knowledge of CAMTS Accreditation Standards for patients requiring air medical transport
Physical/ Medical Fitness
1. Individuals must be healthy enough to function under field conditions, which may include all or some of the following: 
* 12-hour shifts, austere conditions (possibly no showers, housing in tents, portable toilets)
* Extreme weather conditions (long exposure to heat and humidity, lack of air conditioning, extreme cold, or wet environments)
* Long periods of standing
2. Individuals should not require personal medications that require refrigeration of any kind
3. Individuals should not have any physical conditions, impairments, or restrictions that would preclude them from participating in the moving and lifting of patients and/or equipment and supplies
4. Immunizations:
* Td toxoid or Tdap. Receipt of primary series and booster within 10 years.
* Documentation of Hepatitis B Vaccination Series and documentation of a positive titer (antibody to HBsAg) OR completion of a waiver of liability
Certification
Completion of at least one of the following:
1. Certified Flight Registered Nurse (CFRN)
2. Certified Transport Registered Nurse (CTRN)
3. Certified Emergency Nurse (CEN)
4. Critical Care Registered Nurse (CCRN)
EMS Job Title 7:   Emergency Medical Responder
Description: The primary focus of the Emergency Medical Responder is to initiate immediate lifesaving care to critical patients who access the emergency medical system.   The Emergency Medical Responder possesses the education and experience in areas of patient care commensurate with the patient care mission.  Additionally, the Emergency Medical Responder has the basic knowledge and skills necessary to provide lifesaving interventions while awaiting additional EMS response and to assist higher level personnel at the scene and during transport.   The Emergency Medical Responder functions as part of a comprehensive EMS response, under medical oversight. He/she performs basic interventions with minimal equipment.

REQUISITE CRITERIA
The table below lists minimum requisite criteria, based on existing protocols and standards, for an Emergency Medical Responder to participate in the NIMS Integration Centers National Emergency Responder Credentialing System.

Category
Criteria
Education
Completion of state-recognized first responder program based on the NHTSAs National Standard Curriculum 
Training9
Completion of the following courses/ curricula:
1. ICS-100:  Introduction to ICS     
2. FEMA IS-700:  NIMS, An Introduction
3. OSHA 1910.120 HazMat Awareness Training or equivalent basic instruction on responding to and operating in a CBRNE MCI
Experience
Ongoing involvement with an EMS-providing entity, organization, or agency
Certification
Successful completion of a state-approved program at this level or National Registry of Emergency Medical Technicians (NREMT) certification at this level
Licensing
Active status of legal authority to function as a first responder or an emergency medical responder granted by a state, the District of Columbia, or U.S. territory
EMS Job Title 7:   Emergency Medical Responder

RECOMMENDED CRITERIA
The recommended criteria that follow are intended to supplement previously listed requisite criteria for the NIMS Integration Centers consideration and referral to organizations, as appropriate. 
The table below lists the EMS Working Groups recommended criteria for an Emergency Medical Responder to participate in the NIMS Integration Centers National Emergency Responder Credentialing System. These criteria incorporate and/or modify existing protocols and standards and/or propose their development where they do not exist. 

Category
Criteria
Education
Successful completion of the minimum terminal learning objectives for Emergency Medical Responder as defined by the NHTSAs National EMS education standards10
Training
Ongoing training in the management and care of patients involved in MCIs
Physical/ Medical Fitness
1. Individuals must be healthy enough to function under field conditions, which may include all or some of the following: 
* 12-hour shifts, austere conditions (possibly no showers, housing in tents, portable toilets)
* Extreme weather conditions (long exposure to heat and humidity, lack of air conditioning, extreme cold, or wet environments)
* Long periods of standing
2. Individuals should not require personal medications that need refrigeration of any kind
3. Individuals should not have any physical conditions, impairments, or restrictions that would preclude them from participating in the moving and lifting of patients and/or equipment and supplies
4. Immunizations:
* Td toxoid or Tdap. Receipt of primary series and booster within 10 years.
* Documentation of Hepatitis B Vaccination Series and documentation of a positive titer (antibody to HBsAg) OR completion of a waiver of liability
EMS Job Title 8:   Emergency Medical Technician (EMT)
Description:  The primary focus of an Emergency Medical Technician is to provide basic, noninvasive interventions to reduce the morbidity and mortality associated with acute out-of-hospital medical and traumatic emergencies. This may occur at an emergency scene until transportation resources arrive, from an emergency scene to a health care facility, between health care facilities, or in other healthcare settings.  Additionally, the Emergency Medical Technician  possesses the education and experience in areas of patient care that are commensurate with the patient care mission, providing care to minimize secondary injury and provide comfort to the patient and family while transporting the patient to an emergency care facility. The Emergency Medical Technician level is the minimum licensure level for personnel transporting patients in ambulances.

REQUISITE CRITERIA
The table below lists minimum requisite criteria, based on existing protocols and standards, for an Emergency Medical Technician to participate in the NIMS Integration Centers National Emergency Responder Credentialing System.

Category
Criteria
Education
Completion of a state-recognized EMT program based on NHTSAs National Standard Curriculum
Training11
Completion of the following courses/ curricula:
1. ICS-100:  Introduction to ICS    
2. FEMA IS-700:  NIMS, An Introduction
3. OSHA 1910.120 HazMat Awareness Training or equivalent basic instruction on responding to and operating in a CBRNE MCI
Experience
Ongoing involvement with an EMS-providing entity, organization, or agency  
Certification
Successful completion of a state-approved program at this level or NREMT certification at this level
Licensing
Active status of legal authority to function as an Emergency Medical Technician granted by a state, the District of Columbia, or U.S. territory
EMS Job Title 8:   Emergency Medical Technician (EMT)

RECOMMENDED CRITERIA
The recommended criteria that follow are intended to supplement previously listed requisite criteria for the NIMS Integration Centers consideration and referral to organizations, as appropriate. 
The table below lists the EMS Working Groups recommended criteria for an Emergency Medical Technician to participate in the NIMS Integration Centers National Emergency Responder Credentialing System. These criteria incorporate and/or modify existing protocols and standards and/or propose their development where they do not exist. 

Category
Criteria
Education
Successful completion of the minimum terminal learning objectives for Emergency Medical Technician as defined by NHTSAs National EMS education standards12
Training
Ongoing training in the management and care of patients involved in MCIs 
Physical/ Medical Fitness
1. Individuals must be healthy enough to function under field conditions, which may include all or some of the following: 
* 12-hour shifts, austere conditions (possibly no showers, housing in tents, portable toilets)
* Extreme weather conditions (long exposure to heat and humidity, lack of air conditioning, extreme cold, or wet environments)
* Long periods of standing
2. Individuals should not require personal medications that need refrigeration of any kind
3. Individuals should not have any physical conditions, impairments, or restrictions that would preclude them from participating in the moving and lifting of patients and/or equipment and supplies
4. Immunizations:
* Td toxoid or Tdap. Receipt of primary series and booster within 10 years.
* Documentation of Hepatitis B Vaccination Series and documentation of a positive titer (antibody to HBsAg) OR completion of a waiver of liability
EMS Job Title 9:   Emergency Vehicle Operator
Description:  The primary focus of an Emergency Vehicle Operator is the safe operation of assigned emergency vehicles less than 26,000 lbs. Gross Vehicle Weight (GVW) used for patient care and/or transport.  The Emergency Vehicle Operator is responsible for checking the fuel and oil levels and inspects the vehicle to ensure that the brakes, windshield wipers, and lights are working and that a fire extinguisher, flares, and other safety equipment are aboard and in working order. The Emergency Vehicle Operator ensures cargo is secure and adjusts the mirrors so that both sides of the vehicle are visible from the drivers seat.  
Drivers report equipment that is inoperable, missing, or loaded improperly to the Emergency Vehicle Operator Mechanic.

REQUISITE CRITERIA
The table below lists minimum requisite criteria, based on existing protocols and standards, for an Emergency Vehicle Operator to participate in the NIMS Integration Centers National Emergency Responder Credentialing System.

Category
Criteria
Training13
Completion of the following courses/ curricula:
1. ICS-100:  Introduction to ICS     
2. FEMA IS-700:  NIMS, An Introduction
3. OSHA 1910.120 HazMat Awareness Training or equivalent basic instruction on responding to and operating in a CBRNE MCI 
4. Emergency Vehicle Operators Course, CEVO, or equivalent
5. Defensive Driving Course (DDC4) or equivalent
Experience
Ongoing involvement with an EMS-providing entity, organization, or agency
Certification
Emergency Vehicle Operator course
Licensing
Valid drivers license 
EMS Job Title 9:   Emergency Vehicle Operator

RECOMMENDED CRITERIA
The recommended criteria that follow are intended to supplement previously listed requisite criteria for the NIMS Integration Centers consideration and referral to organizations, as appropriate. 
The table below lists the EMS Working Groups recommended criteria for an Emergency Vehicle Operator to participate in the NIMS Integration Centers National Emergency Responder Credentialing System. These criteria incorporate and/or modify existing protocols and standards and/or propose their development where they do not exist. 

Category
Criteria
Experience
2 years minimum driving experience plus a minimum of 1 year Emergency Vehicle Operator (EVO) experience 
Physical/ Medical Fitness
1. Individuals must be healthy enough to function under field conditions, which may include all or some of the following: 
* 12-hour shifts, austere conditions (possibly no showers, housing in tents, portable toilets)
* Extreme weather conditions (long exposure to heat and humidity, lack of air conditioning, extreme cold, or wet environments)
* Long periods of standing
2. Individuals should not require personal medications that need refrigeration of any kind
3. Individuals should not have any physical conditions, impairments, or restrictions that would preclude them from participating in the moving and lifting of patients and/or equipment and supplies
4. Immunizations:
* Td toxoid or Tdap. Receipt of primary series and booster within 10 years.
* Documentation of Hepatitis B Vaccination Series and documentation of a positive titer (antibody to HBsAg) OR completion of a waiver of liability
EMS Job Title 10:   Emergency Vehicle Operator-Heavy
Description: The primary focus of an Emergency Vehicle Operator-Heavy is the safe operation of heavy or large emergency vehicles over 26,000 lbs. GVW with special operating requirement (airbrakes, medium- or heavy-duty chassis) used for patient care and/or transport.  The Emergency Vehicle Operator-Heavy is responsible for checking the fuel and oil levels and inspects the vehicle to ensure that the brakes, windshield wipers, and lights are working and that a fire extinguisher, flares, and other safety equipment are aboard and in working order. The Emergency Vehicle Operator--Heavy ensures cargo is secure and adjusts the mirrors so that both sides of the vehicle are visible from the drivers seat. Drivers report equipment that is inoperable, missing, or loaded improperly to the Emergency Vehicle Mechanic.

REQUISITE CRITERIA
The table below lists minimum requisite criteria, based on existing protocols and standards, for an Emergency Vehicle Operator-Heavy to participate in the NIMS Integration Centers National Emergency Responder Credentialing System.

Category
Criteria
Training14
Completion of the following courses/ curricula:
1. ICS-100:  Introduction to ICS     
2. FEMA IS-700:  NIMS, An Introduction
3. OSHA 1910.120 HazMat Awareness Training or equivalent basic instruction on responding to and operating in a CBRNE MCI 
4. Emergency Vehicle Operators Course, CEVO, (for heavy or large emergency vehicles over 26,000 lbs. GVW), or equivalent
5. DDC4 or equivalent
Experience
1. Ongoing involvement with an EMS-providing entity, organization, or agency
2. Demonstrate basic competency of vehicle operation  
Certification
EVO
Licensing
Valid drivers license
EMS Job Title 10:   Emergency Vehicle Operator-Heavy

RECOMMENDED CRITERIA
The recommended criteria that follow are intended to supplement previously listed requisite criteria for the NIMS Integration Centers consideration and referral to organizations, as appropriate. 
The table below lists the EMS Working Groups recommended criteria for an Emergency Vehicle Operator-Heavy to participate in the NIMS Integration Centers National Emergency Responder Credentialing System. These criteria incorporate and/or modify existing protocols and standards and/or propose their development where they do not exist. 

Category
Criteria
Experience
2 years minimum driving experience plus a minimum of 1 year EVO and 1 year EVO-Heavy experience
Physical/ Medical Fitness
1. Individuals must be healthy enough to function under field conditions, which may include all or some of the following: 
* 12-hour shifts, austere conditions (possibly no showers, housing in tents, portable toilets)
* Extreme weather conditions (long exposure to heat and humidity, lack of air conditioning, extreme cold, or wet environments)
* Long periods of standing
2. Individuals should not require personal medications that need refrigeration of any kind
3. Individuals should not have any physical conditions, impairments, or restrictions that would preclude them from participating in the moving and lifting of patients and/or equipment and supplies
4. Immunizations:
* Td toxoid or Tdap. Receipt of primary series and booster within 10 years.
* Documentation of Hepatitis B Vaccination Series and documentation of a positive titer (antibody to HBsAg) OR completion of a waiver of liability

EMS Job Title 11:   EMS Physician
Description:  The primary focus of the EMS Physician is to ensure quality patient care and provide medical oversight of EMS resources within an established command and control system during an incident response.   The EMS Physician is a licensed physician who possesses the education and experience in areas of medicine and out-of-hospital care commensurate with the patient care mission.   The EMS Physicians primary responsibilities include the development and initiation of EMS protocols, oversight of EMS resource allocation, and appropriate handling, treatment, and transportation of victims. 
The EMS Physician has the  authority over all patient care and clinical aspects of the EMS service.  

REQUISITE CRITERIA
The table below lists minimum requisite criteria, based on existing protocols and standards, for an EMS Physician to participate in the NIMS Integration Centers National Emergency Responder Credentialing System.

Category
Criteria
Education
Graduate of an accredited medical school and completion of an accredited residency program
Training
Completion of the following courses/ curricula:
1. ICS-100:  Introduction to ICS  
2. ICS-200:  Basic ICS
3. ICS-300:  Intermediate ICS   
4. FEMA IS-700:  NIMS, An Introduction
5. OSHA 1910.120 HazMat Awareness Training or equivalent basic instruction on responding to and operating in a CBRNE MCI
Experience
1. Minimum of 2 years of experience or training in out-of-hospital emergency care of the acutely ill or injured patient????
2. Knowledge of Federal, State, and  local MCI and disaster plans
3. Active medical practice
Certification
Current DEA registration
Licensing
Active status of legal authority to function as a physician granted by a state, the District of Columbia, or U.S. territory
EMS Job Title 11:   EMS Physician

RECOMMENDED CRITERIA
The recommended criteria that follow are intended to supplement previously listed requisite criteria for the NIMS Integration Centers consideration and referral to organizations, as appropriate. 
The table below lists the EMS Working Groups recommended criteria for an EMS Physician to participate in the NIMS Integration Centers National Emergency Responder Credentialing System. These criteria incorporate and/or modify existing protocols and standards and/or propose their development where they do not exist. 

Category
Criteria
Training
Completion of the following courses and/or curriculum:
1. Base Station Course or equivalent
Physical/ Medical Fitness
1. Individuals must be healthy enough to function under field conditions, which may include all or some of the following: 
* 12-hour shifts, austere conditions (possibly no showers, housing in tents, portable toilets)
* Extreme weather conditions (long exposure to heat and humidity, lack of air conditioning, extreme cold, or wet environments)
* Long periods of standing
2. Individuals should not require personal medications that need refrigeration of any kind
3. Individuals should not have any physical conditions, impairments, or restrictions that would preclude them from participating in the moving and lifting of patients and/or equipment and supplies
4. Immunizations:
* Td toxoid or Tdap. Receipt of primary series and booster within 10 years.
* Documentation of Hepatitis B Vaccination Series and documentation of a positive titer (antibody to HBsAg) OR completion of a waiver of liability
EMS Job Title 12:   EMS Transportation Group Supervisor
Description: The primary focus of an EMS Transportation Group Supervisor is the coordination of patient transportation and maintenance of records relating to the patients identification, condition, and destination.  He/she designates ambulance Staging Area(s), ensures that patient information and destinations are recorded, requests additional ambulances as required, coordinates requests for air medical transportation through the air medical transport manager, coordinates the establishment of the helipads with the medical branch director and air medical transport manager, and ensures the establishment of communications with hospitals.
The EMS Transportation Group Supervisor reports to the medical branch director and supervises the medical communications coordinator and the ambulance coordinator. The EMS Transportation Group Supervisor is responsible for the coordination of patient transportation and maintenance of records relating to the patients identification, condition, and destination.15

REQUISITE CRITERIA
The table below lists minimum requisite criteria, based on existing protocols and standards, for an EMS Transportation Group Supervisor to participate in the NIMS Integration Centers National Emergency Responder Credentialing System.

Category
Criteria
Training16
Completion of the following courses/ curricula:
1. ICS-100:  Introduction to ICS     
2. ICS-200:  Basic ICS
3. FEMA IS-700:  NIMS, An Introduction
4. OSHA 1910.120 HazMat Awareness Training or equivalent basic instruction on responding to and operating in a CBRNE MCI
Experience
Ongoing involvement with an EMS-providing entity, organization, or agency
EMS Job Title 12:   EMS Transportation Group Supervisor

RECOMMENDED CRITERIA
The recommended criteria that follow are intended to supplement previously listed requisite criteria for the NIMS Integration Centers consideration and referral to organizations, as appropriate. 
The table below lists the EMS Working Groups recommended criteria for an EMS Transportation Group Supervisor to participate in the NIMS Integration Centers National Emergency Responder Credentialing System. These criteria incorporate and/or modify existing protocols and standards and/or propose their development where they do not exist. 

Category
Criteria
Training17
Completion of the following courses/ curricula:
1. ICS-300:  Intermediate ICS
2. Unit-specific training in the management and care of patients involved in MCIs
Physical/ Medical Fitness
1. Individuals must be healthy enough to function under field conditions, which may include all or some of the following: 
* 12-hour shifts, austere conditions (possibly no showers, housing in tents, portable toilets)
* Extreme weather conditions (long exposure to heat and humidity, lack of air conditioning, extreme cold, or wet environments)
* Long periods of standing
2. Individuals should not require personal medications that need refrigeration of any kind
3. Individuals should not have any physical conditions, impairments, or restrictions that would preclude them from participating in the moving and lifting of patients and/or equipment and supplies
4. Immunizations:
* Td toxoid or Tdap. Receipt of primary series and booster within 10 years.
* Documentation of Hepatitis B Vaccination Series and documentation of a positive titer (antibody to HBsAg) OR completion of a waiver of liability
EMS Job Title 13:   EMS Transportation Unit Leader
Description:   The primary focus of an EMS Transportation Unit Leader is the coordination of patient transportation and maintenance of records relating to the patients identification, condition, and destination.  He/she designates ambulance Staging Area(s), ensures that patient information and destinations are recorded, requests additional ambulances as required, coordinates requests for air medical transportation through the transportation group supervisor or air medical transport manager, coordinates the establishment of the helipads with the medical branch director and air medical transport manager, and ensures the establishment of communications with hospitals.
The EMS Transportation Unit Leader reports to the medical group supervisor and supervises the medical communications coordinator and the ambulance coordinator.18  

REQUISITE CRITERIA
The table below lists minimum requisite criteria, based on existing protocols and standards, for an EMS Transportation Unit Leader to participate in the NIMS Integration Centers National Emergency Responder Credentialing System.

Category
Criteria
Training19
Completion of the following courses/ curricula:
1. ICS-100:  Introduction to ICS     
2. ICS-200:  Basic ICS
3. FEMA IS-700:  NIMS, An Introduction
4. OSHA 1910.120 HazMat Awareness Training or equivalent basic instruction on responding to and operating in a CBRNE MCI
Experience
Ongoing involvement with an EMS-providing entity, organization, or agency
EMS Job Title 13:   EMS Transportation Unit Leader

RECOMMENDED CRITERIA
The recommended criteria that follow are intended to supplement previously listed requisite criteria for the NIMS Integration Centers consideration and referral to organizations, as appropriate. 
The table below lists the EMS Working Groups recommended criteria for an EMS Transportation Unit Leader to participate in the NIMS Integration Centers National Emergency Responder Credentialing System. These criteria incorporate and/or modify existing protocols and standards and/or propose their development where they do not exist. 

Category
Criteria
Training20
Completion of the following courses/ curricula:
1. ICS-300:  Intermediate ICS
2. Ongoing training in the management and care of patients involved in MCIs
Physical/ Medical Fitness
1. Individuals must be healthy enough to function under field conditions, which may include all or some of the following: 
* 12-hour shifts, austere conditions (possibly no showers, housing in tents, portable toilets)
* Extreme weather conditions (long exposure to heat and humidity, lack of air conditioning, extreme cold, or wet environments)
* Long periods of standing
2. Individuals should not require personal medications that need refrigeration of any kind
3. Individuals should not have any physical conditions, impairments, or restrictions that would preclude them from participating in the moving and lifting of patients and/or equipment and supplies
4. Immunizations:
* Td toxoid or Tdap. Receipt of primary series and booster within 10 years.
* Documentation of Hepatitis B Vaccination Series and documentation of a positive titer (antibody to HBsAg) OR completion of a waiver of liability.
EMS Job Title 14:   EMS Treatment Unit Leader
Description: The primary focus of the EMS Treatment Unit Leader is the coordination of treatment, preparation for transport, directing movement of patients to loading location(s), and coordinating movement of patients from the Triage Area to Treatment Areas with the triage unit leader.   The EMS Treatment Unit Leader requests sufficient medical reserves and supplies, establishes communications and coordination with the transportation unit leader, ensures continual triage of patients throughout Treatment Areas, and directs movement of patients to ambulance loading area(s).  The EMS Treatment Unit Leader possesses the education and experience in areas of patient care that are commensurate with the patient care mission.  
The EMS Treatment Unit Leader reports to the medical group supervisor and supervises treatment managers and the treatment dispatch manager.  

REQUISITE CRITERIA
The table below lists minimum requisite criteria, based on existing protocols and standards, for an EMS Treatment Unit Leader to participate in the NIMS Integration Centers National Emergency Responder Credentialing System.

Category
Criteria
Education
Completion of state recognized First Responder program based on NHTSAs National Standard Curriculum 
Training21
Completion of the following courses/ curricula:
1. ICS-100:  Introduction to ICS
2. ICS-200:  Basic ICS
3. FEMA IS-700:  NIMS, An Introduction
4. OSHA 1910.120 HazMat Awareness Training or equivalent basic instruction on responding to and operating in a CBRNE MCI
Experience
Ongoing involvement with an EMS-providing entity, organization, or agency
Certification
Successful completion of a state-approved program at this level or NREMT certification at this level
Licensing
Active status of legal authority to function as a first responder or an EMR granted by a state, the District of Columbia, or U.S. territory
EMS Job Title 14:   EMS Treatment Unit Leader

RECOMMENDED CRITERIA
The recommended criteria that follow are intended to supplement previously listed requisite criteria for the NIMS Integration Centers consideration and referral to organizations, as appropriate. 
The table below lists the EMS Working Groups recommended criteria for an EMS Treatment Unit Leader to participate in the NIMS Integration Centers National Emergency Responder Credentialing System. These criteria incorporate and/or modify existing protocols and standards and/or propose their development where they do not exist. 

Category
Criteria
Education
Successful completion of the minimum terminal learning objectives for Emergency Medical Responder as defined by NHTSAs National EMS Education Standards22
Training
Ongoing training in the management and care of patients involved in MCIs
Physical/ Medical Fitness
1. Individuals must be healthy enough to function under field conditions, which may include all or some of the following: 
* 12-hour shifts, austere conditions (possibly no showers, housing in tents, portable toilets)
* Extreme weather conditions (long exposure to heat and humidity, lack of air conditioning, extreme cold, or wet environments), and
* Long periods of standing
2. Individuals should not require personal medications that need refrigeration of any kind
3. Individuals should not have any physical conditions, impairments, or restrictions that would preclude them from participating in the moving and lifting of patients and/or equipment and supplies
4. Immunizations:
* Td toxoid or Tdap. Receipt of primary series and booster within 10 years.
* Documentation of Hepatitis B Vaccination Series and documentation of a positive titer (antibody to HBsAg) OR completion of a waiver of liability
EMS Job Title 15:   EMS Triage Unit Leader
Description:  The primary focus of the EMS Triage Unit Leader is to provide triage management and movement of patients from the Triage Area. The EMS Triage Unit Leader informs the medical group supervisor of resource needs, implements the triage process, coordinates movement of patients from the Triage Area to the appropriate Treatment Area, maintains security and control of the Triage Area, and establishes the morgue.   The EMS Triage Unit Leader possesses the education and experience in areas of patient care that are commensurate with the patient care mission.  
The EMS Triage Unit Leader reports to the medical group supervisor and supervises triage personnel, litter bearers, and the morgue.

REQUISITE CRITERIA
The table below lists minimum requisite criteria, based on existing protocols and standards, for an EMS Triage Unit Leader to participate in the NIMS Integration Centers National Emergency Responder Credentialing System.

Category
Criteria
Education
Completion of state recognized First Responder program based on NHTSAs National Standard Curriculum 
Training23
Completion of the following courses/ curricula:
1. ICS-100:  Introduction to ICS     
2. ICS-200:  Basic ICS
3. FEMA IS-700:  NIMS, An Introduction
4. OSHA 1910.120 HazMat Awareness Training or equivalent basic instruction on responding to and operating in a CBRNE MCI
Experience
Ongoing involvement with an EMS-providing entity, organization, or agency
Certification
Successful completion of a state-approved program at this level or NREMT certification at this level
Licensing
Active status of legal authority to function as a first responder or an EMR granted by a state, the District of Columbia, or U.S. territory
EMS Job Title 15:   EMS Triage Unit Leader

RECOMMENDED CRITERIA
The recommended criteria that follow are intended to supplement previously listed requisite criteria for the NIMS Integration Centers consideration and referral to organizations, as appropriate. 
The table below lists the EMS Working Groups recommended criteria for an EMS Triage Unit Leader to participate in the NIMS Integration Centers National Emergency Responder Credentialing System. These criteria incorporate and/or modify existing protocols and standards and/or propose their development where they do not exist. 

Category
Criteria
Education
Successful completion of the minimum terminal learning objectives for EMR as defined by NHTSAs National EMS Education Standards24
Training
Completion of the following courses/ curricula:
1. ICS-300:  Intermediate ICS
2. Ongoing training in the management and care of patients involved in MCIs
Physical/ Medical Fitness
1. Individuals must be healthy enough to function under field conditions, which may include all or some of the following: 
* 12-hour shifts, austere conditions (possibly no showers, housing in tents, portable toilets)
* Extreme weather conditions (long exposure to heat and humidity, lack of air conditioning, extreme cold, or wet environments), and
* Long periods of standing
2. Individuals should not require personal medications that need refrigeration of any kind
3. Individuals should not have any physical conditions, impairments, or restrictions that would preclude them from participating in the moving and lifting of patients and/or equipment and supplies
4. Immunizations:
* Td toxoid or Tdap. Receipt of primary series and booster within 10 years.
* Documentation of Hepatitis B Vaccination Series and documentation of a positive titer (antibody to HBsAg) OR completion of a waiver of liability

EMS Job Title 16:   Medical Branch Director
Description:  The primary focus of a Medical Branch Director is the implementation of the Incident Command System (ICS) Incident Action Plan (IAP) within the medical branch. The Medical Branch Director reports to the Operations Section Chief and supervises the medical group(s) and the patient transport function (unit or group).  The Medical Branch Director possesses the education and experience in areas of patient care commensurate with the patient care mission and manages all medical group/branch functions to safely and quickly extricate, triage, treat, and transport all patients according to the IAPs medical objectives.  The Medical Branch Director reviews group assignments for effectiveness of current operations and provides input to Operations Section Chief for the IAP, supervises branch activities, reports to the Operations Section Chief on branch activities, and maintains the unit/activity log.25

REQUISITE CRITERIA
The table below lists minimum requisite criteria, based on existing protocols and standards, for a Medical Branch Director to participate in the NIMS Integration Centers National Emergency Responder Credentialing System.

Category
Criteria
Education
Completion of state-recognized first responder program based on NHTSAs National Standard Curriculum 
Training26
Completion of the following courses/ curricula:
1. ICS-100:  An Introduction to ICS     
2. ICS-200:  Basic ICS
3. ICS-300:  Intermediate ICS
4. FEMA IS-700:  NIMS, An Introduction
5. OSHA 1910.120 HazMat Awareness Training or equivalent basic instruction on responding to and operating in a CBRNE MCI
Experience
Ongoing involvement with an EMS-providing entity, organization, or agency
Certification
Successful completion of a state-approved program at this level or NREMT certification at this level 
Licensing
Active status of legal authority to function as a first responder or an EMR granted by a state, the District of Columbia, or U.S. territoryEMS Job Title 16:   Medical Branch Director

RECOMMENDED CRITERIA
The recommended criteria that follow are intended to supplement previously listed requisite criteria for the NIMS Integration Centers consideration and referral to organizations, as appropriate. 
The table below lists the EMS Working Groups recommended criteria for a Medical Branch Director to participate in the NIMS Integration Centers National Emergency Responder Credentialing System. These criteria incorporate and/or modify existing protocols and standards and/or propose their development where they do not exist. 

Category
Criteria
Education
Successful completion of the minimum terminal learning objectives for EMR as defined by NHTSAs National EMS education standards27
Training
Completion of the following courses/ curricula:
1. Unit-specific training in the management and care of patients involved in MCIs
Physical/ Medical Fitness
1. Individuals must be healthy enough to function under field conditions, which may include all or some of the following: 
* 12-hour shifts, austere conditions (possibly no showers, housing in tents, portable toilets)
* Extreme weather conditions (long exposure to heat and humidity, lack of air conditioning, extreme cold, or wet environments)
* Long periods of standing
2. Individuals should not require personal medications that need refrigeration of any kind
3. Individuals should not have any physical conditions, impairments, or restrictions that would preclude them from participating in the moving and lifting of patients and/or equipment and supplies
4. Immunizations:
* Td toxoid or Tdap. Receipt of primary series and booster within 10 years.
* Documentation of Hepatitis B Vaccination Series and documentation of a positive titer (antibody to HBsAg) OR completion of a waiver of liability
 EMS Job Title 17:   Medical Group Supervisor
Description: The primary focus of the Medical Group Supervisor is to implement all medical group/branch functions to safely and quickly extricate, triage, treat, and transport all patients according to the incident medical objectives. The Medical Group Supervisor possesses the education and experience in areas of patient care commensurate with the patient care mission.  The Medical Group Supervisor establishes command and control of the activities within a medical group, establishes the medical group with assigned personnel, and requests additional personnel and resources sufficient to respond to the magnitude of the incident. 
The Medical Group Supervisor reports to the medical branch director and supervises the triage unit leader, treatment unit leader, patient transport unit leader, and medical supply coordinator.28

REQUISITE CRITERIA
The table below lists minimum requisite criteria, based on existing protocols and standards, for a Medical Group Supervisor to participate in the NIMS Integration Centers National Emergency Responder Credentialing System.

Category
Criteria
Education
Completion of state-recognized first responder program based on NHTSAs National Standard Curriculum 
Training29
Completion of the following courses/ curricula:
1. ICS-100:  Introduction to ICS  
2. ICS-200:  Basic ICS
3. ICS-300:  Intermediate ICS
4. FEMA IS-700:  NIMS, An Introduction
5. OSHA 1910.120 HazMat Awareness Training or equivalent basic instruction on responding to and operating in a CBRNE MCI
Experience
Ongoing involvement with an EMS-providing entity, organization, or agency
Certification
Successful completion of a state-approved program at this level or NREMT certification at this level
Licensing
Active status of legal authority to function as a first responder or an EMR granted by a state, the District of Columbia, or U.S. territory
EMS Job Title 17:   Medical Group Supervisor

RECOMMENDED CRITERIA
The recommended criteria that follow are intended to supplement previously listed requisite criteria for the NIMS Integration Centers consideration and referral to organizations, as appropriate. 
The table below lists the EMS Working Groups recommended criteria for a Medical Group Supervisor to participate in the NIMS Integration Centers National Emergency Responder Credentialing System. These criteria incorporate and/or modify existing protocols and standards and/or propose their development where they do not exist. 

Category
Criteria
Education
Successful completion of the minimum terminal learning objectives for EMR as defined by NHTSAs National EMS education standards30
Training31
Completion of the following courses/curricula:
1. Unit-specific training in the management and care of patients involved in MCIs
Physical/ Medical Fitness
1. Individuals must be healthy enough to function under field conditions, which may include all or some of the following: 
* 12-hour shifts, austere conditions (possibly no showers, housing in tents, portable toilets)
* Extreme weather conditions (long exposure to heat and humidity, lack of air conditioning, extreme cold, or wet environments)
* Long periods of standing
2. Individuals should not require personal medications that need refrigeration of any kind
3. Individuals should not have any physical conditions, impairments, or restrictions that would preclude them from participating in the moving and lifting of patients and/or equipment and supplies
4. Immunizations:
* Td toxoid or Tdap. Receipt of primary series and booster within 10 years.
* Documentation of Hepatitis B Vaccination Series and documentation of a positive titer (antibody to HBsAg) OR completion of a waiver of liability
EMS Job Title 18:   Medical Supply Coordinator
Description: The primary focus of the Medical Supply Coordinator is to acquire and maintain control of appropriate medical equipment and supplies from units assigned to the medical group.  The Medical Supply Coordinator requests additional medical supplies and distributes medical supplies to treatment and triage units.
The Medical Supply Coordinator reports to the medical group supervisor. 

REQUISITE CRITERIA
The table below lists minimum requisite criteria, based on existing protocols and standards, for a Medical Supply Coordinator to participate in the NIMS Integration Centers National Emergency Responder Credentialing System.

Category
Criteria
Education
Completion of state recognized First Responder program based on NHTSAs National Standard Curriculum 
Training32
Completion of the following courses/ curricula:
1. ICS-100:  Introduction to ICS
2. ICS-200:  Basic ICS
3. FEMA IS-700:  NIMS, An Introduction    
4. OSHA 1910.120 HazMat Awareness Training or equivalent basic instruction on responding to and operating in a CBRNE MCI
Experience
Ongoing involvement with an EMS-providing entity, organization, or agency
Certification
Successful completion of a state-approved program at this level or NREMT certification at this level
Licensing
Active status of legal authority to function as a first responder or an EMR granted by a state, the District of Columbia, or U.S. territory
EMS Job Title 18:   Medical Supply Coordinator

RECOMMENDED CRITERIA
The recommended criteria that follow are intended to supplement previously listed requisite criteria for the NIMS Integration Centers consideration and referral to organizations, as appropriate. 
The table below lists the EMS Working Groups recommended criteria for a Medical Supply Coordinator to participate in the NIMS Integration Centers National Emergency Responder Credentialing System. These criteria incorporate and/or modify existing protocols and standards and/or propose their development where they do not exist. 

Category
Criteria
Education
Successful completion of the minimum terminal learning objectives for EMR as defined by NHTSAs National EMS education standards33
Training
Completion of the following courses/ curricula:
1. ICS-300:  Intermediate ICS
2. Ongoing training in the management and care of patients involved in MCIs
Physical/ Medical Fitness
1. Individuals must be healthy enough to function under field conditions, which may include all or some of the following: 
* 12-hour shifts, austere conditions (possibly no showers, housing in tents, portable toilets)
* Extreme weather conditions (long exposure to heat and humidity, lack of air conditioning, extreme cold, or wet environments), and
* Long periods of standing
2. Individuals should not require personal medications that need refrigeration of any kind
3. Individuals should not have any physical conditions, impairments, or restrictions that would preclude them from participating in the moving and lifting of patients and/or equipment and supplies
4. Immunizations:
* Td toxoid or Tdap. Receipt of primary series and booster within 10 years.
* Documentation of Hepatitis B Vaccination Series and documentation of a positive titer (antibody to HBsAg) OR completion of a waiver of liability
EMS Job Title 19:   Paramedic
Description:  The primary focus of a Paramedic is to provide emergency care based on an advanced assessment and the formulation of a field impression, including basic and advanced skills focusing on the acute management and transportation of the broad range of patients who access the emergency medical system.  The Paramedic possesses the education and experience in areas of medicine and pre-hospital care commensurate with the patient care mission.  The Paramedics skills include invasive and pharmacological interventions to reduce the morbidity and mortality associated with acute out-of-hospital medical and traumatic emergencies. The Paramedic provides care designed to minimize secondary injury and provide comfort to the patient and family while transporting the patient to an appropriate health care facility. 
The Paramedic is the minimum licensure level for patients requiring the full range of advanced out-of-hospital care.

REQUISITE CRITERIA
The table below lists minimum requisite criteria, based on existing protocols and standards, for a Paramedic to participate in the NIMS Integration Centers National Emergency Responder Credentialing System.

Category
Criteria
Education
Completion of a state-recognized paramedic program based on NHTSAs National Standard Curriculum
Training34
Completion of the following courses/ curricula:
1. ICS-100:  Introduction to ICS    
2. FEMA IS-700:  NIMS, An Introduction
3. OSHA 1910.120 HazMat Awareness Training or equivalent basic instruction on responding to and operating in a CBRNE MCI
Experience
Ongoing involvement with an EMS-providing entity, organization, or agency
Certification
Successful completion of a state-approved program at this level or NREMT certification at this level
Licensing
Active status of legal authority to function as a paramedic granted by a state, the District of Columbia, or U.S. territory
EMS Job Title 19:   Paramedic

RECOMMENDED CRITERIA
The recommended criteria that follow are intended to supplement previously listed requisite criteria for the NIMS Integration Centers consideration and referral to organizations, as appropriate. 
The table below lists the EMS Working Groups recommended criteria for a Paramedic to participate in the NIMS Integration Centers National Emergency Responder Credentialing System. These criteria incorporate and/or modify existing protocols and standards and/or propose their development where they do not exist. 

Category
Criteria
Education
Successful completion of the minimum terminal learning objectives for paramedic as defined by NHTSAs National EMS education standards.35 
Training
Completion of the following courses/ curricula:
1. ICS-200:  Basic ICS
2. Ongoing training in the management and care of patients involved in MCIs 
Physical/Medical Fitness
1. Individuals must be healthy enough to function under field conditions, which may include all or some of the following: 
* 12-hour shifts, austere conditions (possibly no showers, housing in tents, portable toilets)
* Extreme weather conditions (long exposure to heat and humidity, lack of air conditioning, extreme cold, or wet environments)
* Long periods of standing
2. Individuals should not require personal medications that need refrigeration of any kind
3. Individuals should not have any physical conditions, impairments, or restrictions that would preclude them from participating in the moving and lifting of patients and/or equipment and supplies
4. Immunizations:
* Td toxoid or Tdap. Receipt of primary series and booster within 10 years.
* Documentation of Hepatitis B Vaccination Series and documentation of a positive titer (antibody to HBsAg) OR completion of a waiver of liability
1 Per National Incident Management System (NIMS) compliance at the time of publication, Incident Command System (ICS)- and Federal Emergency Management Agency (FEMA) Independent Study (IS)- training courses are listed.  Equivalent courses must meet the NIMS National Standard Curriculum.
2 Per NIMS compliance at the time of publication, ICS- and FEMA IS- training courses are listed.  Equivalent courses must meet the NIMS National Standard Curriculum.

3 Per NIMS compliance at the time of publication, ICS- and FEMA IS- training courses are listed.  Equivalent courses must meet the NIMS National Standard Curriculum.
4 Per NIMS compliance at the time of publication, ICS- and FEMA IS- training courses are listed.  Equivalent courses must meet the NIMS National Standard Curriculum.
5 NHTSAs National EMS education standards are a component of the EMS Education Agenda for the Future: A System Approach, a comprehensive plan for a national EMS education system that will result in improved efficiency in the education process, enhanced consistency in the quality of the EMS education, and greater competency of the entry level EMS provider.  Emergency Medical Responder (EMR), Emergency Medical Technician (EMT), and paramedic job titles should be expected to transition to these educational standards as they are implemented. 

6 Per NIMS compliance at the time of publication, ICS- and FEMA IS- training courses are listed.  Equivalent courses must meet the NIMS National Standard Curriculum.
7 Does not require current certificate; individuals will have successfully completed training.
8 Per NIMS compliance at the time of publication, ICS- and FEMA IS- training courses are listed.  Equivalent courses must meet the NIMS National Standard Curriculum.
9 Per NIMS compliance at the time of publication, ICS- and FEMA IS- training courses are listed.  Equivalent courses must meet the NIMS National Standard Curriculum.
10 NHTSAs National EMS education standards are a component of the EMS Education Agenda for the Future: A System Approach, a comprehensive plan for a national EMS education system that will result in improved efficiency in the education process, enhanced consistency in the quality of the EMS education and greater competency of the entry level EMS provider.  EMR, EMT, and paramedic job titles should be expected to transition to these educational standards as they are implemented. 

11 Per NIMS compliance at the time of publication, ICS- and FEMA IS- training courses are listed.  Equivalent courses must meet the NIMS National Standard Curriculum.
12 NHTSAs National EMS education standards are a component of the EMS Education Agenda for the Future: A System Approach, a comprehensive plan for a national EMS education system that will result in improved efficiency in the education process, enhanced consistency in the quality of the EMS education and greater competency of the entry level EMS provider.  EMR, EMT, and paramedic job titles should be expected to transition to these educational standards as they are implemented.

13 Per NIMS compliance at the time of publication, ICS- and FEMA IS- training courses are listed.  Equivalent courses must meet the NIMS National Standard Curriculum.
14 Per NIMS compliance at the time of publication, ICS- and FEMA IS- training courses are listed.  Equivalent courses must meet the NIMS National Standard Curriculum.
15 The patient transport function may initially be established as a unit and upgraded to a group based on incident size and complexity.

16 Per NIMS compliance at the time of publication, ICS- and FEMA IS- training courses are listed.  Equivalent courses must meet the NIMS National Standard Curriculum.
17 Per NIMS compliance at the time of publication, ICS- and FEMA IS- training courses are listed.  Equivalent courses must meet the NIMS National Standard Curriculum.
18 The patient transport function may initially be established as a Unit and upgraded to a group based on incident size and complexity. 
 
19 Per NIMS compliance at the time of publication, ICS- and FEMA IS- training courses are listed.  Equivalent courses must meet the NIMS National Standard Curriculum.
20 Per NIMS compliance at the time of publication, ICS- and FEMA IS- training courses are listed.  Equivalent courses must meet the NIMS National Standard Curriculum.
21 Per NIMS compliance at the time of publication, ICS- and FEMA IS- training courses are listed.  Equivalent courses must meet the NIMS National Standard Curriculum.
22 NHTSAs National EMS education standards are a component of the EMS Education Agenda for the Future: A System Approach, a comprehensive plan for a national EMS education system that will result in improved efficiency in the education process, enhanced consistency in the quality of the EMS education and greater competency of the entry level EMS provider.  EMR, EMT, and paramedic job titles should be expected to transition to these educational standards as they are implemented. 

23 Per NIMS compliance at the time of publication, ICS- and FEMA IS- training courses are listed.  Equivalent courses must meet the NIMS National Standard Curriculum.
24 NHTSAs National EMS education standards are a component of the EMS Education Agenda for the Future: A System Approach, a comprehensive plan for a national EMS education system that will result in improved efficiency in the education process, enhanced consistency in the quality of the EMS education and greater competency of the entry level EMS provider.  EMR, EMT, and paramedic job titles should be expected to transition to these educational standards as they are implemented. 

25 The medical function may be initially established as a group and upgraded to a branch based on incident size or complexity.  
26 Per NIMS compliance at the time of publication, ICS- and FEMA IS- training courses are listed.  Equivalent courses must meet the NIMS National Standard Curriculum.
27 NHTSAs National EMS education standards are a component of the EMS Education Agenda for the Future: A System Approach, a comprehensive plan for a national EMS education system that will result in improved efficiency in the education process, enhanced consistency in the quality of the EMS education and greater competency of the entry level EMS provider.  EMR, EMT, and paramedic job titles should be expected to transition to these educational standards as they are implemented. 
28 The medical function may be initially established as a group and upgraded to a branch based on incident size or complexity.
 
29 Per NIMS compliance at the time of publication, ICS- and FEMA IS- training courses are listed.  Equivalent courses must meet the NIMS National Standard Curriculum.
30 NHTSAs National EMS education standards are a component of the EMS Education Agenda for the Future: A System Approach, a comprehensive plan for a national EMS education system that will result in improved efficiency in the education process, enhanced consistency in the quality of the EMS education and greater competency of the entry level EMS provider.  EMR, EMT, and paramedic job titles should be expected to transition to these educational standards as they are implemented. 

31 Per NIMS Compliance at the time of publication, ICS- and FEMA IS- training courses are listed.  Equivalent courses must meet the NIMS National Standard Curriculum.
32 Per NIMS compliance at the time of publication, ICS- and FEMA IS- training courses are listed.  Equivalent courses must meet the NIMS National Standard Curriculum.
33 NHTSAs National EMS education standards are a component of the EMS Education Agenda for the Future: A System Approach, a comprehensive plan for a national EMS education system that will result in improved efficiency in the education process, enhanced consistency in the quality of the EMS education, and greater competency of the entry level EMS provider.  EMR, EMT, and paramedic job titles should be expected to transition to these educational standards as they are implemented. 
34 Per NIMS compliance at the time of publication, ICS- and FEMA IS- training courses are listed.  Equivalent courses must meet the NIMS National Standard Curriculum.
35 NHTSAs National EMS education standards are a component of the EMS Education Agenda for the Future: A System Approach, a comprehensive plan for a national EMS education system that will result in improved efficiency in the education process, enhanced consistency in the quality of the EMS education and greater competency of the entry level EMS provider.  EMR, EMT, and paramedic job titles should be expected to transition to these educational standards as they are implemented. 

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Working Group Guidelines

DESIGNING A NATIONAL EMERGENCY RESPONDER CREDENTIALING SYSTEM

B-2

November 2005	DRAFT

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