Tragedy can strike any of us at anytime. Participants were asked to rate five perceived general challenges in implementing the sepsis protocol. The Google Translate Tool is displayed dynamically on Montgomery County web pages using a Google javascript function. The lukewarm support for sepsis alerts appears to extend to sepsis care in general as evidenced by 50% of EMS units lacking a thermometer, which is a necessity to evaluate for infection. In many respects, we have evolved into an "EMS-based fire department.". As of 2011, 38 states use the NREMT examination for EMT certification and 45 states use the NREMT examination for Paramedic certification. The Emergency Medical Services (EMS) Division provides emergency and non-emergency medical services to the citizens of Anne Arundel County. The data was limited to sepsis care within Maryland. Please indicate any additional training/education that has been provided to EMS clinicians in your jurisdiction, beyond the MIEMSS protocol update, regarding prehospital emergency care for sepsis. 2015 MD Protocol Study Guide Flashcards | Quizlet Implementation of a statewide system for coronary reperfusion for ST-segment elevation myocardial infarction. 4. UPMC Western Maryland Emergency Department Contact Information. 2023 Maryland Stars of Life and Right Care Awards. Should you choose to NOT be transported, you will be asked to sign a "Patient Refusal of Care Form" and there will be no charge to you or your insurance. 1) General lack of knowledge of sepsis 2) Non-specific signs and symptoms 3) Short transport times 4) Determining a suspected source of infection 5) Other, 16. The MCH Program is available at no charge to eligible residents of Frederick County, Maryland. Emergency Medical Services Division | Anne Arundel County, MD Hospital systems are responsible for vaccine administration to hospital-based healthcare workers. An Automated External Defibrillator allows minimally trained laypersons to treat victims of Sudden Cardiac Arrest (SCA). Age 6 months and older. A reminder email was sent to all jurisdictions on February 19th, 2020. An example of a Priority 2 call is a serious shots fired or officer in trouble/officer requires urgent assistance. Eight of fourteen jurisdictions (57%) somewhat agreed, agreed, or strongly agreed. The other option was selected twice. The majority (57%) of surveyed medical directors led agencies with a high population (>500,000 people). Update information when necessary. Although the protocols are statewide, oversight and implementation occur at the county level. Proceed without lights or siren. Paramedics that are assigned to the Mobile Community Healthcare Program are not your typical paramedic. response levels. Half a million people call the county home. Call our Call Center. "Code 1", "Code 2", "Code 4", and "Code 5" redirect here. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. People who have NOT received a link directly from Montgomery County, and who come to a County vaccination clinic, WILL be turned away. Prior to July 1, all EMS clini-cians must complete the Maryland EMS Update: 2021, which will highlight the new material. This study has several limitations. Providers certified before 2020 may still practice under current EMT-I (I/99) certification level, and renew it indefinitely with completion of CME hours each cycle. Managing group assignment rule priority levels | EMS Administration Guide JavaScript is required to use content on this page. Although the protocols are statewide, oversight and implementation occur at the county level. Any provider between the levels of Emergency medical technician and Paramedic is either a form of EMT-Intermediate or an Advanced EMT. The MCFRS prides itself on providing outstanding and rapid treatment and transport for patients suffering from time dependent medical emergencies such as heart attacks, strokes, traumatic injuries and cardiac arrests. i . Calls are graded by either the control room direct (in the case of emergency calls) or by some sort of first contact centre (nonemergency calls). Permission granted to disobey road rules. Moderately receptive or higher was selected by 79% of medical directors, with 57% answering very or extremely receptive. Please enable scripts and reload this page. Additionally, some agencies use "Code 99" or a derivative, which typically designates a major emergency of the highest priority. Next, they were asked how strongly they agreed with the statement sepsis alerting is a priority initiative in my jurisdiction. chest darts and pain management. Emergency: Life-threatening - Respond lights and sirens, Emergency:Non-life-threatening - Respond without lights and sirens, Non Emergency: Respond without lights and sirens. All EMS billing questions should be directed to Change Healthcare, (833) 812-0564 . At present time, use of the NREMT examination for EMT-Intermediate 85 and 99 have not been included in this list. Code 2: An acute but non-time critical response. Priority 9 is used for administration taskings. The protocol update is available for continuing education credit on the MIEMSS Online Training Center (www.emsonlinetraining.org). 1) Number of prehospital sepsis alerts 2) IV access initiation 3) IV fluid volume administered 4) Vasopressor administration 5) True positive (appropriate sepsis alert activation) 6) False positives (false activations) 7) Cases of failure to activate 8) Other, 11. Emergency or Non-Emergency. The EMS clinician is required to notify the receiving hospital of a SEPSIS ALERT if the patient meets sepsis criteria. The results of this study are novel in highlighting the complex situations facing Maryland medical directors. The majority (79%) of medical directors agree that access to core measures, such as the number of true or false positive sepsis alerts, is important to assess EMS clinician performance. sharing sensitive information, make sure youre on a federal for all emergency response providers, ensuring MCFRS compliance with the Health Insurance Portability and Accountability Act (HIPAA) and federal and state regulations, administering the majority of MCFRS legal obligations relating to the retention and disclosure of patient care and other operational reports and records, Captain Wes Shipley, Quality Assurance Officer, Captain Ty Dement, Assistant Quality Assurance Officer, Captain Jeffrey Kane, Assistant Quality Assurance Officer, Captain Nicholas Wagner, Quality Improvement Officer, Ms. Pilley Doe, RN, MIH Community Health Nurse, Ms. Jennifer Forester, LCSW-C Adult Protective Services Case Manager and MCFRS MIH Community Social Worker. If your answer was no, please select N/A. Maryland Institute for Emergency Medical Services Systems . JavaScript is disabled. Finally, some states have levels that have partially been phased out. PPT Hospital Patch and Documentation Practices for EMS - MFRI In many respects, we have evolved into an EMS-based fire department. The MCFRS prides itself on providing outstanding and rapid treatment and transport for patients suffering from time dependent medical emergencies such as heart attacks, strokes, traumatic injuries and cardiac arrests. This is the response for most calls, including bushfires and road crashes. A 17-question survey pertaining to EMS sepsis care was emailed to medical directors of all 24 EMS jurisdictions in Maryland (Appendix 1). maryland ems priority levels ***. Instead, the MCH Program works alongside of the patients healthcare team to ensure that existing care plans are properly implemented and maintained, and to provide additional support to the clinicians in the form of enhanced assessments and individualized, in-home patient care. Smyth MA, Brace-McDonnell SJ, Perkins GD. District Courts (Annapolis & Glen Burnie). If your Answer to the previous question was Yes, please indicate how this information is currently obtained from hospitals. and transmitted securely. Re-Route Alert The EMS System's access to a hospital's ED must be open, uncomplicated, and unrestrained. server. Progress through the tiers depends on the vaccine deliveries we receive from the State of Maryland and the federal government. Final Deadline: Friday, March 31, 2023. An example is a cardiac arrest or serious traffic accident. No lights or siren authorised and follow all traffic rules. An ongoing and increased commitment to sepsis care by EMS jurisdictions is required to continue to advance prehospital sepsis management. Is issued to Firefighters and Police Officers, usually after their P.O.S.T. It may not display this or other websites correctly. In many respects, we have evolved into an "EMS-based fire department.". The only things that I can think of are the hospital was a good 15-20 miles away on the other side of Charleston, it was the 70's and liability insure concerns were not as great, or somehow a break of the femur was considered a higher priority (I kind of doubt that last one). PDF Maryland Medical Protocols for EMS - 2021 - MIEMSS Nomination forms for the 2023 Annual Stars of Life and Right Care When It Counts Awards are open and available through the Smart Sheet application links. 5. EMS applies group assignment rules to endpoints only if the rules are enabled on the Endpoints > Group Assignment Rules page. In the list, each state's certification levels are provided from most basic at the top to most advanced at the bottom. Two participants did not answer. If refractory to fluids, an epinephrine drip is initiated. Surveyed medical directors (86%) believe the most difficult obstacle to overcome for EMS clinicians in the treatment of sepsis are nonspecific signs and symptoms. The State of Maryland pledges to provide constituents, businesses, customers, and Multiple Emergency Medical Services (EMS) agencies across the United States have implemented sepsis protocols. Trauma ByPass. 30.03.02.02 - Criteria for Approval as a Jurisdictional EMS Operational Program Clinician perception of the effectiveness of an automated early warning and response system for sepsis in an academic medical center. b) Priority 2 Less serious condition, requiring emergency medical Prince George'S County, Maryland Fire/Emergency Medical Services 1) >500,000 people 2) 250,000 to <500,000 people 3) 125,000 to <250,000 people 4) 75,000 to <125,000 people 5) <75,000 people. Create a Website Account - Manage notification subscriptions, save form progress and more. Other challenges that participants reported were initiating appropriate treatment when sepsis is suspected (29%) and notifying the receiving hospital that sepsis is suspected (21%). The denitions of each level of priority are described below: Priority 1Critically ill or injured person re- When a subscriber moves out of the area covered by Frederick County, the subscription is voided.7. resources. Code 2 - Immediate risk of serious injury to a person or damage to property. Free text answers were regarding the changing definitions of diagnosis, lack of lactate measurement, and no provisions for prehospital antibiotic administration. Types of high priority calls that benefit from audit include: Cardiac arrest; Priority trauma . Identification of sepsis by prehospital clinicians was seen as a challenge by 86% of medical directors due to non-specific signs and symptoms. Road rules must be obeyed. - Non-Emergency Basic Life Support transports . $320.00-Emergency Basic Life Support transports $420.00- Advanced Life Support, Level 1 transports . $600.00-Advanced Life Support, Level 2 transports . $700.00-Ground mileage of $10.00 will be charged per mile, from incident pick up to the closest medical facility. official website and that any information you provide is encrypted The patient level of acuity (priority level) used in this study is as-signed by the out-of-hospital provider. Baltimore County partners with Change Healthcare, a national management company, to handle billing and collection. Cardiovascular disease is the leading cause of death in Maryland, accounting for 171.4 deaths per 100,000 residents in 2011 (MD Vital Statistics Report, 2011). Department DirectoryBoards & CommissionsOther Entities, Anne Arundel County provides a wide array of services and programs for its Citizens, Businesses, and Visitors. This is similar to other time-sensitive diseases such as stroke or myocardial infarction [5-6]. And, emergency response capabilities remain available to serve our residents who are experiencing high priority emergency medical events. Implementing a Statewide Prehospital Sepsis Protocol: Perspectives of Code Regs. All available officers on radio frequencys respond. Johns Hopkins University School of Medicine issued approval IRB00235157. Yellow Alert. Includes populations unable to work from home and unable to control social distancing. PDF Reimbursement for New Models of EMS Care Delivery - December 2019 - MIEMSS A thermometer was not always present on EMS units in seven (50%) of jurisdictions, which was the most frequently cited challenge specifically within the Maryland sepsis protocol. If you have general questions or wish to speak to a telephone triage nurse, please call 240-964-8500. 826 0 obj <>/Filter/FlateDecode/ID[<14A3B7B69EE74C43B7DE8EC48E8AB4CB><728163265897A642A82A6339F620D37A>]/Index[806 55]/Info 805 0 R/Length 104/Prev 239704/Root 807 0 R/Size 861/Type/XRef/W[1 3 1]>>stream Typically, an Ambulance, Paramedic Ambulance or Medic . Walchok JG, Pirrallo RG, Furmanek D, et al. National Library of Medicine Code 3: Non-urgent event, such as a previously extinguished fire or community service cases (such as animal rescue or changing of smoke alarm batteries for the elderly). Maryland Institute for Emergency Medical Services Systems Proceed without lights or siren. Please indicate the size of the population served by your jurisdiction. In some states there are also EMS-RN's which is a Registered Nurse trained in Pre-Hospital response. These services will be delivered with a commitment to pride, equality, respect and integrity. The function is used to translate County web pages into different languages. Does your jurisdiction receive sepsis follow-up information/outcomes from the hospitals that your EMS clinicians routinely transport to? Please rate how receptive your front-line EMS clinicians have been to the implementation of the Sepsis Protocol. An official website of the United States government. Click here for more information or to subscribe. No jurisdictions disagreed or strongly disagreed. In order to respond 'code red' a driver must be suitably trained and have qualified in appropriate police driver training courses.[7]. Please note: Arizona is no longer certifying new EMT-Is. Code 3 - Routine job. Each state is free to add or subtract levels as each state sees fit. The Anne Arundel County Government consists of Departments and Offices as well as Boards & Commissions and other entities. Quality improvement is an integral part of emergency medicine practice and is a requirement under the Code of Maryland Regulations (COMAR). Normally used, examples of incidents graded as an immediate priority include incidents in which life is at risk, there is serious injury (or risk of), serious road traffic collisions, and where serious crime is in-progress or has just taken place. While states are able to set their own additional requirements for state certification, a quasi-national certification body exists in the form of the National Registry of Emergency Medical Technicians (NREMT). Each respondent was asked their opinion of the challenges facing EMS providers regarding prehospital sepsis care. Receptiveness of EMS clinicians and leadership. The Emergency Medical Services (EMS) Division provides emergency and non-emergency medical services to the citizens of Anne Arundel County. Emergency medical responder levels by U.S. state. also use their own response codes; for example, Code 3 may be called a Hot Response, and Code 1 may be called a Cold Response. Emergency service response codes - Wikipedia 1) Access via CRISP 2) Direct liaison from hospital 3) Other, 13. There is increasing recognition of the potential impact that EMS has on early identification of septic patients [4]. The MD Medical Protocols for Emergency Medical Services Providers. We remain firmly committed to this aspect of our EMIHS program. State regulations are updated quarterly; we currently have two versions available. The challenge that received the highest average rating was engagement of field personnel with a rating of 64. Although every jurisdiction reported that there is some form of additional training or education regarding prehospital sepsis care, only 64% believed that EMS clinicians have received adequate training. Short transport times (57%), general lack of sepsis knowledge (36%), and determining a source of infection (36%) also presented difficulties. Recognizing the success of these interventions, Marylands State EMS agency, Maryland Institute of Emergency Medical Services (MIEMSS), approved a statewide sepsis protocol in 2016. Regarding training on sepsis, nine of fourteen jurisdictions (64%) agreed that EMS providers have had adequate training, two out of the fourteen jurisdictions (14%) neither agreed nor disagreed, and three jurisdictions (21%) indicated that EMS providers were inadequately trained. Prehospital sepsis protocols have been implemented by EMS systems across the country to initiate treatment in the field and expedite physician evaluation upon arrival to the emergency department [7-9]. This operations centre is manned by volunteers routing calls for assistance to the closest unit who will dispatch the events to individual teams. Additional investment and dedication to sepsis care will advance prehospital sepsis treatment in Maryland. Participants were asked how important prehospital activation of sepsis alerts are for patient care, and 29% described it as important, 43% neutral, and 29% felt that it was not important. Please rate the following challenges you have faced in implementing the Sepsis Protocol in your jurisdiction with 0 being not a challenge, and 100 being the greatest challenge, or N/A if not a challenge. Behavioral Health Services and Family Support, Title VI Nondiscrimination Plan Information. Prehospital sepsis care was viewed to be important amongst the medical directors surveyed. Laura Stokes EMS Billing Specialist Email Ph: 301-600-1644 FAQs . . A call requiring the use of lights and sirens is often colloquially known as a blue light run. ", "ARKANSAS STATE BOARD OF HEALTH SECTION OF EMERGENCY MEDICAL SERVICES: RULES AND REGULATIONS FOR EMERGENCY MEDICAL SERVICES", "ARKANSAS STATE BOARD OF HEALTH SECTION OF EMERGENCY MEDICAL SERVICES: SCOPE OF PRACTICE", "EMS Statues, Regulations, and Legislation", "Emergency medical responder (EMR) registration | Department of Public Health and Environment", "Intravenous Therapy And Medication Administration Course Curriculum", "Rules Pertaining to EMS Practice and Medical Director Oversity", "EMS Provider Certification Frequently Asked Questions", "Emergency Medical Services - Licensure/Certification/Exams", "Georgia Office of EMS Course Approval-Initial Education for Licensure", "Certifying Emergency Medical Service Personnel", "Idaho Emergency Medical Services Bureau", "Emergency Medical System and Highway Safety", "Iowa EMT-Paramedic to Paramedic Specialist Transition Application", "EMS Personnel Information Frequently Asked Questions (FAQ)", "EMT and Paramedic Licensing Information", "Certification for Out-of-Hospital Providers", "New Hampshire EMS Provider License Application", "Mobility Assistance Vehicle and Basic Life Support Ambulance Services", "Advanced Life Support Services; Mobile Intensive Care Programs, Specialty Care Transport Services and Air Medical Services", "Emergency Medical Technicians-Paramedic: Training and certification", "Emergency Medical Services Statistical Information", "NC DHSR OEMS: Credentialing and Compliance", "Training, Testing and Certification Requirements", "Welcome to EMT Educational Requirements", "Emergency Medical Services Regulations 216-RICR-20-10-2", "South Dakota Basic Life Support SCOPE of PRACTICE", "South Dakota Scope of Practice Guide for Advanced Life Support Personnel - EMT I/85, EMT-A, EMT I/99, EMT-P", "Critical Care Paramedic Standardized Modules and Objectives", "Requirements for initial certification/licensure", "Vermont Statewide Emergency Medical Services Protocols", "Transitioning to the new National EMS Scope of Practice and Education Standards", International Federation for Emergency Medicine, International Conference on Emergency Medicine, Australasian College for Emergency Medicine, Canadian Association of Emergency Physicians, Care of the Critically Ill Surgical Patient, https://en.wikipedia.org/w/index.php?title=Emergency_medical_responder_levels_by_U.S._state&oldid=1146297270, Emergency medical services in the United States, Creative Commons Attribution-ShareAlike License 3.0, Advanced Emergency Medical Technician (AEMT), Emergency Medical Technician Intermediate (EMT-I) **(Alabama is no longer certifying new EMT-Is (as of 2003). 1) STEMI 2) Stroke 3) Cardiac Arrest 4) Sepsis 5) Opioid Epidemic/Naloxone 6) Mobile Integrated Community Health 7) Active Shooter Preparedness 8) Other, 7. Consent was obtained by all participants in this study. This code is rarely used for initial responders, but is given to further appliances if the incident doesn't require immediate assistance. fraud hotline to receive allegations of This analysis revealed that medical directors must balance multiple competing high-priority initiatives as well as several logistical, operational,and human factors. https://www.montgomerycountymd.gov/covid19/vaccine/, * Long-Term Care Facilities staff & residents, * Developmental Disability Administration group homes, Vaccinators (Local Heath Departments, school nurse, etc. Google is aware of this issue. More than half (57%) stated sepsis alerting was a priority in their jurisdiction; however, in a listing of eight initiatives, sepsis was the least prioritized. %PDF-1.7 % transport for seniors and persons with disabilities), Education sector (teachers & support staff), Adults 16(18)-64 years old with medical conditions, Immunocompromised conditions (from blood or bone marrow transplant, immune deficiencies, HIV, prolonged use of corticosteroids or other immunosuppressive medication), Essential workers not previously in Phase 1A or Phase 1B, Legal (states attorneys, public defenders, judiciary), Public health workers non-COVID response, Social & Human Services (Aging, DSS, Human Services) field/in-home services, Continuity of government (elected officials). The other option was selected twice. More comparison features will be added as we have more versions to compare. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. KEY GOALS Provide high quality medical care to individuals receiving emergency medical services. In the United States, response codes are used to describe a mode of response for an emergency unit responding to a call. Road traffic exemptions may be utilised along with audible and visual warning equipment. Even though primary management and regulation of prehospital providers is at the state level, the federal government does have a model scope of practice including minimum skills for EMRs, EMTs, Advanced EMTs and Paramedics set through the National Highway Traffic Safety Administration (NHTSA).[1]. You are using an out of date browser. 999 calls to the ambulance service are triaged using either the NHS Pathways system or the Medical Priority Dispatch System. Maryland Code of Regulations; Title 30 - MARYLAND INSTITUTE FOR EMERGENCY MEDICAL SERVICES SYSTEMS (MIEMSS) Subtitle 03 - EMS OPERATIONAL PROGRAMS; Chapter 30.03.02 - Jurisdictional EMS Operational Programs; Md. Emergency Services Board | Kent County Maryland The ambulance does not use lights and sirens to respond. The term downgrade may be used in the opposite situation. Pharmacy Resident Rotation - University of Maryland School of Medicine ), AEMT (Advanced Emergency Medical Technician), EMT-Intermediate (Emergency Medical Technical Intermediate), TEMS (Tactical Emergency Medical Service Endorsement) Primarily for SWAT teams, AEMT (Advanced Emergency Medical Technician, IEMT (Intermediate Emergency Medical Technician), This page was last edited on 24 March 2023, at 00:44. Emergency Medical Services - Frederick County MD Anne Arundel County established a charter form of governmentin 1964. Some emergency medical services use "Priority" instead: The National Incident Management System (NIMS) states "it is required that plain language be used for multi-agency, multi-jurisdiction and multi-discipline events, such as major disasters and exercises", and federal grants became contingent on this beginning fiscal year 2006. 1) Suspected source of infection not defined well enough in protocols 2) Thermometer not always available on EMS units 3) Notification to hospital when sepsis is suspected 4) Initiation of appropriate treatment when sepsis is suspected 5) Other, 15. Kumar A, Roberts D, Wood KE, et al. Emergency Medical Responder (Not recognized by the Arkansas Department of Health, certification issued by local EMS Authorities and/or the Arkansas Fire Training Academy), Public Safety (Acts as EMR but is separate from the NREMT Certification for it. Region I (Allegany and Garret counties) had a 0% response rate, Region II (Frederick and Washington counties) had a 50% response rate, Region III (Anne Arundel, Baltimore City, Baltimore County, Carroll, Harford, and Howard counties) had a 100% response rate, Region IV (Caroline, Cecil, Dorchester, Kent, Queen Annes, Somerset, Talbot, Wicomico, and Worcester counties) had a 44% response rate, and Region V (Calvert, Charles, Montgomery, Prince Georges, and St. Marys counties) had a 60% response rate. As outlined in the Maryland Medical No jurisdictions disagreed with the statement. We respect your privacy, and our staff adheres to, and is committed to following strict policies of confidentiality with regard to patient healthcare information. Please rate how receptive your organization's leadership have been to the implementation of the Sepsis Protocol. The questionnaire was created using Qualtrics XM (Qualtrics; Provo, Utah, USA). hotline in the past has helped to eliminate The answer options were from 0 to 100 with 100 being the greatest challenge. Sepsis core measures are new, established in 2015 [11], and are not as widely reported. Guidi JL, Clark K, Upton MT, et al. Mobile Community Health. A subset of frontline essential workers has the highest risk for potential exposure as they are unable to work from home or control social distancing. Difficulties in assessing the performance of EMS clinicians was noted to be a challenge to implementing the protocol for 71% of respondents. The authors have declared that no competing interests exist. ), EMT- IV (Intravenous Therapy certification), Critical Care Endorsement to Paramedic level certification, EMT-Intermediate/85 (no new licenses granted), Cardiac Technician (no new licenses granted since 1998, similar to the NREMT-I/99), Paramedic (at least 504 classroom hours plus 320 clinical hours), Paramedi (also known as Mobile Intensive Care Technician or MICT), Advanced Emergency Medical Technician-85 (AEMT-85) (No new licenses granted), Advanced Emergency Medical Technician-2011, EMT-Intermediate (analogous to EMT-Intermediate/85), EMT-Paramedic (analogous to EMT-Intermediate/99), Paramedic Specialist (analogous to EMT-Paramedic), Critical Care Paramedic Endorsement for Paramedic, Critical Care Paramedic Endorsement for Paramedic level certification, Emergency Medical Responder (EMR) - Formerly known as First Responder, Emergency Medical Technician-Basic (EMT-B), Cardiac Rescue Technician-Intermediate* (CRT-I) (analogous to EMT Intermediate/99), Emergency Medical Responder (EMR) (Also Medical First Responder), Emergency Medical Technician (EMT) (formerly EMT - Basic), Advanced Emergency Medical Technician (AEMT) (analogous to EMT-Intermediate/85), EMT-Intermediate/99 (no new licenses granted at this level since 2002, however previous holders can continue to renew theirs), AEMT-Intermediate (No new certifications granted, will now be replaced with AEMT), EMT (analogous to EMT-Basic; only used for providers under the age of 18 and providers requesting reciprocity from another state), Emergency Medical Responder (EMR)(National Curriculum), Paramedic (National Curriculum) (requires a college degree), Emergency Medical Services Vehicle Operator (EMSVO), EMS-Instructor (EMS-I) (Additional endorsement), Advanced Emergency Medical Technician Cardiac (AEMT-C) (State Specific), Emergency Medical Technician - Intermediate/85, Emergency Medical Technician - Intermediate/99, Critical Care Paramedic (now officially endorsed by the state), Licensed Paramedic (*Degree Requirement* Requires either an Associates Degree in EMS -OR- a Bachelors Degree in any field.

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