State of California Title 22, Division 9:Prehospital Emergency Medical Services,Regulations in Effect as of July 1, 2021

State of California

Title 22, Division 9:Prehospital

Emergency Medical Servises

Regulations in Effect as of

July 1, 2021

Emergency Medical Services Authority

Health and Human Services Agency

Regulations in Effect as of July 1, 2021 ● I

Gavin Newsom

Governor

State of California

Mark Ghaly MD, MPH

Secretary

Health and Human Services Agency

Dave Duncan MD

Director

Emergency Medical Services Authority

Updated July 2021

www.emsa.ca.gov

The attached compilation of EMS Regulations (Title 22. Social Security,

Division 9. Prehospital Emergency Medical Services) has been updated for

your convenience to include recent regulatory changes. Although every

effort has been made to ensure that this document is accurate and

complete, no guarantee is being made or implied.

An electronic version of this document is available on our website. While

visiting our website, please be sure to sign up for the “EMSA Dispatch”

electronic newsletter and connect to EMSA on Facebook, Twitter and

YouTube.

Regulations in Effect as of July 1, 2021 ● II

A quick look at the

California EMS Authority

State Emergency Medical Services

The Emergency Medical Services Authority (EMSA) was created in 1980 to

provide leadership in developing EMS systems throughout California and to

develop standards for training and scope of practice for EMS personnel.

Prior to 1980, California did not have a central state agency responsible for

ensuring the development and coordination of EMS services and programs

statewide.

Although the many stakeholders in EMS, including local administrators, fire

agencies, ambulance companies, hospitals, physicians, nurses, and other

health care providers did not agree on all issues, there was a consensus

that a more unified approach was needed to emergency and disaster

medical services.

After several years of effort by the EMS constituents to establish a state

lead agency, in 1980 Governor Jerry Brown signed into law the Emergency

Medical Services System and Prehospital Emergency Care Personnel Act

(SB 125) creating the Emergency Medical Services Authority and adding

Division 2.5 to the Health and Safety Code (sections 1797-1799).

The mission of EMSA is to prevent injuries, reduce suffering, and save lives

by developing standards for and administering an effective statewide

coordinated system of quality emergency medical care and disaster medical

response that integrates public health, public safety, and healthcare.

Our vision encompasses strong internal and external working relationships

that promote public trust and quality patient care. Emergency and disaster

medical services in California are rooted in the skills and commitment of the

first responders, EMTs, nurses, physicians, and administrators who deliver

care to the public and operate the system. In order for high quality services

to be delivered efficiently, all aspects of EMS systems must work together,

mutually reinforcing and supporting each other for the benefit of the patient.

The California EMS Authority plays a central role in improving the quality of

emergency medical services available for all Californians by setting

standards, building consensus, and providing leadership. EMSA is

organized into the following three divisions:

• The EMS Personnel Standards Division develops and implements

regulations for training, certification, licensing and scope of practice

for emergency medical personnel, including emergency medical

technician, advanced EMT, paramedic, firefighter, peace officer and

lifeguard. They license, investigate and discipline paramedics

Regulations in Effect as of July 1, 2021 ● III

statewide for civil and criminal violations of the California Health and

Safety Code. They also approve first aid and CPR training programs

that are required for child care providers and school bus drivers. In

addition, they approve epinephrine auto injector training programs

for the general public and EMT training programs run by statewide

safety agencies.

• The EMS Systems Division provides statewide coordination and

leadership for the planning, development, implementation, and

evaluation of the local EMS systems, the statewide trauma system,

and the California Poison Control System. They establish

regulations and guidelines and review local EMS plans and

programs to ensure they meet minimum standards. This division

also manages EMS data collection, trauma system data collection,

quality assurance, dispatch and communication standards, and

provides statewide coordination of Stroke, STEMI, and EMS for

Children programs.

• The Disaster Medical Services Division fulfills EMSA’s role as the

lead agency responsible for coordinating California’s medical

response to disasters. The Division organizes a statewide network

to provide medical resources to local governments in support of

their disaster response. This may include the identification,

acquisition and deployment of medical supplies, personnel and

mobile medical assets from unaffected regions of the state to meet

the needs of disaster victims.

While day-to-day management of California’s EMS system is the statutory

responsibility of the counties, through the local EMS agencies, EMSA’s job

is to coordinate the system statewide. In addition to establishing standards

through regulation, here are a few

examples of the important work

EMSA does on behalf of Californians

to support the EMS system:

 Paramedic Licensure and

Enforcement: EMSA licenses

more than 23,000 paramedics

statewide. The enforcement unit

also investigates actions by

paramedics that may be violations of the professional and ethical

standards for paramedics in the Health and Safety Code and take

licensure action when necessary to protect the public.

 EMS Personnel Registry: EMSA operates the statewide EMS

Personnel Central Registry - an online database containing

certification/licensure status of every EMT, Advanced EMT and

Regulations in Effect as of July 1, 2021 ● IV

Paramedic in the state. The system has enabled certification in one

county to be verified throughout the state. The website receives more

than 4,300 inquiries about individual providers each week.

 First Aid, CPR and Epinephrine Regulations and Training: EMSA

oversees first aid and CPR training for 80,000 child care providers and

school bus drivers. In addition, EMSA administers layperson

epinephrine auto-injector certification and regulates programs that

provide epinephrine auto-injector training.

 Mobile Medical Assets: EMSA has 42 Disaster Medical Support Units

(DMSU) filled with medical supplies and equipment strategically placed

throughout the state that are ready to re-supply ambulance strike teams

in the event that the local EMS resources are overwhelmed. In addition,

EMSA coordinates the California Medical Assistance Team (CAL-MAT)

program. CAL-MATs are scalable teams of volunteer medical

professionals capable of responding to a disaster anywhere in the state

within 12-14 hours of activation. EMSA also coordinates the Mission

Support Team (MST) program. The MST provides oversight and

logistical support for state deployed medical teams. EMSA maintains

trucks, trailers, supplies & equipment caches to support the mobile

medical assets, including communications equipment and a command

control and communications vehicle. EMSA also maintains mobile

medical tent structures that can be deployed to support medical surge

and sheltering operations during disasters.

 California Poison Control System: EMSA supports and oversees the

statewide system that provides free, immediate answers to poisoning

questions twenty-four (24) hours a day via telephone at 1-800-222-

1222. The California Poison Control System receives more than

300,000 calls per year.

 Emergency Medical Services for Children: EMSA using a grant from

the Maternal and Child Health Bureau, U.S. Department of Health and

Human Services, and with the assistance of subcommittees of experts

in various aspects of pediatric care, has developed guidelines,

standards, and key products that make up a comprehensive model for

emergency medical services for children (EMSC).

 California Emergency Medical Services Information System

(CEMSIS): In cooperation with the National EMS Information System,

EMSA administers a statewide system to collect prehospital and trauma

center data. The information is used to support local quality

improvement and participate in national data collection efforts.

Regulations in Effect as of July 1, 2021 ● V

 Disaster Healthcare

Personnel: More than 94,000

healthcare professionals from

dozens of medical specialties

have registered with California’s

Disaster Healthcare Volunteers

(DHV) program so that when

disaster strikes, they can be

mobilized to help. The DHV

system allows EMSA to

automatically verify credentials for 49 different professions. In addition,

EMSA coordinates 430 Medical Reserve Corps units which are local

teams of trained volunteers that are integrated into the DHV program.

 Stroke and STEMI: EMSA staff participated in a Stroke Work Group

and ST-Myocardial Infarction (STEMI) Work Group, both co-convened

by the American Heart & Stroke Association and the California

Department of Public Health, Stroke & STEMI Prevention Program. The

work group developed Stroke and STEMI guidelines which informed

STEMI and Stroke regulations adopted by the Authority.

 Trauma System Coordination: EMSA provides statewide coordination

and leadership for the planning, development, and implementation of a

State Trauma Plan. EMSA responsibilities also include the development

of regulations for local trauma care systems and trauma centers, the

provision of technical assistance to LEMSAs developing, implementing,

or evaluating components of a local

trauma care system, and the review and

approval of local Trauma Plans to ensure

compliance with the Health and Safety

Code and the California Code of

Regulations.

 Scope of Practice: EMSA approves the

scope of practice for EMS providers and

designates training and care for

specialized paramedics who serve on a

tactical law enforcement team, on a helicopter or fixed-wing aircraft, or

on a search and rescue team.

 Local EMS Agency Systems Plans Review: EMSA reviews EMS

plans from local EMS agencies to ensure they meet the requirements of

the Health and Safety Code and California Code of Regulations, and

provide a coordinated system of emergency medical care. This includes

evaluation of the ambulance zones.

Regulations in Effect as of July 1, 2021 ● VI

CALIFORNIA CODE OF REGULATIONS

Title 22: Social Security

Division 9: Prehospital Emergency Medical Services

Chapter 1. Emergency Medical Services Authority and Commission on

Emergency Medical Services - Conflict of Interest Code.........................1

Chapter 1.1: Training Standards for Child Care Providers ......................3

Article 1: Definitions ...............................................................................3

Article 2: Training Requirements for Child Care Providers....................7

Article 3: Training Program Approval.....................................................7

Article 4: Training Program Director and Instructor Requirements........9

Article 5: Course Hours and Class Requirements ...............................14

Article 6: Class Rosters, Course Completion Documents and Stickers

.............................................................................................................21

Article 7: Fees ......................................................................................22

Chapter 1.2: First Aid Testing for School Bus Drivers...........................24

Article 1: Definitions .............................................................................24

Article 2: General .................................................................................24

Article 3: Examination Standards.........................................................24

Chapter 1.5: First Aid and CPR Standards and Training for Public

Safety Personnel ........................................................................................26

Article 1: Definitions .............................................................................26

Article 2: General Training Provisions .................................................28

Article 3: Public Safety First Aid and CPR Training Standards ...........29

Article 4: Public Safety First Aid and CPR Course Approval

Requirements.......................................................................................44

Chapter 1.9: Lay Rescuer Epinephrine Auto-Injector Training

Certification Standards..............................................................................50

Article 1: Definitions .............................................................................50

Article 2: Certification Requirements ...................................................52

Article 3: Training Program Requirements ..........................................54

Article 4: Fees ......................................................................................60

Chapter 2: Emergency Medical Technician .............................................61

Article 1: Definitions .............................................................................61

Article 2: General Provisions ...............................................................64

Article 3: Program Requirements for EMT Training Programs............77

Article 4: EMT Certification ..................................................................93

Article 5: Maintaining EMT Certification...............................................95

Article 6: Record Keeping and Fees..................................................102

Chapter 3: Advanced Emergency Medical Technician.........................103

Art

icle 1: Definitions ...........................................................................

103

Art

icle 2: General Provisions .............................................................105

Article 3: Program Requirements for Advanced EMT Training

Programs ...........................................................................................112

Article 4: Certification .........................................................................123

Article 5: Operational Requirements..................................................131

Regulations in Effect as of July 1, 2021 ● VII

Article 6: Record Keeping and Fees..................................................135

Chapter 4: Emergency Medical Technician-Paramedic ....................... 138

Article 1: Definitions........................................................................... 138

Article 2: General Provisions ............................................................. 141

Article 3: Program Requirements for Paramedic Training Programs 149

Article 4: Applications and Examinations ..........................................184

Article 5: Licensure ............................................................................ 191

Article 6: License Renewals, License Audit Renewals and License

Reinstatements.................................................................................. 197

Article 7: System Requirements ........................................................ 201

Article 8: Record Keeping and Fees..................................................206

Article 9: Discipline and Reinstatement of License ...........................210

Chapter 6: Process for EMT and Advanced EMT Disciplinary Action

...........................................................................Error! Bookmark not defined.

Article 1: Definitions........................................................................... 215

Article 2: General Provisions ............................................................. 217

Article 3: Evaluation and Investigation .............................................. 222

Article 4: Determination and Notification of Action ............................ 223

Article 5: Local Responsibilities .........................................................229

Chapter 7: Trauma Care Systems .......................................................... 231

Article 1: Definitions........................................................................... 231

Article 2: Local EMS Agency Trauma System Requirements ........... 235

Article 3: Trauma Center Requirements ............................................242

Article 4: Quality Improvement ..........................................................267

Article 5: Transfer of Trauma Patients............................................... 268

Chapter 7.1: ST-Elevation Myocardial Infarction Critical Care System

................................................................................................................... 269

Article 1: Definitions........................................................................... 269

Article 2: Local EMS Agency STEMI Critical Care System

Requirements .................................................................................... 273

Article 3: Prehospital STEMI Critical Care System Requirements .... 275

Article 4: STEMI Critical Care Facility Requirements ........................276

Article 5: Data Management, Quality Improvement and Evaluations 278

Chapter 7.2: Stroke Critical Care System .............................................. 282

Article 1: Definitions........................................................................... 282

Article 2: Local EMS Agency Stroke Critical Care System

Requirements .................................................................................... 286

Article 3: Prehospital Stroke Critical Care System Requirements..... 288

Article 4: Hospital Stroke Care Requirements and Evaluations ........ 289

Article 5: Data Management, Quality Improvement and Evaluation.. 297

Chapter 8: Prehospital EMS Aircraft Regulations ................................299

Article 1: Definitions........................................................................... 299

Article 2: General Provisions ............................................................. 302

Article 3: Personnel ........................................................................... 304

Article 4: System Operation............................................................... 305

Article 5: Equipment and Supplies, Aircraft Specifications................306

Chapter 9: Poison Control Center Regulations .................................... 308

Regulations in Effect as of July 1, 2021 ● VIII

Article 1: Definitions ...........................................................................308

Article 2: General Provisions .............................................................309

Article 3: Designation Process...........................................................314

Chapter 10: California EMT Central Registry ........................................318

Article 1: Definitions ...........................................................................318

Article 2: General Provisions .............................................................319

Article 3: Central Registry Data Requirements..................................323

Article 4: Background Checks for EMT and Advanced EMT.............326

Chapter 11: EMS Continuing Education ................................................329

Article 1: Definitions ...........................................................................329

Article 2: Approved Continuing Education .........................................332

Article 3: Continuing Education Records ...........................................334

Article 4: CE Provider Approval Process ...........................................335

Article 5: CE Provider Denial/Disapproval Process ...........................336

Article 6: CE Providers for EMS Personnel .......................................337

Chapter 12: EMS System Quality Improvement ....................................342

Article 1: Definitions ...........................................................................342

Article 2: EMS Service Provider.........................................................342

Article 3: Paramedic Base Hospital ...................................................344

Article 4: Local EMS Agency .............................................................345

Article 5: EMS Authority.....................................................................346

Chapter 13: EMS System Regulations ...................................................348

Chapter 14: Emergency Medical Services for Children .......................350

Article 1: Definitions ...........................................................................350

Article 2: Local EMS Agency EMSC Program Requirements ...........353

Article 3: Pediatric Receiving Centers ...............................................356

Article 4: Data Management, Quality Improvement and Evaluations 365

California Commission on EMS..............................................................368

EMS Statutes Outside of the EMS Act ...................................................369

California Health and Safety Code..........................................................369

Index of EMSA Publications and Guidelines.........................................372

Local EMS Agencies ................................................................................373

Multi-County EMS Agencies....................................................................375

Map of California’s Local EMS Agencies ...............................................376

Statutes in Effect as of January 1, 2020 ● 1

CHAP

TER 1. Emergency Medical Services Authority and Commission

on Emergency Medical Services - Conflict of Interest Code

The Political Reform Act, Government Code Sections 81000, et seg.,

requires state and local government agencies and commissions to adopt

and promulgate Conflict of lnterest Codes. The Fair Political Practices

Commission has adopted a regulation, 2 Cal Code of Regulations Section

18730, which contains the terms of a standard Conflict of Interest Code,

which can be incorporated by reference, and which may be amended by the

Fair Political Practices Commission to conform to amendments in the

Political Reform Act after public notice and hearings. Therefore, the terms of

Cal Code of Regulations Section 18730 and any amendments to it duly

adopted by the Fair Political Practices Commission, along with the attached

Appendix in which officials and employees are designated and disclosure

categories are set forth, are hereby incorporated by reference and constitute

the Conflict of Interest Code of the State Emergency Medical Services

Authority and the Commission on Emergency Medical Services.

Designated employees and Commission members shall file statements of

economic interests with the Authority. Upon receipt of the statements of the

Director of Emergency Medical Services Authority and the Commission

Members, the Authority shall make and retain a copy and forward the

original of these statements to the Fair Political Practices Commission.

STATE EMS AUTHORITY AND EMS COMMISSION MEMBERS

Designated Positions

Disclosure Categories

Commission Members

1, 2, 3

Director, EMSA

1, 2, 3, 4

Chief Deputy Director

1, 2, 3, 4

Consultants

1, 2, 3, 4

With respect to Consultants, the Director may determine in writing that a

particular consultant is hired to perform a range of duties that are limited in

scope and thus is not required to comply with the disclosure requirements

described in these categories. Such description shall include a description of

the consultant's duties and, based upon that description, a statement of the

extent of disclosure requirements. The Director shall forward a copy of this

determination to the Fair Political Practices Commission. Nothing herein

excuses any such consultant from any other provision of this Conflict of

Interest Code.

Category 1

Designated employees in this category shall disclose investments in,

Regulations in Effect as of July 1, 2021 ● 2

income from, and business positions with any business entity or non-profit

corporation which:

(a) Provides emergency medical services including, but not limited to

hospitals, medical clinics, laboratories, pharmacies and ambulance

companies;

(b) Manufactures, sells, or distributes medical equipment, supplies or

services;

medical services programs; or,

(d) Provides consulting services for the planning or provision of emergency

medical services.

Category 2

Designated employees in this category shall disclose investments in,

income from, and business positions with any business entity or for-profit

corporation of the type which provides goods or services to the EMS

Authority.

Category 3

Designated employees in this category shall disclose investments in and

sources of income from business entities of the type providing training for

persons engaged in Emergency Medical Services programs.

Category 4

Designated employees in this category shall disclose investments in and

sources of income from business entities of the type which provide goods or

services to the EMS Authority.

Regulations in Effect as of July 1, 2021 ● 3

CHAP

TER 1.1. Training Standards for Child Care Providers

ARTICLE 1: Definitions

§ 100000.1. Child.

“

Child” means a person who is under 18 years of age who is being provided

care and supervision in a child care facility.

Note: Authority cited: Sections 1797.107 and 1797.191, Health and Safety

Code. Reference: Sections 1596.750, 1596.866 and 1797.191, Health and

Safety Code.

§ 10

0000.2. Child Care Facility.

“

Child care facility” means a facility which provides nonmedical care to

children under 18 years of age in need of personal services, supervision, or

assistance essential for sustaining the activities of daily living or for the

protection of the individual on less than a 24-hour basis. Child care facility

includes child care centers and family child care homes.

Note: Authority cited: Sections 1797.107 and 1797.191, Health and Safety

Code. Reference: Sections 1596.750, 1596.866 and 1797.191, Health and

Safety Code.

§ 100000.3. Child Care Center.

“

Child care center” means any child care facility other than a family child

care home, and includes infant centers, preschools, and extended child care

facilities.

Note: Authority cited: Sections 1797.107 and 1797.191, Health and Safety

Code. Reference: Sections 1596.750, 1596.866 and 1797.191, Health and

Safety Code.

§ 10

0000.4. Family Child Care Home.

“

Family Child Care Home” means a home which regularly provides care,

protection, and supervision of 14 or fewer children, in the provider's own

home, for periods of less than 24 hours per day, while the parents or

guardians are away, and includes the following:

(a) “Large family child care home” means a home that provides family child

care for 7 to 14 children, inclusive, including children under the age of 10

years who reside at the home, as set forth in Section 1597.465 of the Health

and Safety Code and as defined in Chapter 3 of Division 12 of Title 22 of the

California Code of Regulations.

Regulations in Effect as of July 1, 2021 ● 4

(b) “Small family child care home” means a home that provides family child

care to eight or fewer children, including children under the age of 10 years

who reside at the home, as set forth in Section 1597.44 of the Health and

Safety Code and as defined in Chapter 3 of Division 12 of Title 22 of the

California Code of Regulations.

Note: Authority cited: Sections 1797.107 and 1797.191, Health and Safety

Code. Reference: Sections 1596.78, 1596.866, 1597.44, 1597.465 and

1797.191, Health and Safety Code.

§ 100000.5. Child Care Provider.

“Child care provider” means a person who provides care to children in a

child care facility that is licensed pursuant to Chapter 3.5 (commencing with

Section 1596.90) or Chapter 3.6 (commencing with Section 1597.30) of the

Health and Safety Code.

Note: Authority cited: Sections 1797.107 and 1797.191, Health and Safety

Code. Reference: Sections 1596.791, 1596.90, 1597.30 and 1596.866,

Health and Safety Code.

§ 100000.6. Training Program.

“Training program” means a program that applies to the Emergency Medical

Services Authority (EMS Authority) for review and approval of its child care

pediatric first aid, CPR, and/or preventive health and safety training

program.

Note: Authority cited: Sections 1797.107 and 1797.191, Health and Safety

Code. Reference: Sections 1596.791, 1596.90, 1596.866 and 1597.30,

Health and Safety Code.

§ 100000.7. Approved Training Program.

“Approved training program, or approved program”, means a training

program that is approved by the EMS Authority to provide pediatric first aid,

CPR, and/or preventive health and safety training to child care providers.

Note: Authority cited: Sections 1797.107 and 1797.191, Health and Safety

Code. Reference: Sections 1596.90, 1596.791, 1596.866 and 1597.30,

Health and Safety Code.

§ 100000.8. Affiliate Program.

“Affiliate program” means the training program that provides an approved

child care pediatric first aid, CPR, or preventive health and safety training

Regulations in Effect as of July 1, 2021 ● 5

because of its association with a training program approved by the EMS

Authority.

Note: Authority cited: Sections 1797.107 and 1797.191, Health and Safety

Code. Reference: Sections 1596.791, 1596.90, 1596.866 and 1597.30,

Health and Safety Code.

§ 100000.9. Training Program Director.

“Training program director” means the person who is named in the EMS

Authority review and approval application as being the director of a pediatric

first aid, CPR and/or preventive health and safety training program. This

person is responsible for the administration of the child care pediatric first

aid, CPR or preventive health and safety training program that has been

approved by the EMS Authority.

Note: Authority cited: Sections 1797.107 and 1797.191, Health and Safety

Code. Reference: Sections 1596.791, 1596.90, 1596.866 and 1597.30,

Health and Safety Code.

§ 100000.10. Training Program Instructor.

“Training program instructor” means a person who teaches the approved

child care pediatric first aid, CPR, or preventive health and safety training to

child care providers, pursuant to the Health and Safety Code Section

1596.866.

Note: Authority cited: Sections 1797.107 and 1797.191, Health and Safety

Code. Reference: Sections 1596.791, 1596.90, 1596.866 and 1597.30,

Health and Safety Code.

§ 100000.11. Pediatric First Aid.

“Pediatric first aid” means the recognition of, and immediate care for injury

or sudden illness, including medical emergencies, to an infant or child, prior

to the availability of medical care by licensed or certified health care

professionals.

Note: Authority cited: Sections 1797.107 and 1797.191, Health and Safety

Code. Reference: Sections 1596.866 and 1797.191, Health and Safety

Code.

§ 100000.12. Pediatric Cardiopulmonary Resuscitation.

“Pediatric cardiopulmonary resuscitation” or “pediatric CPR” means

establishing and maintaining, on an infant or child, an open airway, ensuring

adequate respiration either spontaneously or by use of rescue breathing,

Regulations in Effect as of July 1, 2021 ● 6

and ensuring adequate circulation either spontaneously or by means of

closed chest cardiac compression. Pediatric CPR includes adult CPR for

purposes of children over eight years of age.

Note: Authority cited: Sections 1797.107 and 1797.191, Health and Safety

Code. Reference: Section 1596.866, Health and Safety Code.

§ 100000.13. Preventive Health and Safety.

“Preventive health and safety” means the course required for child care

providers that encompasses study in recognition, management, and

prevention of infectious diseases, including immunizations, and prevention

of childhood injuries among children in child care facilities.

Note: Authority cited: Sections 1797.107 and 1797.191, Health and Safety

Code. Reference: Section 1596.866, Health and Safety Code.

§ 100000.14. Certificate of Approval.

“Certificate of approval” means the certificate that is issued by the EMS

Authority to the approved training program. The certificate shall state that

the program is approved to provide child care pediatric first aid, CPR, or

preventive health and safety training.

Note: Authority cited: Sections 1797.107 and 1797.191, Health and Safety

Code. Reference: Section 1596.866, Health and Safety Code.

§ 100000.15. Course Completion Document.

“Course completion document” means the card, certificate, or other written

document issued by an approved training program to a student who has

completed the child care pediatric first aid, pediatric CPR, or the preventive

health and safety training.

Note: Authority cited: Sections 1797.107 and 1797.191, Health and Safety

Code. Reference: Section 1596.866, Health and Safety Code.

§ 100000.16. Course Completion Sticker.

“Course completion sticker” means the EMS Authority sticker that is

purchased by the approved training program and its affiliate for pediatric first

aid, CPR, or the preventive health and safety training. An appropriate sticker

shall be affixed to each course completion document issued by approved

training programs and their affiliates for the pediatric first aid, CPR, or

preventive health and safety training.

Regulations in Effect as of July 1, 2021 ● 7

Note: Authority cited: Sections 1797.107 and 1797.191, Health and Safety

Code. Reference: Section 1596.866, Health and Safety Code.

TICLE 2: Training Requirements for Child Care Providers

§ 10

0000.17. Training Requirements for Child Care Providers.

(a) The training requirements for pediatric first aid and CPR for child care

providers shall be satisfied by maintaining current certification in pediatric

first aid and CPR. Current certification is demonstrated by possession of the

following:

(1) A current pediatric first aid course completion card issued either by the

American Red Cross or by a training program that has been approved by

the EMS Authority, and

(2) A current pediatric CPR course completion card issued either by the

American Red Cross or the American Heart Association, or by a training

program that has been approved by the EMS Authority.

(b) Retraining in pediatric first aid and CPR shall occur at least every two

years.

providers may be satisfied by completion of a course and certification in

preventive health and safety. Certification in preventive health and safety is

demonstrated by a child preventive health and safety course completion

document issued by an approved training program.

(d) The requirement for taking the preventive health and safety training is

one time only.

Note: Authority cited: Sections 1596.866, 1797.107 and 1797.191, Health

and Safety Code. Reference: Sections 1596.866 and 1797.191, Health and

Safety Code.

TICLE 3: Training Program Approval

100000.18. Application Process for Program Review and Approval.

Training programs in pediatric first aid, pediatric CPR, and preventive health

and safety shall submit to the EMS Authority the following information when

applying for program review and approval:

(a) Name of the program, name of the business (if it is different than the

name of the program), business address, telephone number and program

director of the training program, institution, organization, or agency;

Regulations in Effect as of July 1, 2021 ● 8

(b) A resume of the director's education and experience in methods,

materials, and evaluation of instruction in the areas of child care training

(pediatric first aid, CPR, and preventive health and safety);

and CPR program or Form EMS-App 102-1/99 for the child preventive

health and safety program incorporated by reference) with the following

attachments:

(1) A copy of the training course curriculum, including any workbooks,

videos, textbooks, or handouts if used in the course;

(2) A detailed plan for evaluation of trainee competency;

(3) A detailed plan for evaluation of instructor competency;

(4) A detailed curriculum for instructor training in the pediatric first aid, and

CPR, or the preventive health and safety training for child care providers;

(5) A list of all affiliated training programs;

(6) A copy of the business license (if licensed); and

(7) The required fees for program review and EMS Authority course

completion stickers.

(d) All program materials specified in this chapter shall be subject to periodic

review, evaluation and monitoring by the EMS Authority.

Note: Authority cited: Sections 1596.866 and 1797.107, Health and Safety

Code. Reference: Sections 1596.866, 1797.113 and 1797.191, Health and

Safety Code.

§ 100000.19. Program Approval Documentation.

(a) The EMS Authority shall notify the training program within twenty

working days of receiving its request for training program approval, that the

request was received and contains the information requested in Section

100000.18 of this Chapter or shall specify what information is missing from

the request.

(b) Program approval or disapproval shall be made in writing by the EMS

Authority to the applying training program within sixty days of receiving all

application information. The training program shall complete all

modifications to an application or program required by the EMS Authority

before approval can be given.

Regulations in Effect as of July 1, 2021 ● 9

approval in writing once the training program is reviewed and found in

compliance with all program requirements. The EMS Authority shall issue a

program approval certificate with the effective date and an expiration date.

(d) Program approval shall be for two years from the last day of the month in

which the approval is given.

(e) Approved training programs shall notify the EMS Authority in writing, and

within thirty days of any change in course content, hours of instruction, or

program director. Advance notice shall be given whenever possible. All

changes shall be reviewed and approved by the EMS Authority.

(f) Directors of training programs shall provide a copy of the EMS Authority

certificate of training program approval to all of their affiliate programs.

(g) All training programs and their affiliate programs shall show a copy of

their EMS Authority certificate of approval to students who are taking their

child care provider first aid, CPR, or preventive health and safety training,

and to the prospective child care training students who inquire about these

training programs.

Note: Authority cited: Sections 1596.866 and 1797.107, Health and Safety

Code. Reference: Sections 1596.750, 1596.866 and 1797.191, Health and

Safety Code.

§ 100000.20. Withdrawal of Program Approval.

Failure to comply with any requirement for program approval, use of any

unqualified teaching personnel, or noncompliance with any other applicable

provision of this Chapter may result in probation, suspension, revocation, or

denial of renewal of program approval by the EMS Authority following the

provisions of the Administrative Procedure Act, Section 11500 et. Seq. of

the Government Code. An approved training program shall have no more

than thirty (30) days from date of written notice to comply with this chapter.

Note: Authority cited: Sections 1596.866, 1797.107 and 1797.191, Health

and Safety Code. Reference: Sections 1596.866 and 1797.191, Health and

Safety Code.

TICLE 4: Training Program Director and Instructor Requirements

100000.21. Director Requirements.

Each training program shall have an approved program director who shall

be qualified by education and experience in methods, materials, and

Regulations in Effect as of July 1, 2021 ● 10

evaluation of instruction. Duties of the program director shall include but not

be limited to:

(a) Administering the training program.

(b) Approving course content.

(d) Coordinating all instructional activities related to the course.

(e) Approving and monitoring instructor training.

(f) Approving, monitoring, and evaluating all instructors and affiliate program

directors.

(g) Notifying in writing their affiliate programs of all policies, curriculum

changes, and regulations that are issued by the EMS Authority.

(h) Assuring that all aspects of the training program are in compliance with

this Chapter and other related laws.

Note: Authority cited: Sections 1596.866 and 1797.107, Health and Safety

Code. Reference: Sections 1596.750, 1596.866 and 1797.191, Health and

Safety Code.

§ 100000.22. Requirements for Instructor Training for Pediatric First Aid and

CPR.

(a) Only instructors who possess a current pediatric first aid and CPR card

shall teach EMSA-approved pediatric first aid and CPR training program

courses.

(b) Approved training programs shall determine which of the following hours

of training are required for instructors, based on competency in essential

knowledge and skills and previous hours of training in relevant courses.

(1) Eight hours of training in the approved program curriculum are required

for instructor certification/authorization after completion of first aid and CPR

training and/or demonstrated competency in essential skills.

(2) Thirty-two hours of training are required for instructor

certification/authorization if applicant has no prior training and/or

demonstrated competency in essential skills.

hiring, franchising, or affiliating with an instructor. The training shall be given

as a condition of hiring, franchising, or affiliating with an instructor, and shall

Regulations in Effect as of July 1, 2021 ● 11

include, but not be limited to, the course content specified in Section

100000.23 of this chapter.

(d) Each training organization shall maintain written verification of instructor

qualifications for each certified instructor.

Note: Authority cited: Sections 1797.107 and 1797.191, Health and Safety

Code. Reference: Sections 1597.866 and 1797.191, Health and Safety

Code.

§ 100000.23. Required Course Content for Pediatric First Aid and CPR

Instructor Training.

(a) The training program for instructors shall include, but not be limited to,

the following topics:

(1) Teaching methods;

(2) Teaching presentation and student assessment;

(3) Child development impact and issues;

(4) Administrative and quality assurance;

(5) Participant health and safety, including care and use of manikins;

(6) Issues of cultural sensitivity;

(7) Assurance that child care context is part of all content areas; and

(8) Topics and skills specified in Section 100000.30(a).

(b) The training program for instructors shall also assess and evaluate an

instructor's ability to teach the following essential skills:

(1) Primary assessment, including management of suspected head and

neck injuries;

(2) Rescue breathing;

(3) Techniques for response to choking (conscious and unconscious

children);

(4) Techniques for controlling bleeding;

(5) Pediatric CPR; and

(6) Splinting of fractures and sprains.

Regulations in Effect as of July 1, 2021 ● 12

presentation and competency at assessing student skills.

Note: Authority cited: Sections 1797.107 and 1797.191, Health and Safety

Code. Reference: Sections 1596.798, 1596.866, 1596.8661 and 1797.191,

Health and Safety Code; and Section 3765, Business and Professions

Code.

§ 100000.24. Requirements for Instructor Training for Child Preventive

Health and Safety.

(a) Only instructors who possess a current pediatric first aid and CPR card

shall teach approved child preventive health and safety training program

courses. In addition, all child preventive health and safety instructors shall

have completed a minimum of twenty-four hours of child preventive health

and safety training that included, but is not limited to, the course content

specified in Section 100000.30(b) of this chapter, within twelve months prior

to beginning to teach an approved program. Until January 1, 2001, the

twenty-four hours of training may include preventive health and safety

training given by the instructor.

(b) Approved training programs shall determine which of the following hours

of training are required for instructors, based on competency in essential

knowledge and skills and previous hours of training in relevant courses.

(1) Eight hours of training in the approved program curriculum are required

for instructor certification/authorization if applicant has previous instructor

training after completion of first aid, CPR, and preventive health and safety

training and/or demonstrated competency in essential skills.

(2) Twenty-four hours of training are required for instructor

certification/authorization if applicant has no prior instructor training and/or

demonstrated competency in essential skills.

by the approved training program that is hiring, franchising or affiliating with

an instructor. The training shall be given as a condition of hiring, franchising

or affiliating with an instructor, and shall include, but not be limited to, the

course content specified in Section 100000.25 of this chapter.

(d) Each training organization shall maintain written verification of instructor

qualifications for each certified instructor.

Note: Authority cited: Sections 1797.107 and 1797.191, Health and Safety

Code. Reference: Sections 1596.866, 1597.866 and 1797.191, Health and

Safety Code.

Regulations in Effect as of July 1, 2021 ● 13

§ 100000.25. Required Course Content for Child Preventive Health and

Safety Instructor Training.

The training program for instructors shall include, but not be limited to the

following topics:

(a) Teaching methods for adult students;

(b) Teaching presentation and student assessment;

(d) Administrative and training quality assurance;

(e) Topics and skills specified in Section 100000.30(b);

(f) Issues of cultural awareness and sensitivity;

(g) Assurance that child care context is part of all content areas;

(h) Knowledge of child care; and

(i) Knowledge of child care statutes and regulations.

Note: Authority cited: Sections 1797.107 and 1797.191, Health and Safety

Code. Reference: Sections 1596.866 and 1797.191, Health and Safety

Code.

§ 100000.26. Methodology for Evaluation of Instructor Competence.

Methods to evaluate instructor competence shall include, but not be limited

to, the following:

(a) Demonstration of mastery in all curriculum areas;

(b) Essential knowledge and skills assessment; and

Note: Authority cited: Sections 1797.107 and 1797.191, Health and Safety

Code. Reference: Sections 1596.866 and 1797.191, Health and Safety

Code.

§ 100000.27. Instructor Certification/Authorization Requirements.

(a) Approved training programs shall issue certification cards that document

certification of instructors. Certification cards shall contain an expiration date

not to exceed two years from the date of instructor certification.

Regulations in Effect as of July 1, 2021 ● 14

(b) Approved training programs shall evaluate their instructors, determine

the number of retraining hours needed, and provide retraining to their

instructors in any of the course content specified in Sections 100000.23 and

100000.25.

expiration of original certification, to document recertification of qualified

instructors. These recertification cards shall contain an expiration date not to

exceed two years from the date of instructor recertification.

Note: Authority cited: Sections 1797.107 and 1797.191, Health and Safety

Code. Reference: Sections 1596.866 and 1797.191, Health and Safety

Code.

§ 100000.28. Monitoring of Instructors.

(a) Methods to monitor certified instructors by training organizations shall

include, but not be limited to, review of student evaluations and periodic

direct observation of provider training.

(b) Training organizations shall have an agreement of understanding with

their program instructors specifying that the instructors shall teach according

to the stated organization standards. These agreements shall be signed by

the program instructor and program director.

Note: Authority cited: Sections 1797.107 and 1797.191, Health and Safety

Code. Reference: Sections 1596.866 and 1797.191, Health and Safety

Code.

TICLE 5: Course Hours and Class Requirements

100000.29. Course Hours and Class Size Requirements.

(a) The initial course of instruction shall consist of not less than eight hours

in pediatric first aid and pediatric CPR. Training programs teaching pediatric

first aid only are allowed with instruction in pediatric first aid to consist of not

less than four hours in addition to a minimum of four hours of pediatric CPR.

The eight hour course shall consist of no less than four hours of pediatric

first aid and no less than four hours of pediatric CPR. Training programs

may teach these four hour courses in pediatric first aid and pediatric CPR

separately.

(b) Retraining in pediatric first aid and CPR shall consist of no less than four

hours of pediatric first aid and no less than four hours of pediatric CPR.

Retraining in pediatric first aid and CPR shall be completed at least every

two years.

Regulations in Effect as of July 1, 2021 ● 15

consist of no less than seven hours. The requirement for taking this course

is one time only.

(d) The class size ratio for pediatric first aid and pediatric CPR shall not

exceed one instructor to twelve students for the skills practice and

evaluation components of the curriculum.

(e) The class size ratio for preventive health and safety training shall not

exceed one instructor to thirty students.

Note: Authority cited: Sections 1797.107 and 1797.191, Health and Safety

Code. Reference: Sections 1596.866 and 1797.191, Health and Safety

Code.

§ 100000.30. Required Course Content.

(a) The course content for pediatric first aid and CPR shall include

instruction to result in competence in the following topics and skills, which

shall prepare personnel within the child care setting to recognize and treat

the ill or injured child, as follows:

(1) Patient examination and injury assessment principles;

(2) Orientation and access to the emergency medical services system;

(3) Recognition and treatment of:

(A) Burns;

(B) Environmental exposure;

(D) Bites and stings (including human, animal, snake, insect and marine

life);

(E) Fainting and seizures;

(F) Dental emergencies;

(G) Diabetic emergencies;

(H) Eye injuries and irritants;

(I) Head and neck injuries;

Regulations in Effect as of July 1, 2021 ● 16

(J) Respiratory distress (including use of inhaled medications and nebulizers

for children with lung diseases);

(K) Fractures and sprains;

(L) Exposure and response to toxic substances;

(M) Shock management; and

(N) Wounds (including cuts, bruises, scrapes, punctures, slivers, penetrating

injuries from foreign objects, amputations and avulsions).

(4) Assembly and use of first aid kits and supplies;

(5) Understanding of standard precautions and personal safety in giving

emergency care;

(6) First aid action plan within a group care setting (including classroom

management while caring for an injured or ill child);

(7) Injury reporting;

(8) Reassuring parents and children in an emergency situation; and

(9) How to talk to young children about emergencies and instructing children

in the emergency action plan.

(b) The course content for preventive health and safety training shall include

instruction to result in competence in the following topics and skills, which

shall prepare personnel to recognize, manage, and prevent infectious

diseases and childhood injuries as follows:

(1) Prevention of Infectious Disease.

(A) Standard precautions.

1. Sanitation;

2. Hand washing; and

3. Use of gloves.

(B) Hygiene for children and care givers.

1. Hand washing; and

2. Diapering.

Regulations in Effect as of July 1, 2021 ● 17

(D) Maintenance of health records and forms.

(E) Process for review of medical form information, including medication

administration, allergies, immunizations, and health insurance; and

(F) Infectious disease policies.

1. Notices for exposure to disease;

2. Guidelines for the exclusion/inclusion of sick children;

3. Diseases that should be reported to local health agencies and to child

care facility children's parents;

4. Guidelines for managing mildly ill children; and

5. Guidelines for staff health regarding potential risk of infectious diseases,

including but not limited to cytomegalovirus (CMV) and Hepatitis B.

(G) Community Resources, to include information on local resources for

services that deal with children's health and the prevention of infectious

disease shall be given to trainees by the training instructor.

(2) Child Injury Prevention

(A) Risk of injury related to developmental stages (i.e., falling, choking, head

injuries);

(B) Establishing and adhering to safety policies in the child care setting;

(SIDS) and Shaken Baby Syndrome;

(D) Managing children's risky behaviors that can lead to injury;

(E) Regular assessments for the safety of indoor and outdoor child care

environments and play equipment; and

(F) Transportation of children during child care.

1. Motor vehicle safety;

2. Child passenger safety;

3. Field trip safety; and

Regulations in Effect as of July 1, 2021 ● 18

4. School bus safety.

(G) Community resources, to include information on local resources for

services that deal with children's health and the prevention of childhood

injuries shall be given to trainees by the training instructor.

(H) Child abuse resources, i.e., where to go in your community for help and

information regarding child abuse.

in the following:

(1) Children's nutrition, i.e., age-appropriate meal planning to ensure

nutritional requirements and the correct portions of food for monitoring

children's food intake.

(A) The food pyramid and how to apply it to children;

(B) Appropriate eating behaviors for children (i.e., snacking); and

These medical needs include but are not limited to food allergies and

diabetes.

(D) Awareness of feeding/growth problems such as failure-to-thrive.

(E) The connection between diet and dental decay in children.

(2) Environmental sanitation.

(A) Vector prevention;

(B) Kitchen cleanliness and sanitation practices;

(3) Air quality.

(A) Hazards of smoking (including, second hand smoke);

(B) Importance of keeping air filters clean;

(D) Hazards of use of fireplaces; and

(E) The connection between allergens and children's respiratory illnesses,

and how to reduce airborne allergens.

Regulations in Effect as of July 1, 2021 ● 19

(4) Food quality.

(A) Safe food practices;

(B) Safe food handling;

(D) Preparing foods safely (i.e., washing produce; keeping raw meats and

utensils used on raw meats away from cooked foods or foods that will be

eaten raw; the importance of keeping cold foods cold, and hot foods hot);

(E) Safe storage of food (including prevention of lead poisoning);

(F) Fully cooking meats and eggs;

(G) Use of only pasteurized fruit juices; and

(H) Dangers of e. coli and salmonella.

(5) Water quality.

(6) Children with special needs.

(A) Knowledge of resources for services for children with special health care

needs; and

(B) Knowledge of the Americans with Disabilities Act, and how it pertains to

children with special needs in child care.

(7) Community resources, knowledge of city, county and state resources,

both non-profit and governmental, for services for children.

(8) Child abuse identification and prevention.

(A) Child abuse mandated reporting requirements;

(B) Signs of child abuse and neglect; and

(9) Procedures to reduce the risks of the following injuries, including but not

limited to: burns, choking, falls, poisonings (lead, iron, acetaminophen, and

other medications), oral injury, suffocation, drowning, injuries from weapons,

and injuries from animals.

(10) Earthquake and emergency preparedness.

Regulations in Effect as of July 1, 2021 ● 20

(A) Preparing the child care for major disasters; and

(B) Community resources for gaining information regarding preparing for

disasters and/or assistance in case of a disaster.

Note: Authority cited: Sections 1797.107 and 1797.191, Health and Safety

Code. Reference: Sections 1596.798, 1596.8661, 1597.866 and 1797.191,

Health and Safety Code; and Section 3765, Business and Professions

Code.

§ 100000.31. Essential Skills Practice and Evaluation.

The pediatric first aid and CPR training program shall include practice and

evaluation of the following skills:

(a) Primary assessment, including management of suspected head and

neck injuries.

(b) Care for pediatric choking victims, both conscious and unconscious.

(d) Splinting and care for fractures, sprains, strains and dislocated joints.

(e) Pediatric CPR.

(f) Pediatric rescue breathing.

Note: Authority cited: Sections 1797.107 and 1797.191, Health and Safety

Code. Reference: Sections 1597.866 and 1797.191, Health and Safety

Code.

§ 100000.32. Methodology for Evaluation of Trainee Competency.

Each training program shall develop, and submit as part of the course, a

plan for evaluating trainee competence in all content and skills areas.

Following are methods which may be used to evaluate competency:

(a) Self evaluation in conjunction with other methods.

(b) Demonstration of mastery other than written.

(d) Use of problem solving scenarios.

Regulations in Effect as of July 1, 2021 ● 21

Note: Authority cited: Sections 1797.107 and 1797.191, Health and Safety

Code. Reference: Sections 1597.866 and 1797.191, Health and Safety

Code.

TICLE 6: Class Rosters, Course Completion Documents and Stickers

100000.33. Class Rosters.

Each EMS Authority-approved pediatric first aid and CPR training program

and child preventive health and safety training program shall submit class

rosters to the EMS Authority for each of the pediatric first aid and CPR

training sessions and for each of the child preventive health and safety

training sessions, within 30 calendar days of course completion. These

class rosters shall include the name, address, and phone number of each

student of the training. The rosters shall also include the serial number listed

on the course completion sticker that is issued to each student upon the

completion of the training.

Note: Authority cited: Sections 1797.107 and 1797.191, Health and Safety

Code. Reference: Sections 1596.866 and 1797.191, Health and Safety

Code.

§ 100000.34. Course Completion Documents and Stickers.

(a) Approved programs in pediatric first aid, CPR and preventive health and

safety practices training shall place pre-printed stickers from the EMS

Authority on their course completion documents. The stickers verify that the

training program is EMS Authority-approved, indicate which training the

student completed, and assigns a tracking number to the course completion

document.

(b) Affiliate programs shall order their course completion stickers from the

EMS Authority.

providing a complete list of their affiliate programs, including the instructor

names, program names, business addresses and business telephone

numbers to the EMS Authority.

(d) Affiliate programs shall complete and submit to the EMS Authority the

first page of the application (EMS-APP100-1/95, Rev. 3/99 and EMS-

APP102-1/99, Rev. 10/99) and a course completion sticker order form

(EMS-900, Rev. 8/99) and turn this into the EMS Authority prior to

purchasing course completion stickers.

(e) Course completion documents with the appropriate EMS Authority

course completion stickers for the child care training in pediatric first aid,

Regulations in Effect as of July 1, 2021 ● 22

CPR and preventive health and safety training shall be issued by the

training program to the student within 21 calendar days after the training is

completed.

(f) The course completion documents for pediatric first, CPR, and preventive

health and safety training shall have the name of the program training

director, the name and signature of the course instructor, the course

completion date and expiration date.

Note: Authority cited: Sections 1797.107, 1797.113 and 1797.191, Health

and Safety Code. Reference: Sections 1596.866, 1797.113 and 1797.191,

Health and Safety Code.

TICLE 7: Fees

100000.35. Fees.

Each training program submitting an application (Forms EMS-App 100-1/95,

Rev. 3/99 and EMS-App 102-1/99, Rev. 10/99) for program review, shall be

assessed a fee of:

(a) Two hundred and forty ($240) dollars for the initial training program

review, for the pediatric first aid and CPR training course. Training programs

that have been reviewed and approved by the EMS Authority will receive 40

course completion stickers, at no extra cost, for their $240 review fee.

(b) Two hundred and forty ($240) dollars for the initial training and program

review of the preventive health and safety training course. Training

programs that have been reviewed and approved by the EMS Authority will

receive 40 course completion stickers, at no extra cost, for their $240 review

fee.

the pediatric first aid and CPR training course. Training programs that have

been reviewed and approved by the EMS Authority will receive 40 course

completion stickers, at no extra cost, for their $240 review fee.

(d) Two hundred and forty ($240) dollars for the biannual training review for

the preventive health training course. Training programs that have been

reviewed and approved by the EMS Authority will receive 40 course

completion stickers, at no extra cost, for their $240 review fee.

(e) Three dollars for each (pediatric first aid, pediatric CPR, and/or

preventive health and safety) preprinted course completion sticker, to be

issued by the approved program to students upon course completion.

Regulations in Effect as of July 1, 2021 ● 23

Note: Authority cited: Sections 1797.107, 1797.113 and 1797.191, Health

and Safety Code. Reference: Sections 1596.866, 1797.113 and 1797.191,

Health and Safety Code.

Regulations in Effect as of July 1, 2021 ● 24

CHAP

TER 1.2. First Aid Testing for School Bus Drivers

ARTICLE 1: Definitions

§ 100001. First Aid.

“

First Aid” means the recognition of and immediate care for injury or sudden

illness prior to the availability of emergency medical care by licensed or

certified health care professionals.

(Section filed 8-29-86, operative 9-28-86; Register 86, No. 35)

Note: Authority cited: Section 12522, Vehicle Code. Reference: Section

12522, Vehicle Code.

§ 100002. Pre-Established Standard.

Pre-established standard means a determined passing score established by

the testing agency prior to the commencement of the examination.

(Section filed 8-29-86, operative 9-28-86; Register 86, No. 35)

Note: Authority cited: Section 12522, Vehicle Code. Reference: Section

12522, Vehicle Code.

ARTICLE 2: General

§ 10

0003. Application of Chapter to School Bus Drivers.

All school bus drivers shall demonstrate proficiency in first aid practices by

successfully completing in accordance with pre-established standards, a

competency based written examination administered by the California

Highway Patrol, in addition to any other requirement for a school bus driver's

certificate.

(Section filed 8-29-86, operative 9-28-86; Register 86, No. 35)

Note: Authority cited: Section 12522, Vehicle Code. Reference: Section

12522, Vehicle Code.

TICLE 3: Examination Standards

§ 10

0004. First Aid Practices Proficiency.

The examination administered by the California Highway Patrol in first aid

practices shall test an applicant's ability to recognize and render first aid in

the following emergency medical situations:

Regulations in Effect as of July 1, 2021 ● 25

(a) Respiratory emergencies: obstructed airway and difficulty breathing;

(b) Cardiac arrest: severe allergic reaction and shock;

chest and abdomen, suspected fractures and dislocations; burns; suspected

internal bleeding and suspected spinal injuries;

(d) Poisonings: drug or alcohol overdose;

(e) Altered consciousness: diabetic emergencies and convulsions;

(f) Environmental emergencies: heat illness and hypothermia; and

(g) Knowledge of EMS system access (utilization of emergency phone

number: “9-1-1”).

(Section filed 8-29-86, operative 9-28-86; Register 86, No. 35)

Note: Authority cited: Section 12522, Vehicle Code. Reference: Section

12522, Vehicle Code.

Regulations in Effect as of July 1, 2021 ● 26

CHAP

TER 1.5. First Aid and CPR Standards and Training for Public

Safety Personnel

ARTICLE 1: Definitions

§ 100005. Automated External Defibrillator or AED.

“Automated External Defibrillator or AED” means an external defibrillator

capable of cardiac rhythm analysis which will charge and deliver a shock

either automatically or by user interaction after electronically detecting and

assessing ventricular fibrillation or rapid ventricular tachycardia.

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Sections 1797.182 and 1797.183, Health and Safety Code; and

Section 13518, Penal Code.

§ 100006. Public Safety AED Service Provider.

“Public Safety AED Service Provider” means an agency, or organization

which is responsible for, and is approved to operate, an AED.

Note: Authority cited Sections 1797.107, 1797.182 and 1797.183, Health

and Safety Code. Reference: Sections 1797.182 and 1797.183, Health and

Safety Code; and Section 13518, Penal Code.

§ 100007. Cardiopulmonary Resuscitation.

“Cardiopulmonary resuscitation” (CPR) means establishing and maintaining

an open airway, ensuring adequate respiration, and ensuring adequate

circulation either spontaneously or by means of closed chest cardiac

compression, according to standards promulgated by the current American

Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation

(CPR) and Emergency Cardiovascular Care (ECC).

Note: Authority cited Section 1797.107, Health and Safety Code. Reference:

Sections 1797.182 and 1797.183, Health and Safety Code; and Section

13518, Penal Code.

§ 100008. Firefighter.

“Firefighter” means any regularly employed and paid officer, employee or

member of a fire department or fire protection or firefighting agency of the

State of California, or any city, county, city and county, district or other

public or municipal corporation or political subdivision of California or any

member of an emergency reserve unit of a volunteer fire department or fire

protection district.

Regulations in Effect as of July 1, 2021 ● 27

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Section 1797.182, Health and Safety Code.

§ 100009. Public Safety First Aid.

“Public safety first aid” means the recognition of and immediate care for

injury or sudden illness, including medical emergencies, by public safety

personnel prior to the availability of medical care by licensed or certified

health care professionals.

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Sections 1797.182 and 1797.183, Health and Safety Code; and

Section 13518, Penal Code.

§ 100010. Lifeguard.

“Lifeguard” means any regularly employed and paid officer, employee, or

member of a public aquatic safety department or marine safety agency of

the State of California, or any city, county, city and county, district or other

public or municipal corporation or political subdivision of California.

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Section 1797.182, Health and Safety Code.

§ 100011. Peace Officer.

“Peace officer” means any city police officer, sheriff, deputy sheriff, peace

officer member of the California Highway Patrol, marshal or deputy marshal

or police officer of a district authorized by statute to maintain a police

department or other peace officer required by law to complete the training

specified in this Chapter.

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Section 1797.183, Health and Safety Code; and Section 13518,

Penal Code.

§ 100012. Primarily Clerical or Administrative.

“Primarily clerical or administrative” means the performance of clerical or

administrative duties for ninety percent (90%) or more of the time worked

within each pay period.

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Sections 1797.182 and 1797.183, Health and Safety Code; and

Section 13518, Penal Code.

Regulations in Effect as of July 1, 2021 ● 28

§ 100013. Regularly Employed.

“Regularly employed” means being given wages, salary, or other

remuneration for the performance of those duties normally carried out by

lifeguards, firefighters, or peace officers.

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Sections 1797.182 and 1797.183, Health and Safety Code.

ARTICLE 2: General Training Provisions

§ 10

0014. Application and Scope.

Except those whose duties are primarily clerical or administrative, the

following regularly employed public safety personnel shall be trained to

administer first aid, CPR and use an AED according to the standards set

forth in this Chapter:

(1) lifeguard;

(2) firefighter;

(3) peace officer.

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Sections 1797.182 and 1797.183, Health and Safety Code; and

Section 13518, Penal Code.

§ 100015. Training Programs in Operation.

Training programs in operation prior to the effective date of these

regulations shall submit evidence of compliance with this Chapter to the

appropriate approving authority as specified in Section 100023 of this

Chapter within twenty-four (24) months after the effective date of these

regulations.

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Sections 1797.182 and 1797.183, Health and Safety Code; and

Section 13518, Penal Code.

§ 100016. Time Limitation for Initial Training.

The initial training requirements specified in Section 100017 of this Chapter

shall be satisfactorily completed within one (1) year from the effective date

of the individual's initial employment and, whenever possible, prior to

assumption of regular duty in one of the personnel categories set forth in

Section 100014 of this Chapter.

Regulations in Effect as of July 1, 2021 ● 29

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Sections 1797.182 and 1797.183, Health and Safety Code; and

Section 13518, Penal Code.

ARTICLE 3: Public Safety First Aid and CPR Training Standards

§ 100017. Public Safety First Aid and CPR Course Content.

(

a) The initial course of instruction shall at a minimum consist of not less

than twenty-one (21) hours in first aid and CPR.

(b) The course of instruction shall include, but need not be limited to, the

following scope of courses as described in (c) below, which shall prepare

personnel specified in Section 100014 of this Chapter to recognize the injury

or illness of the individual and render assistance.

aid level treatment of at least the following topics and shall be competency

based:

(1) Role of the public safety first aid provider;

(A) Personal safety;

(i) Scene size-up.

(B) Body substance isolation, including removing contaminated gloves;

(D) Emergency Medical Services (EMS) access;

(E) Integration with EMS personnel to include active shooter incidents;

(F) Minimum equipment and first aid kits.

(2) Heart attack and sudden cardiac arrest;

(A) Respiratory and circulatory systems;

(B) Heart attack;

(D) Chain of survival.

(3) CPR and AED for adults, children, and infants, following current AHA

Guidelines for CPR and ECC at the Healthcare provider level;

Regulations in Effect as of July 1, 2021 ● 30

(A) Basic airway management;

(B) Rescue breathing;

(i) Mouth-to-mouth;

(ii) Mouth-to-mask;

(iii) Bag-valve-mask (BVM).

(i) Basic AED operation;

(ii) Using the AED;

(iii) Troubleshooting and other considerations.

(D) Single rescuer CPR/AED on adult, child and infant;

(E) Two rescuer CPR/AED on adult, child and infant;

(F) Recovery position.

(4) Management of foreign body airway obstruction on adults, children, and

infants;

(A) Conscious patients;

(B) Unconscious patients.

(5) Recognition and identification of adult and pediatric patients for both

medical and traumatic emergencies;

(A) Performing a primary assessment;

(B) Performing a secondary assessment;

(6) Medical emergencies;

(A) Pain, severe pressure, or discomfort in chest;

(B) Breathing difficulties, including asthma and COPD;

(D) Altered mental status;

Regulations in Effect as of July 1, 2021 ● 31

(E) Stroke;

(F) Diabetic emergencies;

(i) Administration of oral glucose.

(G) Seizures;

(H) Alcohol and drug emergencies;

(i) Assisted naloxone administration and accessing EMS.

(I) Severe abdominal pain;

(J) Obstetrical emergencies.

(7) Burns;

(A) Thermal burns;

(B) Chemical burns;

(8) Facial injuries;

(A) Objects in the eye;

(B) Chemical in the eye;

(D) Dental emergencies.

(9) Environmental emergencies;

(A) Heat emergencies;

(B) Cold emergencies;

(10) Bites and stings;

(A) Insect bites and stings;

(B) Animal and human bites;

Regulations in Effect as of July 1, 2021 ● 32

(11) Poisoning;

(A) Ingested poisoning;

(B) Inhaled poisoning;

substances;

(i) Recognition of exposure;

(ii) Scene safety.

(D) Poison control system.

(12) Identify signs and symptoms of psychological emergencies.

(13) Patient movement;

(A) Emergency movement of patients;

(B) Lifts and carries which may include: using soft litters and manual

extractions including fore/aft, side-by-side, shoulder/belt.

(14) Tactical and rescue first aid principles applied to violent circumstances;

(A) Principles of tactical casualty care;

(i) Determining treatment priorities.

(15) Orientation to the EMS system, including:

(A) 9-1-1 access;

(B) Interaction with EMS personnel;

(16) Trauma emergencies;

(A) Soft tissue injuries and wounds;

(B) Amputations and impaled objects;

(i) Review of basic treatment for chest wall injuries;

(ii) Application of chest seals.

Regulations in Effect as of July 1, 2021 ● 33

(D) Head, neck, or back injury;

(E) Spinal immobilization;

(F) Musculoskeletal trauma and splinting;

(G) Recognition of signs and symptoms of shock;

(i) Basic treatment of shock;

(ii) Importance of maintaining normal body temperature.

(H) Internal bleeding;

(I) Control of bleeding, including direct pressure, tourniquet, hemostatic

dressings, chest seals and dressings;

(i) Training in the use of hemostatic dressings shall result in competency in

the application of hemostatic dressings. Included in the training shall be the

following topics and skills:

1. Review of basic methods of bleeding control to include but not be limited

to direct pressure, pressure bandages, tourniquets, and hemostatic

dressings and wound packing;

2. Types of hemostatic dressings.

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Sections 1797.176, 1797.182, 1797.183 and 1797.193, Health

and Safety Code; and Section 13518, Penal Code.

§ 100018. Authorized Skills for Public Safety First Aid Providers.

(a) A Public safety first aid provider, after completion of training and

demonstration of competency to the satisfaction of the approved training

provider for each skill listed in this section, is authorized to perform medical

care while at the scene of an emergency including, but not limited to, CPR

and AED and may do any of the following:

(1) Evaluate the ill and injured.

(2) Provide treatment for shock.

(3) Use the following techniques to support airway and breathing:

(A) Manual airway opening methods, including head-tilt chin-lift and/or jaw

thrust;

Regulations in Effect as of July 1, 2021 ● 34

(B) Manual methods to remove an airway obstruction in adults, children, and

infants;

(4) Perform the following during emergency care:

(A) Spinal immobilization;

(B) Splinting of extremities;

(D) Assist with administration of oral glucose;

(E) Assist patients with administration of physician-prescribed epinephrine

devices and naloxone;

(F) Assist in emergency childbirth;

(G) Hemorrhage control using direct pressure, pressure bandages,

principles of pressure points, and tourniquets. Hemostatic dressings may be

used from the list approved by the EMS Authority;

(H) Chest seals and dressings;

(I) Simple decontamination techniques and use of decontamination

equipment;

(J) Care for amputated body parts;

(K) Provide basic wound care.

(b) The authorized skills of a public safety first aid provider shall not exceed

those activities authorized in this section.

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Sections 1797.176, 1797.182, 1797.183 and 1797.197, Health

and Safety Code; and Section 13518, Penal Code.

§ 100019. Optional Skills.

(a) In addition to the activities authorized by Section 100018 of this Chapter,

public safety personnel may perform any or all of the following optional skills

specified in this section when the public safety first aid provider has been

trained and tested to demonstrate competence following initial instruction,

and when authorized by the Medical Director of the local EMS agency

(LEMSA).

Regulations in Effect as of July 1, 2021 ● 35

(b) A LEMSA shall establish policies and procedures that require public

safety first aid personnel to demonstrate trained optional skills competency

at least every two years, or more frequently as determined by the EMS

quality improvement program (EMSQIP).

(1) Training in the administration of epinephrine shall result in the public

safety first aid provider being competent in the administration of epinephrine

and managing a patient of a suspected anaphylactic reaction. The training

shall include the following topics and skills:

(A) Common causative agents;

(B) Signs and symptoms of anaphylaxis;

(D) Management to include but not be limited to:

1. Need for appropriate personal protective equipment and scene safety

awareness.

(E) Profile of epinephrine to include, but not be limited to:

1. Class;

2. Mechanisms of drug action;

3. Indications;

4. Contraindications;

5. Dosage and route of administration;

6. Side/adverse effects.

(F) Administration of epinephrine by auto-injector including;

1. Site selection and administration;

2. Medical asepsis;

3. Disposal of contaminated items and sharps.

(2) At the completion of this training, the student shall complete a

competency based written and skills examination for administration of

epinephrine which shall include:

Regulations in Effect as of July 1, 2021 ● 36

(A) Assessment of when to administer epinephrine;

(B) Managing a patient before and after administering epinephrine;

suffering anaphylaxis or receiving epinephrine administration;

(D) Using universal precautions and body substance isolation procedures

during medication administration;

(E) Demonstrating aseptic technique during medication administration;

(F) Demonstrate preparation and administration of epinephrine by auto-

injector;

(G) Proper disposal of contaminated items and sharps.

(d) Supplemental oxygen therapy using a non-rebreather face mask or nasal

cannula, and bag-valve-mask ventilation.

(1) Training in the administration of oxygen shall result in the public safety

first aid provider being competent in the administration of supplemental

oxygen and use of bag-valve-mask ventilation for a patient requiring oxygen

administration and ventilation. The training shall include the following topics

and skills:

(A) Integrating the use of supplemental oxygen by non-rebreather mask or

nasal cannula based upon local EMS protocols;

(B) Assessment and management of patients with respiratory distress;

1. Class;

2. Mechanism of Action;

3. Indications;

4. Contraindications;

5. Dosage and route of administration (mask, cannula, bag-valve-mask);

6. Side/adverse effects.

(D) Oxygen Delivery Systems;

Regulations in Effect as of July 1, 2021 ● 37

1. Set up of oxygen delivery including tank opening, use of regulator and

liter flow selection;

2. Percent of relative oxygen delivered by type of mask;

3. Oxygen delivery for a breathing patient, including non-rebreather mask

and nasal cannula;

4. Bag-Valve-Mask and Oxygen delivery for a non-breathing patient.

(E) Safety precautions.

(2) At the completion of the training, the student shall complete a

competency based written and skills examination for the administration of

oxygen which shall include the topics listed above and:

(A) Assessment of when to administer supplemental oxygen and ventilation

with a bag-valve-mask;

(B) Managing a patient before and after oxygen administration;

(D) Demonstrating application of supplemental oxygen by non-rebreather

mask and nasal cannula on a breathing patient;

(E) Demonstrating use of bag-valve-mask on a non-breathing patient.

(e) Administration of auto-injectors containing atropine and pralidoxime

chloride for nerve agent exposure for self or peer care, when authorized by

the Medical Director of a LEMSA, while working for a public safety provider.

(1) Training in the administration of auto-injectors containing atropine and

pralidoxime shall result in the public safety first aid provider being competent

in the administration of auto-injectors for nerve agent intoxication. The

training shall include the following topics and skills:

(A) Integrating the use of auto-injectors for nerve agent intoxication based

upon local EMS protocols;

(B) Assessment and recognition of patients with nerve agent intoxication;

for appropriate personal protective equipment, decontamination principles,

and scene safety awareness;

(D) Profile of atropine and pralidoxime chloride to include, but not be limited

to:

Regulations in Effect as of July 1, 2021 ● 38

1. Class;

2. Mechanism of action;

3. Indications;

4. Contraindications;

5. Dosage and route of administration;

6. Side/adverse effects.

(E) Auto-Injector delivery and types (i.e. Duo-Dote, Mark I);

1. Medical asepsis;

2. Site selection and administration;

3. Disposal of contaminated items and sharps;

4. Safety precautions.

(2) At the completion of the training, the student shall complete a

competency based written and skills examination for the administration of

auto-injectors containing atropine and pralidoxime chloride for nerve agent

intoxication which shall include the topics listed above and:

(A) Assessment of when to administer nerve agent auto-injector;

(B) Managing a patient before and after auto-injector administration;

administration of atropine and pralidoxime;

(D) Demonstrating preparation, site selection, and administration of the

auto-injector;

(E) Demonstrating universal precautions and body substance isolation

procedure during medication administration;

(F) Demonstrating aseptic technique during medication administration;

(G) Proper disposal of contaminated items and sharps.

(f) Administration of naloxone for suspected narcotic overdose.

(1) Training in the administration of naloxone shall result in the public safety

first aid provider being competent in the administration of naloxone and

Regulations in Effect as of July 1, 2021 ● 39

managing a patient of a suspected narcotic overdose. The training shall

include the following topics and skills:

(A) Common causative agents;

(B) Assessment findings;

(D) Need for appropriate personal protective equipment and scene safety

awareness;

(E) Profile of Naloxone to include, but not be limited to:

1. Indications;

2. Contraindications;

3. Side/adverse effects;

4. Routes of administration;

5. Dosages.

(F) Mechanisms of drug action;

(G) Calculating drug dosages;

(H) Medical asepsis;

(I) Disposal of contaminated items and sharps.

(2) At the completion of this training, the student shall complete a

competency based written and skills examination for administration of

naloxone which shall include:

(A) Assessment of when to administer naloxone;

(B) Managing a patient before and after administering naloxone;

during medication administration;

(D) Demonstrating aseptic technique during medication administration;

(E) Demonstrate preparation and administration of parenteral medications

by a route other than intravenous;

Regulations in Effect as of July 1, 2021 ● 40

(F) Proper disposal of contaminated items and sharps.

(g) Use of oropharyngeal airways (OPAs) and nasopharyngeal airways

(NPAs).

(1) Training in the use of OPAs and NPAs shall result in the public safety

first aid provider being competent in the use of the devices and airway

control and shall include the following topics and skills:

(A) Anatomy and physiology of the respiratory system;

(B) Assessment of the respiratory system;

and mechanical;

(D) The role of OPA and NPA airway adjuncts in the sequence of airway

control;

(E) Indications and contraindications of OPAs and NPAs;

(F) The role of pre-oxygenation in preparation for OPAs and NPAs;

(G) OPA and NPA insertion and assessment of placement;

(H) Methods for prevention of basic skills deterioration;

(I) Alternatives to the OPAs and NPAs.

(2) At the completion of initial training a student shall complete a

competency based written and skills examination for airway management

which shall include the use of basic airway equipment and techniques and

use of OPAs and NPAs.

Note: Authority cited: Sections 1797.107 and 1797.197, Health and Safety

Code. Reference: Sections 1797.182 and 1797.183, Health and Safety

Code; and Section 13518, Penal Code.

§ 100020. Trial Studies.

Public safety personnel may perform any prehospital emergency medical

care treatment procedure(s) or administer any medication(s) on a trial basis

when approved by the Medical Director of the LEMSA and the Director of

the Authority. The Medical Director of the LEMSA shall review the medical

literature on the procedure or medication and determine in his/her

professional judgment whether a trial study is needed.

Regulations in Effect as of July 1, 2021 ● 41

(a) The Medical Director of the LEMSA shall review a trial study plan which,

at a minimum, shall include the following:

(1) A description of the procedure(s) or medication(s) proposed, the medical

conditions for which they can be utilized, and the patient population that will

benefit.

(2) A compendium of relevant studies and material from the medical

literature.

(3) A description of the proposed study design, including the scope of study

and method of evaluating the effectiveness of the procedure(s) or

medication(s), and expected outcome.

(4) Recommended policies and procedures to be instituted by the LEMSA

regarding the use and medical control of the procedure(s) or medication(s)

used in the study.

(5) A description of the training and competency testing required to

implement the study. Training on subject matter shall be consistent with the

related topic(s) and skill(s) specified in Section 100160, Chapter 4

(Paramedic regulations), Division 9, Title 22, California Code of Regulations.

(b) The Medical Director of the LEMSA shall appoint a local medical

advisory committee to assist with the evaluation and approval of trial

studies. The membership of the committee shall be determined by the

Medical Director of the LEMSA, but shall include individuals with knowledge

and experience in research and the effect of the proposed study on the EMS

system.

a copy of the proposed trial study plan at least forty-five (45) calendar days

prior to the proposed initiation of the study to the Director of the Authority for

approval in accordance with the provisions of Section 1797.221 of the

Health and Safety Code. The Authority shall inform the Commission on EMS

of studies being initiated.

(d) The Authority shall notify the Medical Director of the LEMSA submitting

its request for approval of a trial study within fourteen (14) working days of

receiving the request that the request has been received.

(e) The Director of the Authority shall render the decision to approve or

disapprove the trial study within forty-five (45) calendar days of receipt of all

materials specified in subsections (a) and (b) of this section.

(f) Within eighteen (18) months of the initiation of the procedure(s) or

medication(s), the Medical Director of the LEMSA shall submit to the

Regulations in Effect as of July 1, 2021 ● 42

Commission on EMS a written report which includes at a minimum the

progress of the study, number of patients studied, beneficial effects, adverse

reactions or complications, appropriate statistical evaluation, and general

conclusion.

(g) The Commission on EMS shall review the above report within two (2)

meetings and advise the Authority to do one of the following:

(1) Recommend termination of the study if there are adverse effects or if no

benefit from the study is shown.

(2) Recommend continuation of the study for a maximum of eighteen (18)

additional months if potential but inconclusive benefit is shown.

(3) Recommend the procedure or medication be added to the authorized

skills for public safety personnel.

(h) If option (g)(2) is selected, the Commission on EMS may advise

continuation of the study as structured or alteration of the study to increase

the validity of the results.

(i) At the end of the additional eighteen (18) month period, a final report shall

be submitted to the Commission on EMS with the same format as described

in (f) above.

(j) The Commission on EMS shall review the final report and advise the

Authority to do one of the following:

(1) Recommend termination or further extension of the study.

(2) Accept the study recommendations.

(3) Recommend the procedure or medication be added to the authorized

skills for public safety personnel.

(k) The Authority may require a trial study(ies) to cease after thirty-six (36)

months.

Note: Authority cited: Sections 1797.107 and 1797.170, Health and Safety

Code. Reference: Sections 1797.182, 1797.183 and 1797.221, Health and

Safety Code.

§ 100021. Public Safety AED Service Provider.

A public safety AED service provider is an agency or organization that

employs individuals as defined in Section 100014, and who obtain AEDs for

the purpose of providing AED services to the general public.

Regulations in Effect as of July 1, 2021 ● 43

(a) A public safety AED service provider shall be approved by the LEMSA,

or in the case of state or federal agencies, the EMS Authority, prior to

beginning service. In order to receive and maintain AED service provider

approval, a public safety AED service provider shall ensure compliance with

the requirements of this Chapter.

(b) Public Safety AED service provider approval may be revoked or

suspended for failure to maintain the requirements of this section.

meet and provide the following:

(1) Provide orientation of AED authorized personnel to the AED;

(2) Ensure maintenance of AED equipment;

(3) Ensure initial training and continued competency of AED authorized

personnel;

(4) Authorize personnel and maintain a listing of all public safety AED

service provider authorized personnel and provide upon request to the

LEMSA or the EMS Authority.

(d) An approved public safety AED service provider and its authorized

personnel shall be recognized statewide.

Note: Authority cited: Sections 1797.107, 1797.182 and 1797.183, Health

and Safety Code. Reference: Sections 1797.182, 1797.183 and 1797.190,

Health and Safety Code; and Section 13518, Penal Code.

§ 100022. Public Safety First Aid and CPR Retraining Requirements.

(a) The retraining requirements of this Chapter shall be satisfied every two

years by successful completion of:

(1) An approved retraining course which includes a review of the topics and

demonstration of skills prescribed in this Chapter and which consists of no

less than eight (8) hours of first aid and CPR including AED every two (2)

years; or

(2) By maintaining current and valid licensure or certification as an EMR,

EMT, Advanced EMT, Paramedic, Registered Nurse, Physician Assistant,

Physician or by maintaining current and valid EMR, EMT, AEMT or

Paramedic registration from the National Registry of EMTs; or

Regulations in Effect as of July 1, 2021 ● 44

(3) Successful completion of a competency based written and skills pretest

of the topics and skills prescribed in this Chapter with the following

restrictions:

(A) That appropriate retraining be provided on those topics indicated

necessary by the pretest, in addition to any new developments in first aid

and CPR;

(B) A final test be provided covering those topics included in the retraining

for those persons failing to pass the pretest; and

cover the topics indicated necessary by the pretest.

(b) The entire retraining course or pretest may be offered yearly by any

approved training course, as defined in Section 100023, but in no event

shall the retraining course including CPR and AED or pretest be offered less

than once every two (2) years.

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Sections 1797.182, 1797.183 and 1797.210, Health and Safety

Code; and Section 13518, Penal Code.

TICLE 4: Public Safety First Aid and CPR Course Approval

Requirements

§ 10

0023. Public Safety First Aid and CPR Approved Courses.

The training requirements of this Chapter may be satisfied by successfully

completing any one of the following course options as determined by the

employing agency in accordance with the course content contained in

Section 100017 of this chapter:

(a) A course in public safety first aid, including CPR and AED, developed

and/or authorized by the California Department of Forestry and Fire

Protection (CAL FIRE) and approved by the EMS Authority; or

(b) A course in public safety first aid, including CPR and AED, authorized by

the Commission on Peace Officer Standards and Training (POST) and

approved by the EMS Authority. No later than 24-months from the adoption

of these regulations, POST, in consultation with the Authority, shall develop

the course curriculum and testing competency standards for these

regulations as they apply to peace officers; or

and authorized by the California Department of Parks and Recreation (DPR)

and approved by the EMS Authority; or

Regulations in Effect as of July 1, 2021 ● 45

(d) A course in public safety first aid, including CPR and AED, developed

and authorized by the Department of the California Highway Patrol (CHP)

and approved by the EMS Authority; or

(e) The U.S. Department of Transportation's emergency medical responder

(EMR) course which includes first aid practices and CPR and AED,

approved by the LEMSA; or

(f) A course of at least 21 hours in first aid equivalent to the standards of the

American Red Cross and healthcare provider level CPR and AED

equivalent to the standards of the American Heart Association in

accordance with the course content contained in Section 100017 of this

chapter and approved by the LEMSA; or

(g) An EMT course which has been approved pursuant to Chapter 2 of this

division; or

(h) An Advanced EMT (AEMT) course which has been approved pursuant to

Chapter 3 of this division; or

(i) A Paramedic course which has been approved pursuant to Chapter 4 of

this division; or

(j) An EMR course approved by the Authority, and developed and

authorized by CAL FIRE, POST, DPR, CHP or other Statewide public safety

agency, as determined by the Authority.

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Sections 1797.182 and 1797.183, Health and Safety Code; and

Section 13518, Penal Code.

§ 100024. Course Approval Process.

(a) For those courses requiring approval, the following shall be submitted to

the approving authority as specified in Section 100023 of this chapter when

requesting approval:

(1) Name of the sponsoring institution, organization, or agency;

(2) Detailed course outline;

(3) Final written examination with pre-established scoring standards; and

(4) Skill competency testing criteria, with pre-established scoring standards;

and

(5) Name and qualifications of instructor(s).

Regulations in Effect as of July 1, 2021 ● 46

(b) Course approval is valid for four (4) years from the date of approval, and

shall be reviewed by the approving authority for approval every four (4)

years, or sooner at the discretion of the approving authority.

documentation as a condition of course approval.

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Sections 1797.182 and 1797.183, Health and Safety Code; and

Section 13518, Penal Code.

§ 100025. Training Program Notification.

(a) The approving authority shall notify the training program submitting its

request for training program approval within twenty-one (21) working days of

receiving the request that:

(1) The request has been received,

(2) The request contains or does not contain the information requested in

Section 100023 and 100024 of this Chapter and,

(3) What information, if any, is missing from the request.

(b) Program approval or disapproval shall be made in writing by the

approving authority to the requesting training program within a reasonable

period of time after receipt of all required documentation as specified by

LEMSA policy.

approval in writing upon the satisfactory documentation of compliance with

all program requirements.

(d) The LEMSA shall notify the Authority concurrently with the training

program of approval, renewal of approval, or disapproval of the training

program, and include the effective date. This notification is in addition to the

name and address of training program, name of the program director, phone

number of the contact person, and program approval/ expiration date of

program approval.

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Sections 1797.182 and 1797.183, Health and Safety Code; and

Section 13518, Penal Code.

Regulations in Effect as of July 1, 2021 ● 47

§ 100026. Withdrawal of Program Approval.

(a) Noncompliance with any criterion required for program approval, use of

any unqualified teaching personnel, or noncompliance with any other

applicable provision of this Chapter may result in denial, probation,

suspension or revocation of program approval by the training program

approving authority.

(b) Notification of noncompliance and action to place on probation, suspend,

or revoke shall be done as follows:

(1) A training program approving authority shall notify the approved training

program course director in writing, by registered mail, of the provisions of

this Chapter with which the training program is not in compliance.

(2) Within fifteen (15) working days of receipt of the notification of

noncompliance, the approved training program shall submit in writing, by

registered mail, to the training program approving authority one of the

following:

(A) Evidence of compliance with the provisions of this Chapter, or

(B) A plan for meeting compliance with the provisions of this Chapter within

sixty (60) calendar days from the day of receipt of the notification of

noncompliance.

(3) Within fifteen (15) working days of receipt of the response from the

approved training program, or within thirty (30) calendar days from the

mailing date of the noncompliance notification if no response is received

from the approved training program, the training program approving

authority shall notify the Authority and the approved training program in

writing, by registered mail, of the decision to accept the evidence of

compliance, accept the plan for meeting compliance, place on probation,

suspend or revoke the training program approval.

(4) If the training program approving authority decides to suspend, revoke,

or place an training program on probation the notification specified in

subsection (a)(3) of this section shall include the beginning and ending

dates of the probation or suspension and the terms and conditions for lifting

of the probation or suspension or the effective date of the revocation, which

may not be less than sixty (60) calendar days from the date of the training

program approving authority's letter of decision to the Authority and the

training program.

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Sections 1797.182 and 1797.183, Health and Safety Code; and

Section 13518, Penal Code.

Regulations in Effect as of July 1, 2021 ● 48

§ 100027. Testing.

(a) The initial and retraining course of instruction shall include a written and

skills examination which tests the ability to assess and manage all of the

conditions, content and skills listed in Sections 100017 and 100018 of this

Chapter.

(b) A passing standard shall be established by the training agency before

administration of the examination and shall be in compliance with the

standard submitted to and approved by the approving authority according to

Sections 100023 and 100024.

knowledge and skills specified in this chapter and have a passing standard

for successful completion of the course and shall ensure competency of

each skill.

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Sections 1797.182 and 1797.183, Health and Safety Code; and

Section 13518, Penal Code.

§ 100028. Training Instructor Requirements.

(a) Training in public safety first aid and CPR for the personnel specified in

Section 100014 of this Chapter shall be conducted by an instructor who is:

(1) Proficient in the skills taught; and

(2) Qualified to teach by education and/or experience.

(b) Validation of the instructor's qualifications shall be the responsibility of

the agency whose training program has been approved by the approving

authority pursuant to Sections 100023 and 100024 of this Chapter.

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Sections 1797.182 and 1797.183, Health and Safety Code; and

Section 13518, Penal Code.

§ 100029. Validation of Course Completion.

(a) Each trainee who successfully completes an approved course of

instruction and successfully passes the competency based written and skills

exams shall be given a certificate or written verification to that effect by the

institution, organization or agency which provides the instruction.

(b) Each certificate or written verification of course completion shall include

the following information:

Regulations in Effect as of July 1, 2021 ● 49

(1) Indicate initial or refresher training and number of training hours

completed;

(2) Date of issue;

(3) Date of expiration;

(i) Expiration of training shall be 2 years from the date of course completion.

trainees and the date(s) on which training courses have been completed for

at least four (4) years.

(d) Such training records shall be made available for inspection by the

LEMSA or approving authority upon request.

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Sections 1797.182 and 1797.183, Health and Safety Code; and

Section 13518, Penal Code.

§ 100030. Program Review.

(a) All course outlines, written tests, and competency testing criteria used in

an approved program shall be subject to oversight and periodic review as

determined by the approving authority.

(b) Program approval and renewal is contingent upon continued compliance

with all required criteria and provisions described in this Chapter, and may

be revoked by the approving authority as described in Section 100026 of

this Chapter.

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Sections 1797.182 and 1797.183, Health and Safety Code; and

Section 13518, Penal Code.

Regulations in Effect as of July 1, 2021 ● 50

CHAPTER 1.9. Lay Rescuer Epinephrine Auto-Injector Training

Certification Standards

ARTICLE 1: Definitions

§ 10

0044. Anaphylaxis.

“Anaphylaxis” means a potentially life-threatening hypersensitivity or allergic

reaction.

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Sections 1797.197 and 1797.197a, Health and Safety Code.

§ 100044.1. Approved Training Program.

“Approved training program” means a training program that is approved by

the EMS Authority to provide epinephrine auto-injector training.

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Sections 1797.197 and 1797.197a, Health and Safety Code.

§ 100044.2. Authorized Health Care Provider.

“Authorized Health Care Provider” means a currently licensed health care

professional who is legally authorized in California to issue a prescription for

or dispense an epinephrine auto-injector to an individual who meets the

requirements of Section 100046 of this Chapter.

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Sections 1797.197 and 1797.197a, Health and Safety Code.

§ 100044.3. Authorized Training Provider.

“Authorized training provider” or “instructor” means an individual who is

authorized by an approved training program to provide epinephrine auto-

injector training as approved by the EMS Authority and who meets the

requirements set forth in Section 100050 of this Chapter.

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Sections 1797.197 and 1797.197a, Health and Safety Code.

§ 100044.4. Automated External Defibrillator.

“Automated external defibrillator” or “AED” means an external defibrillator

capable of cardiac rhythm analysis which will charge and deliver a shock

either automatically or by user interaction after electronically detecting and

assessing ventricular fibrillation or rapid ventricular tachycardia.

Regulations in Effect as of July 1, 2021 ● 51

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Sections 1797.5, 1797.190, 1797.196, 1797.197 and 1797.197a,

Health and Safety Code; and Section 1714.23, Civil Code.

§ 100044.5. Cardiopulmonary Resuscitation.

“Cardiopulmonary resuscitation” (CPR) means ensuring adequate

circulation either spontaneously or by means of closed chest cardiac

compression, establishing and maintaining an open airway, and ensuring

adequate ventilation equivalent to current standards promulgated by the

American Heart Association's (AHA) Guidelines for CPR and Emergency

Cardiovascular Care (ECC) or the American Red Cross.

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Sections 1797.197 and 1797.197a, Health and Safety Code; and

Section 1714.23, Civil Code.

§ 100044.6. Certification of Training.

“Certification of training” means the certification card issued by the EMS

Authority to an individual who satisfies the requirements outlined in Section

100046.

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Sections 1797.197 and 1797.197a, Health and Safety Code.

§ 100044.7. Epinephrine Auto-injector.

“Epinephrine auto-injector” means a disposable drug delivery system with a

spring-activated needle that is designed for emergency administration of

epinephrine to provide rapid, convenient first aid for persons suffering from

anaphylaxis.

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Sections 1797.197 and 1797.197a, Health and Safety Code; and

Section 1714.23, Civil Code.

§ 100044.8. Lay Rescuer.

“Lay rescuer” means any person who has met the training standards and

other requirements of this Chapter but who is not otherwise licensed or

certified to use an epinephrine auto-injector on another person.

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Sections 1797.197 and 1797.197a, Health and Safety Code; and

Section 1714.23, Civil Code.

Regulations in Effect as of July 1, 2021 ● 52

§ 100044.9. Prehospital Emergency Medical Care Person.

“Prehospital emergency medical care person” means any of the following:

authorized registered nurse, mobile intensive care nurse, nurse practitioner,

nurse midwives, clinical nurse specialist, nurse anesthetists, physician

assistant, emergency medical technician, advanced emergency medical

technician, paramedic, lifeguard, firefighter, peace officer, or a physician and

surgeon who provides prehospital emergency medical care or rescue

services.

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Sections 1797.56, 1797.80, 1797.82, 1797.84, 1797.182,

1797.183, 1797.189, 1797.197 and 1797.197a, Health and Safety Code;

and Section 1714.23, Civil Code.

§ 100044.10. Training Program Director.

“Training program director” means the person who is designated in the

application as the director and who provides oversight of the approved

training program as set forth in Section 100049 of this Chapter.

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Sections 1797.197 and 1797.197a, Health and Safety Code.

TICLE 2: Certification Requirements

§ 100045. Application and Scope.

(a) Upon certification by the EMS Authority as defined in Section 100044.6 a

lay rescuer, or off-duty prehospital emergency medical care personnel are

authorized to administer an epinephrine auto-injector to treat a person who

is suffering or reasonably believed to be suffering from anaphylaxis under

the following conditions:

(1) The epinephrine auto-injector is legally obtained by prescription from an

authorized health care provider who may issue a prescription for an

epinephrine auto-injector to a person described in this subdivision for the

purpose of rendering emergency care to another person upon presentation

of current and valid certification card issued by the EMS Authority, and

(2) The epinephrine auto-injector is used on an individual, with the express

or implied consent of that person, to treat anaphylaxis, and

(3) The epinephrine auto-injector is stored and maintained as directed by

the manufacturer's instructions for that product, and

Regulations in Effect as of July 1, 2021 ● 53

(4) The emergency medical services system is activated as soon as

practical when an epinephrine auto-injector is used.

(b) Certified persons shall make, maintain, and make available to EMSA

upon request a record for five years reflecting:

(1) Dates of receipt, use and destruction of each auto-injector dispensed,

and

(2) The name of any person to whom epinephrine was administered by

using an auto-injector, and

(3) The circumstances and manner of disposal of any auto-injectors.

rescuers and off duty prehospital emergency medical care personnel.

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Sections 1797.197 and 1797.197a, Health and Safety Code; and

Section 4119.3, Business and Professions Code.

§ 100046. Certification Requirements.

(a) An individual who meets all of the following criteria shall be eligible for

certification by the EMS Authority:

(1) Successful completion of training from an epinephrine auto-injector

training program approved pursuant to Section 100047 of this Chapter, and

(2) Course completion document provided by the training program and

signed by the class instructor and,

(3) Current certification in CPR and AED for infants, children and adults

equivalent to the current standards of the American Red Cross and/or the

AHA Guidelines for CPR and ECC and,

(4) Payment of all fees pursuant to Section 100054 of this Chapter and,

(5) Submit the State of California Epinephrine Certification Application form

#1.9app (6/2015) herein incorporated by reference.

(b) Currently licensed California health care professionals including

physician assistants, registered nurses, nurse practitioners, nurse midwives,

clinical nurse specialists, nurse anesthetists, mobile intensive care nurses

and currently licensed or certified California paramedics and advanced

emergency medical technicians (AEMTs) shall be deemed to have met the

Regulations in Effect as of July 1, 2021 ● 54

requirement for training and are eligible for certification under this Chapter

and may apply to the EMS Authority for a certification card using the State

of California Epinephrine Certification Application form #1.9app (6/2015).

peace officers in this state who have current documentation of successfully

completed training in the administration of epinephrine by auto-injector,

approved by a local EMS agency or the EMS Authority, are eligible for

certification under this Chapter and may apply to the EMS Authority for a

certification card using the State of California Epinephrine Certification

Application form #1.9app (6/2015).

(d) The effective date of the certification shall be the day the certification is

issued by the EMS Authority.

(e) The certification card shall be valid for two (2) years from the last day of

the month in which it was issued.

(f) The requirements and process for renewal of the certification are the

same as that for the initial certification as described in Section 100046

(a)(1)-(5), (b) and (c).

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Sections 1797.197 and 1797.197a, Health and Safety Code.

TICLE 3: Training Program Requirements

§ 10

0047. Procedures for Training Program Approval.

(a) Prospective training programs shall submit a written request for training

program approval to the EMS Authority.

(b) The EMS Authority shall receive and review the following prior to

program approval:

(1) A statement verifying that the course content meets the requirements set

forth in Section 100048 of this Chapter, and

(2) An outline of course objectives, and

(3) A final written and skills competency examination, and

(4) The name and qualifications of the program director, and

(5) The training program address and phone number, and

(6) A copy of the training course curriculum including any workbooks,

videos, textbooks, or handouts if used in the course, and

Regulations in Effect as of July 1, 2021 ● 55

(7) The required fees for program review, and

(8) A copy of a course completion document to be provided to students who

successfully complete training which shall contain all of the following

elements:

(A) The name of the training program, and

(B) The name of the individual completing the course, and

(D) A signature line for the class instructor, and

(E) Course name.

be subject to periodic review, evaluation and monitoring by the EMS

Authority.

(d) Any person or agency conducting a training program shall notify the

EMS Authority in writing within thirty (30) calendar days of any change in

program director, instructor, and change of address, phone number, and

contact person.

(e) Any change to the curriculum once approved, shall be submitted for

review and approval by the EMS Authority and shall include the

requirements of Section 100048 Subsections (a) and (b) (1)-(12) and

subsection (a)(2) of Section 100054

(f) The EMS Authority may request additional materials or documentation as

a condition of course approval.

(g) The requirements and process for renewal of approval are the same as

that for the initial approval.

(1) The training program shall submit an application for renewal at least sixty

(60) calendar days before the expiration date of their approval in order to

maintain continuous approval.

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Sections 1797.197 and 1797.197a, Health and Safety Code.

§ 100048. Course Content Requirements.

(a) Training in the administration of epinephrine shall result in the lay

rescuer demonstrating competency in the assessment, management and

Regulations in Effect as of July 1, 2021 ● 56

administration of epinephrine to an individual suspected of having an

anaphylactic reaction.

(b) The following topics and skills shall be included in the training:

(1) Common causative agents,

(2) Recognition of symptoms of anaphylaxis,

(3) Recognition of signs of anaphylaxis,

(4) Acquisition and disposal of epinephrine auto-injectors,

(5) Maintenance and quality assessment of epinephrine auto-injectors,

(6) Emergency use of an epinephrine auto-injector

(A) Indications,

(B) Contraindications,

(D) Administration by auto-injector,

(E) Dosing,

(F) Drug actions,

(G) Proper storage, handling and disposal of used/or expired injectors,

(7) Consent law,

(8) Good Samaritan law,

(9) Emergency Care Plans,

(10) Activation of the EMS system by calling 9-1-1,

(11) Commonly available models of epinephrine auto-injectors,

(12) Record keeping requirement as specified in Section 100045(b).

competency based written and skills examination which shall include all the

course content requirements listed in subsection (b) of this Section.

Regulations in Effect as of July 1, 2021 ● 57

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Sections 1797.197 and 1797.197a, Health and Safety Code.

§ 100049. Director Requirements.

(a) Each training program shall have a program director that shall be

qualified by education and experience in methods, materials, and evaluation

of instruction.

(b) Duties of the program director shall include but not be limited to:

(1) Administering the training program, and

(2) Approving course content, and

(3) Approving all written examinations and the final skills examination, and

(4) Approving all instructor(s), and

(5) Assuring all aspects of the training program are in compliance with this

Chapter and other related laws.

(6) Provide to the EMS Authority a list of all instructors at least every thirty

(30) calendar days or,

(7) Notify the EMS Authority of any changes to the approved instructor list

within fifteen (15) calendar days.

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Sections 1797.197 and 1797.197a, Health and Safety Code.

§ 100050. Instructor Requirements.

(a) Each instructor shall:

(1) Be authorized by an approved training program, and

(2) Be approved by the training program director as qualified to teach by

education and experience in methods, materials, and evaluation of

instruction, and

(3) Possess current certification in first aid, CPR and AED.

(b) Upon completion of each epinephrine auto-injector course the instructor

shall provide the individual with a signed course completion document.

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Sections 1797.197 and 1797.197a, Health and Safety Code.

Regulations in Effect as of July 1, 2021 ● 58

§ 100051. Notification of Program Approval.

(a) The EMS Authority shall notify the training program within twenty-one

(21) working days of receiving its request that:

(1) The request has been received, and

(2) The request contains or does not contain the information requested in

Section 100047 of this Chapter, and

(3) What information, if any, is missing from the request.

(b) Program approval or disapproval shall be made in writing by the EMS

Authority to the applying training program within sixty (60) days of receiving

all application information. The training program shall complete all

modifications to an application or program required by the EMS Authority

before approval can be given.

approval in writing once the training program is reviewed and found in

compliance with all program requirements. The EMS Authority shall issue a

certificate of approval to the training program with the effective date and an

expiration date.

(d) Program approval shall be for four (4) years from the last day of the

month in which the approval is given and shall be reviewed by the EMS

Authority for approval every four (4) years or sooner at the discretion of the

EMS Authority.

(e) Approved training programs shall notify the EMS Authority in writing, and

within thirty (30) calendar days of any change in name, address, phone

number, hours of instruction, or program director.

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Sections 1797.197 and 1797.197a, Health and Safety Code.

§ 100052. Withdrawal of Program Approval.

(a) Failure to comply with any requirement for program approval, use of any

unqualified teaching personnel, or noncompliance with any other applicable

provision of this Chapter may result in probation, suspension, revocation, or

denial of renewal of program approval by the EMS Authority.

(b) Notification of noncompliance and action to place on probation, suspend,

or revoke shall be done as follows:

Regulations in Effect as of July 1, 2021 ● 59

(1) The EMS Authority shall notify the approved training program course

director in writing, by registered mail, of the provisions of this Chapter with

which the training program is not in compliance.

(2) Within fifteen (15) working days of receipt of the notification of

noncompliance, the approved training program shall submit in writing, by

registered mail, to the EMS Authority one of the following:

(A) Evidence of compliance with this Chapter, or

(B) A plan for meeting compliance with the provisions of this Chapter within

sixty (60) calendar days from the day of receipt of the notification of

noncompliance.

(3) Within thirty (30) calendar days from the mailing date of the

noncompliance notification the EMS Authority shall notify the approved

training program in writing, by registered mail, of the decision to accept the

evidence of compliance, accept the plan for meeting compliance, place on

probation, suspend or revoke the training program approval.

(4) If the EMS Authority decides to suspend, revoke, or place a training

program on probation the notification specified in the subsection (b) (3) of

this Section shall include the beginning and ending dates of the probation or

suspension and the terms and conditions for lifting of the probation or

suspension or the effective date of the revocation which shall not be less

than sixty (60) calendar days from the date of the EMS Authority's letter of

decision to the approved training program.

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Sections 1797.197 and 1797.197a, Health and Safety Code.

§ 100053. Certification Card.

(a) The EMS Authority shall issue a certification card to each individual who

satisfies the requirements of Section 100046

(b) The certification card shall contain all of the following:

(1) The name of the individual completing the course

(2) The course completion date

(3) Certification expiration date

(4) Certification number

Regulations in Effect as of July 1, 2021 ● 60

(5) The title of the card shall be listed as: Epinephrine Auto-injector

Certification.

(6) The signature of the certified Health and Safety Code Section 1797.197a

Responder, affirming the statement: “I understand the scope of my authority

and responsibilities as a trained Health and Safety Code Section 1797.197a

Responder, and will possess and only employ epinephrine consistent with

that Health and Safety Code Section 1797.197a training and applicable law,

including activation of the Emergency Medical Services System and record

keeping.”

Note: Authority cited: Sections 1797.107, Health and Safety Code.

Reference: Sections 1797.197 and 1797.197a, Health and Safety Code.

TICLE 4: Fees

§ 10

0054. Fees.

(a) Each epinephrine training program submitting a written request for

program approval shall include a fee of:

(1) Five hundred ($500) dollars for approval and re-approval of a training

program.

(2) Two hundred and fifty ($250) dollars for any changes in the course

content or curriculum occurring outside of the renewal period.

(b) Each individual submitting an application for certification, recertification,

or request for a replacement card shall include a fee of:

(1) Fifteen ($15) dollars.

Note: Authority cited: Section 1797.107, Health and Safety Code.

Reference: Sections 1797.197 and 1797.197a, Health and Safety Code.

Regulations in Effect as of July 1, 2021 ● 61

CHAPTER 2. Emergency Medical Technician

ARTICLE 1: Definitions

§ 10

0056. Automated External Defibrillator or AED.

“Automated external defibrillator or AED” means an external defibrillator

capable of cardiac rhythm analysis that will charge and deliver a shock,

either automatically or by user interaction, after electronically detecting and

assessing ventricular fibrillation or rapid ventricular tachycardia.

Note: Authority cited: Sections 1797.107 and 1797.170, Health and Safety

Code. Reference: Sections 1797.52, 1797.107 and 1797.170, Health and

Safety Code.

§ 100056.1. EMT AED Service Provider.

An AED service provider means an agency or organization which is

responsible for, and is approved to operate, an AED.

Note: Authority cited: Sections 1797.107 and 1797.170, Health and Safety

Code. Reference: Sections 1797.52, 1797.107 and 1797.170, Health and

Safety Code.

§ 100056.2. Manual Defibrillator.

“Manual Defibrillator” means a monitor/defibrillator that has no capability or

limited capability for rhythm analysis and will charge and deliver a shock

only at the command of the operator.

Note: Authority cited: Sections 1797.107 and 1797.170, Health and Safety

Code. Reference: Sections 1797.52, 1797.107 and 1797.170, Health and

Safety Code.

§ 100057. Emergency Medical Technician Approving Authority.

(a) “Emergency Medical Technician (EMT) approving authority” means an

agency or person authorized by this Chapter to approve an EMT training

program, as follows:

(1) The EMT approving authority for an EMT training program conducted by

a qualified statewide public safety agency shall be the director of the

Emergency Medical Services Authority (Authority).

(2) Any other EMT training programs not included in subsection (a)(1) shall

be approved by the local EMS agency (LEMSA) that has jurisdiction in the

county where the training program is located.

Regulations in Effect as of July 1, 2021 ● 62

Note: Authority cited: Sections 1797.107, 1797.109 and 1797.170, Health

and Safety Code. Reference: Sections 1797.94, 1797.109, 1797.170 and

1797.208, Health and Safety Code.

§ 100057.1. High Fidelity Simulation.

“High Fidelity Simulation” means using computerized manikins that are

operated by a technologist from another location to produce audible sounds

and to alter, simulate and manage physiological changes within the manikin

to include, but not be limited to, altering the heart rate, respirations,

chest/lung sounds, blood pressure and saturation of oxygen.

Note: Authority cited: Sections 1797.107, 1797.109 and 1797.170, Health

and Safety Code. Reference: Sections 1797.107, 1797.109 and 1797.170,

Health and Safety Code.

§ 100057.2. Electronic Health Record.

“Electronic health record” (EHR) or “electronic patient care record” (ePCR)

means real-time, patient-centered records that make information available

securely to authorized users in a digital format capable of being shared with

other providers across more than one health care organization.

Note: Authority cited: Sections 1797.107, 1797.109 and 1797.170, Health

and Safety Code. Reference: Sections 1797.107, 1797.109, 1797.170,

1797.208 and 1797.227, Health and Safety Code.

§ 100058. California EMT Certifying Entity.

“California EMT certifying entity”, or “EMT certifying entity”, or “certifying

entity” means a public safety agency or the Office of the State Fire Marshal,

if the agency has a training program for EMT personnel that is approved

pursuant to the standards developed pursuant to Section 1797.109 of the

Health and Safety Code, or the medical director of a LEMSA.

Note: Authority cited: Sections 1797.62, 1797.107, 1797.109 and 1797.170,

Health and Safety Code. Reference: Sections 1797.109, 1797.118,

1797.170, 1797.210 and 1797.216, Health and Safety Code.

§ 100059. EMT Certifying Cognitive Examination.

“EMT Certifying Cognitive Examination” means the National Registry of

Emergency Medical Technicians EMT Cognitive Examination to test an

individual applying for certification as an EMT.

Regulations in Effect as of July 1, 2021 ● 63

Note: Authority cited: Sections 1797.107, 1797.109, 1797.170 and

1797.175, Health and Safety Code. Reference: Sections 1797.63, 1797.170,

1797.175, 1797.184, 1797.210 and 1797.216, Health and Safety Code.

§ 100059.1. EMT Certifying Psychomotor Examination.

“Certifying Psychomotor Examination” means the National Registry of

Emergency Medical Technicians EMT Psychomotor Examination to test an

individual applying for certification as an EMT.

Note: Authority cited: Sections 1797.107, 1797.109, 1797.170 and

1797.175, Health and Safety Code. Reference: Sections 1797.63, 1797.170,

1797.175, 1797.184, 1797.210 and 1797.216, Health and Safety Code.

§ 100059.2. EMT Optional Skills Medical Director.

“EMT Optional skills medical director” means a Physician and Surgeon

licensed in California who is certified by or prepared for certification by either

the American Board of Emergency Medicine or the Advisory Board for

Osteopathic Specialties and is appointed by the LEMSA medical director to

be responsible for any of the skills that are listed in Sections 100063(b) and

100064 of this Chapter including medical control. Waiver of the board-

certified requirement may be granted by the LEMSA medical director if such

physicians are not available for approval.

Note: Authority cited: Sections 1797.107 and 1797.170, Health and Safety

Code. Reference: Sections 1797.52, 1797.90, 1797.107, 1797.170,

1797.176 and 1797.202, Health and Safety Code.

§ 100060. Emergency Medical Technician.

“Emergency Medical Technician,” “EMT-Basic” or “EMT” means a person

who has successfully completed an EMT course that meets the

requirements of this Chapter, has passed all required tests, and has been

certified by a California EMT certifying entity.

Note: Authority cited: Sections 1797.107, 1797.109 and 1797.170, Health

and Safety Code. Reference: Sections 1797.61, 1797.80 and 1797.170,

Health and Safety Code.

§ 100061. EMT Local Accreditation.

“Local accreditation” or “accreditation” or “accredited to practice” as used in

this Chapter, means authorization by the LEMSA to practice the optional

skill(s) specified in Section 100064. Such authorization assures that the

EMT has been oriented to the LEMSA and trained in the optional skill(s)

necessary to achieve the treatment standard of the jurisdiction.

Regulations in Effect as of July 1, 2021 ● 64

Note: Authority cited: Sections 1797.107 and 1797.170, Health and Safety

Code. Reference: Sections 1797.7, 1797.170, 1797.176, 1797.177,

1797.178, 1797.200, 1797.204, 1797.206, 1797.210 and 1797.214, Health

and Safety Code.

§ 100061.1. Emergency Medical Services Quality Improvement Program.

“Emergency Medical Services Quality Improvement Program” or “EMSQIP”

means methods of evaluation that are composed of structure, process, and

outcome evaluations which focus on improvement efforts to identify root

causes of problems, intervene to reduce or eliminate these causes, and take

steps to correct the process, and recognize excellence in performance and

delivery of care, pursuant to the provisions of Chapter 12 of this Division.

This is a model program which will develop over time and is to be tailored to

the individual organization's quality improvement needs and is to be based

on available resources for the EMSQIP.

Note: Authority cited: Sections 1797.103, 1797.107 and 1797.170, Health

and Safety Code. Reference: Sections 1797.204 and 1797.220, Health and

Safety Code.

§ 100061.2. Authority.

“Authority” means the Emergency Medical Services Authority.

Note: Authority cited: Sections 1797.107 and 1797.170, Health and Safety

Code. Reference: Section 1797.54, Health and Safety Code.

TICLE 2: General Provisions

§ 10

0062. Application of Chapter.

(a) Except as provided herein, the attendant on an ambulance operated in

emergency service, or the driver if there is no attendant, shall possess a

valid and current California EMT certificate. This requirement shall not apply

during officially declared states of emergency and under conditions specified

in Health and Safety Code, Section 1797.160.

(b) The requirements for EMT certification of ambulance attendants shall not

apply, unless the individual chooses to be certified, to the following:

(1) Physicians currently licensed in California.

(2) Registered nurses currently licensed in California.

(3) Physicians' assistants currently licensed in California.

Regulations in Effect as of July 1, 2021 ● 65

(4) Paramedics currently licensed in California.

(5) Advanced Emergency Medical Technicians (Advanced EMTs) currently

certified in California.

perform their scope of practice in California, when approved by the medical

director of the LEMSA, in order to provide emergency medical services in

response to a request, if all the following conditions are met:

(1) The EMTs are registered by the National Registry of Emergency Medical

Technicians or licensed or certified in another state or under the jurisdiction

of a branch of the Armed Forces including the Coast Guard of the United

States, National Park Service, United States Department of the Interior -

Bureau of Land Management, or the United States Forest Service; and

(2) The EMTs restrict their scope of practice to that for which they are

licensed or certified.

(d) The local EMS agency shall develop and implement policies for the

medical control and medical accountability of care rendered by the EMT.

This shall include, but not be limited to, basic life support protocols, policies

and procedures and documentation, which may include completing an

electronic health record (EHR) that is compliant with the current versions of

the California Emergency Medical Services Information System (CEMSIS)

and the National Emergency Medical Services Information Systems

(NEMSIS) standards.

(e) Pursuant to Health and Safety Code section 1797.170, subdivision (b), a

California-certified EMT shall be recognized as an EMT on a statewide

basis.

(f) If an EMT or Advanced EMT certification card is lost, destroyed,

damaged, or there has been a change in the name of the EMT, a duplicate

certification card may be requested. The request shall be in writing to the

certifying entity that issued the EMT certificate and include a statement

identifying the reason for the request and, if due to a name change, include

a copy of legal documentation of the change in name. The duplicate card

shall bear the same certification number and date of expiration as the

original card.

(g) An individual currently certified as an EMT by the provisions of this

section may voluntarily deactivate his or her EMT certificate as long as the

individual is not under investigation or disciplinary action by a LEMSA

medical director for violations of Health and Safety Code Section 1798.200.

An individual who has voluntarily deactivated his or her EMT certificate shall

comply with the following:

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(1) Discontinue all medical practice requiring an active and valid EMT

certificate,

(2) Return the EMT certificate to the certifying entity, and

(3) Notify the LEMSA to whom the individual is accredited as an EMT that

his or her certification is no longer valid.

(4) Reactivation of the EMT certificate shall be in accordance with the

provisions of Section 100081 of this Chapter.

(5) This information shall be entered into the Central Registry by the

certifying entity who issued the EMT certificate.

Note: Authority cited: Sections 1797.107, 1797.109, 1797.170, 1797.220

and 1797.227, Health and Safety Code. Reference: Sections 1797.160 and

1797.170, Health and Safety Code.

§ 100063. Basic Scope of Practice of Emergency Medical Technician.

(a) During training, while at the scene of an emergency, during transport of

the sick or injured, or during interfacility transfer, a certified EMT or

supervised EMT student is authorized to do any of the following:

(1) Evaluate the ill and injured.

(2) Render basic life support, rescue and emergency medical care to

patients.

(3) Obtain diagnostic signs to include, but not be limited to, temperature,

blood pressure, pulse and respiration rates, pulse oximetry, level of

consciousness, and pupil status.

(4) Perform cardiopulmonary resuscitation (CPR), including the use of

mechanical adjuncts to basic cardiopulmonary resuscitation.

(5) Administer oxygen.

(6) Use the following adjunctive airway and breathing aids:

(A) Oropharyngeal airway;

(B) Nasopharyngeal airway;

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(D) Basic oxygen delivery devices for supplemental oxygen therapy

including, but not limited to, humidifiers, partial rebreathers, and venturi

masks; and

(E) Manual and mechanical ventilating devices designed for prehospital use

including continuous positive airway pressure.

(7) Use various types of stretchers and spinal motion restriction or

immobilization devices.

(8) Provide initial prehospital emergency care to patients, including, but not

limited to:

(A) Bleeding control through the application of tourniquets;

(B) Use of hemostatic dressings from a list approved by the Authority;

(D) Seated spinal motion restriction or immobilization;

(E) Extremity splinting; and

(F) Traction splinting.

(G) Administer oral glucose or sugar solutions.

(H) Extricate entrapped persons.

(I) Perform field triage.

(J) Transport patients.

(K) Apply mechanical patient restraint.

(L) Set up for ALS procedures, under the direction of an Advanced EMT or

Paramedic.

(M) Perform automated external defibrillation.

(N) Assist patients with the administration of physician-prescribed devices

including, but not limited to, patient-operated medication pumps, sublingual

nitroglycerin, and self-administered emergency medications, including

epinephrine devices.

(b) In addition to the activities authorized by subdivision (a) of this Section,

the medical director of the LEMSA may also establish policies and

procedures to allow a certified EMT or a supervised EMT student who is

Regulations in Effect as of July 1, 2021 ● 68

part of the organized EMS system and in the prehospital setting and/or

during interfacility transport to:

(1) Monitor intravenous lines delivering glucose solutions or isotonic

balanced salt solutions including Ringer's lactate for volume replacement.

Monitor, maintain, and adjust if necessary in order to maintain, a preset rate

of flow and turn off the flow of intravenous fluid;

(2) Transfer a patient, who is deemed appropriate for transfer by the

transferring physician, and who has nasogastric (NG) tubes, gastrostomy

tubes, heparin locks, foley catheters, tracheostomy tubes and/or indwelling

vascular access lines, excluding arterial lines;

(3) Administer naloxone or other opioid antagonist by intranasal and/or

intramuscular routes for suspected narcotic overdose;

(4) Administer epinephrine by auto-injector for suspected anaphylaxis and/or

severe asthma;

(5) Perform finger stick blood glucose testing; and

(6) Administer over the counter medications, when approved by the medical

director, including, but not limited to:

(A) Aspirin.

authorized in this Section, Section 100064, and Section 100064.1.

(d) During a mutual aid response into another jurisdiction, an EMT may

utilize the scope of practice for which s/he is trained and authorized

according to the policies and procedures established by the LEMSA within

the jurisdiction where the EMT is employed as part of an organized EMS

system.

Note: Authority cited: Sections 1797.107, 1797.109 and 1797.170, Health

and Safety Code. Reference: Sections 1797.8, 1797.170, 1797.197 and

1797.221, Health and Safety Code.

§ 100063.1. EMT AED Service Provider.

An EMT AED service provider is an agency or organization that employs

individuals as defined in Section 100060, and who obtain AEDs for the

purpose of providing AED services to the general public.

(a) An EMT AED service provider shall be approved by the LEMSA, or in the

case of state or federal agencies, the Authority, prior to beginning service.

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The Authority shall notify LEMSAs of state or federal agencies approved as

EMT AED service providers. In order to receive and maintain EMT AED

service provider approval, an EMT AED service provider shall comply with

the requirements of this section.

(b) An EMT AED service provider approval may be revoked or suspended

for failure to maintain the requirements of this section.

and provide the following:

(1) Provide orientation of AED authorized personnel to the AED;

(2) Ensure maintenance of AED equipment;

(3) Prior to January 1, 2002, ensure initial training and, thereafter, continued

competency of AED authorized personnel;

(4) Collect and report to the LEMSA where the defibrillation occurred, as

required by the LEMSA but no less than annually, data that includes, but is

not limited to:

(A) The number of patients with sudden cardiac arrest receiving CPR prior

to arrival of emergency medical care.

(B) The total number of patients on whom defibrillatory shocks were

administered, witnessed (seen or heard) and not witnessed; and

whose initial monitored rhythm was ventricular tachycardia or ventricular

fibrillation.

(5) Authorize personnel and maintain a current listing of all EMT AED

service providers authorized personnel and provide listing upon request to

the LEMSA or the Authority.

(d) An approved EMT AED service provider and their authorized personnel

shall be recognized statewide.

(e) Authorized personnel means EMT personnel trained to operate an AED

and authorized by an approved EMT AED service provider.

Note: Authority cited: Sections 1797.107 and 1797.170, Health and Safety

Code. Reference: Sections 1797.170, 1797.178, 1797.196, 1797.200,

1797.202, 1797.204, 1797.220, 1798 and 1798.2, Health and Safety Code.

Regulations in Effect as of July 1, 2021 ● 70

§ 100064. EMT Optional Skills.

(a) In addition to the activities authorized by Section 100063 of this Chapter,

a LEMSA may establish policies and procedures for local accreditation of an

EMT student or certified EMT to perform any or all of the following optional

skills specified in this section. Accreditation for EMTs to practice optional

skills shall be limited to those whose EMT certificate is active and are

employed within the jurisdiction of the LEMSA by an employer who is part of

the organized EMS system.

(1) Use of perilaryngeal airway adjuncts.

(A) Training in the use of perilaryngeal airway adjuncts shall consist of not

less than five (5) hours to result in the EMT being competent in the use of

the device and airway control. Included in the above training hours shall be

the following topics and skills:

1. Anatomy and physiology of the respiratory system.

2. Assessment of the respiratory system.

3. Review of basic airway management techniques, which includes manual

and mechanical.

4. The role of the perilaryngeal airway adjuncts in the sequence of airway

control.

5. Indications and contraindications of the perilaryngeal airway adjuncts.

6. The role of pre-oxygenation in preparation for the perilaryngeal airway

adjuncts.

7. Perilaryngeal airway adjuncts insertion and assessment of placement.

8. Methods for prevention of basic skills deterioration.

9. Alternatives to the perilaryngeal airway adjuncts.

(B) At the completion of initial training a student shall complete a

competency-based written and skills examination for airway management

which shall include the use of basic airway equipment and techniques and

use of perilaryngeal airway adjuncts.

demonstration that requires the accredited EMT to demonstrate skills

competency at least every two (2) years, or more frequently as determined

by the EMSQIP.

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(2) Administration of epinephrine by prefilled syringe and/or drawing up the

proper drug dose into a syringe for suspected anaphylaxis and/or severe

asthma.

(A) Training in the administration of epinephrine by prefilled syringe and/or

drawing up the proper drug dose into a syringe for suspected anaphylaxis

and/or severe asthma shall consist of no less than two (2) hours to result in

the EMT being competent in the use and administration of epinephrine by

prefilled syringe and/or drawing up the proper drug dose into a syringe and

managing a patient of a suspected anaphylactic reaction and/or

experiencing severe asthma symptoms. Included in the training hours listed

above shall be the following topics and skills:

1. Names

2. Indications

3. Contraindications

4. Complications

5. Side/adverse effects

6. Interactions

7. Routes of administration

8. Calculating dosages

9. Mechanisms of drug actions

10. Medical asepsis

11. Disposal of contaminated items and sharps

12. Medication administration

(B) At the completion of this training, the student shall complete a

competency based written and skills examination for the use and/or

administration of epinephrine by prefilled syringe and/or drawing up the

proper drug dose into a syringe, which shall include:

1. Assessment of when to administer epinephrine,

2. Managing a patient before and after administering epinephrine,

3. Using universal precautions and body substance isolation procedures

during medication administration,

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4. Demonstrating aseptic technique during medication administration,

5. Demonstrating preparation and administration of epinephrine by prefilled

syringe and/or drawing up the proper drug dose into a syringe, and

6. Proper disposal of contaminated items and sharps.

(3) Administer the medications listed in this subsection.

(A) Using prepackaged products, the following medications may be

administered:

1. Atropine

2. Pralidoxime Chloride

(B) This training shall consist of no less than two (2) hours of didactic and

skills laboratory training to result in competency. In addition, a basic

weapons of mass destruction training is recommended. Training in the

profile of medications listed in subsection (A) shall include, but not be limited

to:

1. Indications

2. Contraindications

3. Side/adverse effects

4. Routes of administration

5. Dosages

6. Mechanisms of drug action

7. Disposal of contaminated items and sharps

8. Medication administration

competency based written and skills examination for the administration of

medications listed in this subsection which shall include:

1. Assessment of when to administer these medications,

2. Managing a patient before and after administering these medications,

3, Using universal precautions and body substance isolation procedures

during medication administration,

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4. Demonstrating aseptic technique during medication administration,

5. Demonstrating the preparation and administration of medications by the

intramuscular route, and

6. Proper disposal of contaminated items and sharps.

(4) Monitor preexisting vascular access devices and intravenous lines

delivering fluids with additional medications pre-approved by the Director of

the Authority. Approval of such medications shall be obtained pursuant to

the following procedures:

(A) The medical director of the LEMSA shall submit a written request, Form

#EMSA-0391, revised (01/17), herein incorporated by reference, and obtain

approval from the director of the Authority, who shall consult with a

committee of LEMSA medical directors named by the Emergency Medical

Services Medical Directors' Association of California, Inc. (EMDAC), for any

additional medications that in his/her professional judgment should be

approved for implementation of Section 100064(a)(4).

(B) The Authority shall, within fourteen (14) working days of receiving the

request, notify the medical director of the LEMSA submitting the request that

the request has been received, and shall specify what information, if any, is

missing.

disapprove the additional medications within ninety (90) calendar days of

receipt of the completed request.

(b) A LEMSA shall establish policies and procedures for skills competency

demonstration that requires the accredited EMT to demonstrate skills

competency at least every two (2) years, or more frequently as determined

by the EMSQIP.

skill allowed. The plan shall, at a minimum, include the following:

(1) A description of the need for the use of the optional skill.

(2) A description of the geographic area within which the optional skill will be

utilized, except as provided in Section 100064(i).

(3) A description of the data collection methodology which shall also include

an evaluation of the effectiveness of the optional skill.

(4) The policies and procedures to be instituted by the LEMSA regarding

medical control and use of the optional skill.

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(5) The LEMSA shall develop policies for accreditation action, pursuant to

Chapter 6 of this Division, for individuals who fail to demonstrate

competency.

(d) A LEMSA medical director who accredits EMTs to perform any optional

skill shall:

(1) Establish policies and procedures for the approval of service provider(s)

utilizing approved optional skills.

(2) Approve and designate selected base hospital(s) as the LEMSA deems

necessary to provide direction and supervision of accredited EMTs in

accordance with policies and procedures established by the LEMSA.

(3) Establish policies and procedures to collect, maintain and evaluate

patient care records.

(4) Establish an EMSQIP. EMSQIP means a method of evaluation of

services provided, which includes defined standards, evaluation of

methodology(ies) and utilization of evaluation results for continued system

improvement. Such methods may include, but not be limited to, a written

plan describing the program objectives, organization, scope and

mechanisms for overseeing the effectiveness of the program.

(5) Establish policies and procedures for additional training necessary to

maintain accreditation for each of the optional skills contained in this

section, if applicable.

(e) The LEMSA medical director may approve an optional skill medical

director to be responsible for accreditation and any or all of the following

requirements.

(1) Approve and monitor training programs for optional skills including

refresher training within the jurisdiction of the LEMSA.

(2) Establish policies and procedures for continued competency in the

optional skill which will consist of organized field care audits, periodic

training sessions and/or structured clinical experience.

(f) The optional skill medical director may delegate the specific field care

audits, training, and demonstration of competency, if approved by the

LEMSA medical director, to a Physician, Registered Nurse, Physician

Assistant, Paramedic, or Advanced EMT, licensed or certified in California

or a physician licensed in another state immediately adjacent to the LEMSA

jurisdiction.

Regulations in Effect as of July 1, 2021 ● 75

(g) An EMT accredited in an optional skill may assist in demonstration of

competency and training of that skill.

(h) In order to be accredited to utilize an optional skill, an EMT shall

demonstrate competency through passage, by preestablished standards,

developed and/or approved by the LEMSA, of a competency-based written

and skills examination which tests the ability to assess and manage the

specified condition.

(i) During a mutual aid response into another jurisdiction, an EMT may

utilize the scope of practice for which s/he is trained, certified and accredited

according to the policies and procedures established by his/her certifying or

accrediting LEMSA.

Note: Authority cited: Sections 1797.107 and 1797.170, Health and Safety

Code. Reference: Sections 1797.8, 1797.52, 1797.58, 1797.90, 1797.170,

1797.173, 1797.175, 1797.176, 1797.202, 1797.208, 1797.212, 1798,

1798.2, 1798.100, 1798.102 and 1798.104, Health and Safety Code.

§ 100064.1. EMT Trial Studies.

An EMT may perform any prehospital emergency medical care treatment

procedure(s) or administer any medication(s) on a trial basis when approved

by the medical director of the LEMSA and the director of the Authority. The

medical director of the LEMSA shall review the medical literature on the

procedure or medication and determine in his/her professional judgement

whether a trial study is needed.

(a) The medical director of the LEMSA shall review a trial study plan which,

at a minimum, shall include the following:

(1) A description of the procedure(s) or medication(s) proposed, the medical

conditions for which they can be utilized, and the patient population that will

benefit.

(2) A compendium of relevant studies and material from the medical

literature.

(3) A description of the proposed study design, including the scope of study

and method of evaluating the effectiveness of the procedure(s) or

medication(s), and expected outcome.

(4) Recommended policies and procedures to be instituted by the LEMSA

regarding the use and medical control of the procedure(s) or medication(s)

used in the study.

Regulations in Effect as of July 1, 2021 ● 76

(5) A description of the training and competency testing required to

implement the study. Training on subject matter shall be consistent with the

related topic(s) and skill(s) specified in Section 100159, Chapter 4

(Paramedic regulations), Division 9, Title 22, California Code of Regulations.

(b) The medical director of the LEMSA shall appoint a local medical advisory

committee to assist with the evaluation and approval of trial studies. The

membership of the committee shall be determined by the medical director of

the LEMSA, but shall include individuals with knowledge and experience in

research and the effect of the proposed study on the EMS system.

a copy of the proposed trial study plan at least forty-five (45) calendar days

prior to the proposed initiation of the study to the director of the Authority for

approval in accordance with the provisions of Section 1797.221 of the

Health and Safety Code. The Authority shall inform the Commission on EMS

of studies being initiated.

(d) The Authority shall notify the medical director of the LEMSA submitting

its request for approval of a trial study within fourteen (14) working days of

receiving the request that the request has been received.

(e) The Director of the Authority shall render the decision to approve or

disapprove the trial study within forty-five (45) calendar days of receipt of all

materials specified in subsections (a) and (b) of this section.

(f) Within eighteen (18) months of the initiation of the procedure(s) or

medication(s), the medical director of the LEMSA shall submit to the

Commission on EMS a written report which includes at a minimum the

progress of the study, number of patients studied, beneficial effects, adverse

reactions or complications, appropriate statistical evaluation, and general

conclusion.

(g) The Commission on EMS shall review the above report within two (2)

meetings and advise the Authority to do one of the following:

(1) Recommend termination of the study if there are adverse effects or if no

benefit from the study is shown.

(2) Recommend continuation of the study for a maximum of eighteen (18)

additional months if potential but inconclusive benefit is shown.

(3) Recommend the procedure or medication be added to the EMT scope of

practice.

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(h) If option (g)(2) is selected, the Commission on EMS may advise

continuation of the study as structured or alteration of the study to increase

the validity of the results.

(i) At the end of the additional eighteen (18) month period, a final report shall

be submitted to the Commission on EMS with the same format as described

in (f) above.

(j) The Commission on EMS shall review the final report and advise the

Authority to do one of the following:

(1) Recommend termination or further extension of the study.

(2) Accept the study recommendations.

(3) Recommend the procedure or medication be added to the EMT scope of

practice.

(k) The Authority may require a trial study(ies) to cease after thirty-six (36)

months.

Note: Authority cited: Section 1797.107 and 1797.170, Health and Safety

Code. Reference: Sections 1797.170 and 1797.221, Health and Safety

Code.

TICLE 3: Program Requirements for EMT Training Programs

§ 10

0065. Approved Training Programs.

(a) The purpose of an EMT training program shall be to prepare individuals

to render prehospital basic life support at the scene of an emergency, during

transport of the sick and injured, or during interfacility transfer within an

organized EMS system.

(b) EMT training may be offered only by approved training programs.

Eligibility for program approval shall be limited to:

(1) Accredited universities and colleges including junior and community

colleges, school districts, and private post-secondary schools as approved

by the State of California, Department of Consumer Affairs, Bureau of

Private Postsecondary and Vocational Education.

(2) Medical training units of a branch of the Armed Forces including the

Coast Guard of the United States.

(3) Licensed general acute care hospitals which meet the following criteria:

Regulations in Effect as of July 1, 2021 ● 78

(A) Hold a special permit to operate a Basic or Comprehensive Emergency

Medical Service pursuant to the provisions of Division 5; and

(B) provide continuing education to other health care professionals.

(4) Agencies of government including public safety agencies.

(5) LEMSAs.

Note: Authority cited: Sections 1797.107, 1797.109, 1797.170 and

1797.173, Health and Safety Code. Reference: Sections 1797.170,

1797.173, 1797.208 and 1797.213 Health and Safety Code.

§ 100066. Procedure for EMT Training Program Approval.

(a) Eligible training programs may submit a written request for EMT program

approval to an EMT approving authority.

(b) The EMT approving authority shall review and approve the following

prior to approving an EMT training program:

(1) A statement verifying usage of the U.S. Department of Transportation

(DOT) National EMS Education Standards (DOT HS 811 077A, January

2009).

(2) A statement verifying CPR training equivalent to the current American

Heart Association's Guidelines for Cardiopulmonary Resuscitation and

Emergency Cardiovascular Care at the Healthcare Provider level is a

prerequisite for admission to an EMT basic course.

(3) Samples of written and skills examinations used for periodic testing.

(4) A final skills competency examination.

(5) A final written examination.

(6) The name and qualifications of the program director, program clinical

coordinator, and principal instructor(s).

(7) Provisions for clinical experience, as defined in Section 100068 of this

Chapter.

(8) Provisions for course completion by challenge, including a challenge

examination (if different from final examination).

(9) Provisions for a twenty-four (24) hour refresher course including

subdivisions (1)-(6) above, required for recertification.

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(A) A statement verifying usage of the United States Department of

Transportation's EMT-Basic Refresher National Standard Curriculum, DOT

HS 808 624, September 1996. The U.S. Department of Transportation's

EMT-Basic Refresher National Standard Curriculum can be accessed

through the U.S. Department of Transportation's website,

https://www.nhtsa.gov/people/injury/ems/pub/basicref.pdf.

(10) The location at which the courses are to be offered and their proposed

dates.

(11) Table of contents listing the required information listed in this

subdivision, with corresponding page numbers.

Authority shall assure that a statewide public safety agency meets the

following criteria in order to approve that agency as qualified to conduct a

statewide EMT training program:

(1) Has a statewide role and responsibility in matters affecting public safety.

(2) Has a centralized authority over its EMT training program instruction

which can correct any elements of the program found to be in conflict with

this Chapter.

(3) Has a management structure which monitors all of its EMT training

programs.

(4) Has designated a liaison to the Authority who shall respond to problems

or conflicts identified in the operation of its EMT training program.

(5) In addition, these agencies shall meet the following additional

requirements:

(A) Designate the principal instructor as a liaison to the EMT approving

authority for the county in which the training is conducted; and

(B) Consult with the EMT approving authority for the county in which the

training is located in developing the EMS System Orientation portion of the

EMT course.

(d) The EMT approving authority shall make available to the Authority, upon

request, any or all materials submitted pursuant to this Section by an

approved EMT training program in order to allow the Authority to make the

determination required by Section 1797.173 of the Health and Safety Code.

Regulations in Effect as of July 1, 2021 ● 80

Note: Authority cited: Sections 1797.107, 1797.109 and 1797.170, Health

and Safety Code. Reference: Sections 1797.170, 1797.173, 1797.208 and

1797.213, Health and Safety Code.

§ 100067. Didactic and Skills Laboratory.

An approved EMT training program shall assure that no more than ten (10)

students are assigned to one (1) principal instructor/teaching assistant

during skills practice/laboratory sessions.

Note: Authority cited: Sections 1797.107, 1797.109, 1797.170 and

1797.173, Health and Safety Code. Reference: Sections 1797.170,

1797.173 and 1797.208, Health and Safety Code.

§ 100068. Clinical Experience for EMT.

Each approved EMT training program shall have written agreement(s) with

one or more general acute care hospital(s) and/or operational ambulance

provider(s) or rescue vehicle provider(s) for the clinical portion of the EMT

training course. The written agreement(s) shall specify the roles and

responsibilities of the training program and the clinical provider(s) for

supplying the supervised clinical experience for the EMT student(s).

Supervision for the clinical experience shall be provided by an individual

who meets the qualifications of a principal instructor or teaching assistant.

No more than three (3) students will be assigned to one (1) qualified

supervisor during the supervised clinical experience.

Note: Authority cited: Sections 1797.107, 1797.109, 1797.170 and

1797.173, Health and Safety Code. Reference: Sections 1797.170,

1797.173 and 1797.208, Health and Safety Code.

§ 100069. EMT Training Program Notification.

(a) Program approval or disapproval shall be made in writing by the EMT

approving authority to the requesting training program within a reasonable

period of time after receipt of all required documentation. This time period

shall not exceed three (3) months.

(b) The EMT approving authority shall establish the effective date of

program approval in writing upon the satisfactory documentation of

compliance with all program requirements.

approval is issued. The approval shall be valid for four (4) years ending on

the last day of the month in which it was issued and may be renewed every

four (4) years subject to the procedure for program approval specified in this

Chapter.

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(d) The LEMSA shall notify the Authority concurrently with the training

program of approval, renewal of approval, or disapproval of the training

program, and include the effective date. This notification is in addition to the

name and address of training program, name of the program director, phone

number of the contact person, frequency and cost for both basic and

refresher courses, student eligibility, and program approval/ expiration date

of program approval.

Note: Authority cited: Sections 1797.107, 1797.109 and 1797.170, Health

and Safety Code. Reference: Sections 1797.109, 1797.170, 1797.173 and

1797.208, Health and Safety Code.

§ 100070. Teaching Staff.

(a) Each EMT training program shall provide for the functions of

administrative direction, medical quality coordination, and actual program

instruction. Nothing in this section precludes the same individual from being

responsible for more than one of the following functions if so qualified by the

provisions of this section:

(b) Each EMT training program shall have an approved program director

who shall be qualified by education and experience with at least forty (40)

hours of documented teaching methodology instruction in areas related to

methods, materials, and evaluation of instruction.

coordinator, shall include but not be limited to:

(1) Administering the training program.

(2) Approving course content.

(3) Approving all written examinations and the final skills examination.

(4) Coordinating all clinical and field activities related to the course.

(5) Approving the principal instructor(s) and teaching assistants.

(6) Signing all course completion records.

(7) Assuring that all aspects of the EMT training program are in compliance

with this Chapter and other related laws.

(d) Each training program shall have an approved program clinical

coordinator who shall be either a Physician, Registered Nurse, Physician

Assistant, or a Paramedic currently licensed in California, and who shall

have two (2) years of academic or clinical experience in emergency

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medicine or prehospital care in the last five (5) years. Duties of the program

clinical coordinator shall include, but not be limited to:

(1) Responsibility for the overall quality of medical content of the program;

(2) Approval of the qualifications of the principal instructor(s) and teaching

assistant(s).

(e) Each training program shall have a principal instructor(s), who may also

be the program clinical coordinator or program director, who shall be

qualified by education and experience with at least forty (40) hours of

documented teaching methodology instruction in areas related to methods,

materials, and evaluation of instruction and shall meet the following

qualifications:

(1) Be a Physician, Registered Nurse, Physician Assistant, or Paramedic

currently licensed in California; or,

(2) Be an Advanced EMT or EMT who is currently certified in California.

(3) Have at least two (2) years of academic or clinical experience in the

practice of emergency medicine or prehospital care in the last five (5) years.

(4) Be approved by the program director in coordination with the program

clinical coordinator as qualified to teach the topics to which s/he is assigned.

All principal instructors from approved EMT Training Programs shall meet

the minimum qualifications as specified in subsection (e) of this Section.

(f) Each training program may have teaching assistant(s) who shall be

qualified by training and experience to assist with teaching of the course and

shall be approved by the program director in coordination with the program

clinical coordinator as qualified to assist in teaching the topics to which the

assistant is to be assigned. A teaching assistant shall be supervised by a

principal instructor, the program director and/or the program clinical

coordinator.

Note: Authority cited: Sections 1797.107, 1797.109 and 1797.170, Health

and Safety Code. Reference: Sections 1797.109, 1797.170 and 1797.208,

Health and Safety Code.

§ 100071. EMT Training Program Review and Reporting.

(a) All program materials specified in this Chapter shall be subject to

periodic review by the EMT approving authority.

(b) All programs shall be subject to periodic on-site evaluation by the EMT

approving authority.

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approving authority in writing, in advance when possible, and in all cases

within thirty (30) calendar days of any change in program director, program

clinical coordinator, principal instructor, change of address, phone number,

and contact person.

(d) For the purposes of this Chapter, student records shall be kept for a

period of not less than four (4) years.

Note: Authority cited: Sections 1797.107, 1797.109 and 1797.170, Health

and Safety Code. Reference: Sections 1797.109, 1797.170 and 1797.208,

Health and Safety Code.

§ 100072. Withdrawal of EMT Training Program Approval.

(a) Failure to comply with the provisions of this Chapter may result in denial,

probation, suspension or revocation of program approval by the EMT

training program approving authority.

(b) The requirements for training program noncompliance notification and

actions are as follows:

(1) An EMT training program approving authority shall provide notification of

noncompliance with this Chapter to the EMT training program provider

found in violation. The notification shall be in writing and sent by certified

mail to the EMT training program course director.

(2) Within fifteen (15) working days from receipt of the noncompliance

notification the approved EMT training program shall submit in writing, by

certified mail, to the EMT training program approving authority one of the

following:

(A) Evidence of compliance with the provisions of this Chapter, or

(B) A plan to comply with the provisions of this Chapter within sixty (60)

calendar days from the day of receipt of the notification of noncompliance.

(3) Within fifteen (15) working days from receipt of the approved EMT

training program's response, or within thirty (30) calendar days from the

mailing date of the noncompliance notification if no response is received

from the approved EMT training program, the EMT training program

approving authority shall issue a decision letter by certified mail to the

Authority and the approved EMT training program. The letter shall identify

the EMT training program approving authority's decision to take one or more

of the following actions:

(A) Accept the evidence of compliance provided.

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(B) Accept the plan for meeting compliance.

(D) Suspend or revoke the training program approval.

(4) The decision letter shall also include, but not be limited to, the following:

(A) Date of the training program approving authority's decision;

(B) Specific provisions found noncompliant by the training program

approving authority, if applicable;

(D) The terms and conditions of the probation or suspension, if applicable;

and

(E) The revocation effective date, if applicable.

(5) If the training program found noncompliant with this Chapter does not

comply with subsection (2) of this Section, the EMT training program

approving authority may uphold the noncompliance finding and initiate a

probation, suspension, or revocation action as described in subsection (3) of

this Section.

(6) The EMT training program approving authority shall establish the

probation, suspension, or revocation effective dates no sooner than sixty

(60) days after the date of the decision letter, as described in subsection (3)

of this Section.

Note: Authority cited: Sections 1797.107, 1797.109 and 1797.170, Health

and Safety Code. Reference: Sections 1797.109, 1797.170 and 1797.208,

Health and Safety Code; and Section 11505, Government Code.

§ 100073. Components of an Approved Program.

(a) An approved EMT training program shall consist of all of the following:

(1) The EMT course, including clinical experience;

(2) Periodic and final written and skills competency examinations to include

all skills covered by course content listed in section 100075;

(3) A challenge examination; and

(4) A refresher course required for renewal or reinstatement.

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(b) The approving authority may approve a training program that offers only

refresher course(s).

Note: Authority cited: Sections 1797.107, 1797.109, 1797.170 and

1797.175, Health and Safety Code. Reference: Sections 1797.109,

1797.170 and 1797.208, Health and Safety Code.

§ 100074. EMT Training Program Required Course Hours.

(a) The EMT course shall consist of not less than one hundred seventy

(170) hours. These training hours shall be divided into:

(1) A minimum of one hundred forty-six (146) hours of didactic instruction

and skills laboratory; and

(2) A minimum of twenty-four (24) hours of supervised clinical experience.

The clinical experience shall include a minimum of ten (10) documented

patient contacts wherein a patient assessment and other EMT skills are

performed and evaluated.

(A) High fidelity simulation, when available, may replace up to six (6) hours

of supervised clinical experience and may replace up to three (3)

documented patient contacts.

(b) The minimum hours shall not include the examinations for EMT

certification as specified in Sections 100059 and 100059.1 of this Chapter.

Note: Authority cited: Sections 1797.107, 1797.109 and 1797.170, Health

and Safety Code. Reference: Sections 1797.170 and 1797.208, Health and

Safety Code.

§ 100075. Required Course Content.

(a) The content of an EMT course shall meet the objectives contained in the

U.S. Department of Transportation (DOT) National EMS Education

Standards (DOT HS 811 077A, January 2009), incorporated herein by

reference, to result in the EMT being competent in the EMT basic scope of

practice specified in Section 100063 of this Chapter. The U.S. DOT National

EMS Education Standards (DOT HS 811 077A, January 2009) can be

accessed through the U.S. DOT National Highway Traffic Safety

Administration at the following website address:

https://ems.gov/pdf/811077a.pdf

(b) Training in the use of hemostatic dressings shall result in the EMT being

competent in the use of the dressing. Included in the training shall be the

following topics and skills:

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(1) Review of basic methods of bleeding control to include but not be limited

to direct pressure, pressure bandages, tourniquets, and EMSA-approved

hemostatic dressings;

(2) Review treatment of open chest wall injuries;

(3) Types of hemostatic dressings; and

(4) Importance of maintaining normal body temperature.

result in the EMT being competent in the administration of naloxone and

managing a patient of a suspected narcotic overdose and shall include the

following topics and skills:

(1) Common causative agents.

(2) Assessment findings.

(3) Management to include, but not be limited to:

(A) Need for appropriate personal protective equipment and scene safety

awareness.

(4) Profile of Naloxone to include, but not be limited to:

(A) Indications.

(B) Contraindications.

(D) Routes of administration.

(E) Dosages.

(F) Mechanisms of drug action.

(G) Calculating drug dosages.

(H) Medical asepsis.

(I) Disposal of contaminated items and sharps.

(J) Medication administration.

(d) Training in the administration of epinephrine for suspected anaphylaxis

and/or severe asthma shall result in the EMT being competent in the use

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and administration of epinephrine by auto-injector and managing a patient of

a suspected anaphylactic reaction and/or experiencing severe asthma

symptoms. Included in the training shall be the following topics and skills:

(1) Common causative agents.

(2) Assessment findings.

(3) Management to include, but not be limited to:

(A) Need for appropriate personal protective equipment and scene safety

awareness.

(4) Profile of epinephrine to include, but not be limited to:

(A) Indications

(B) Contraindications.

(D) Mechanisms of drug action.

(5) Administration by auto-injector.

(6) Medical asepsis.

(7) Disposal of contaminated items and sharps.

(e) Training in the use of finger stick blood glucose testing shall result in the

EMT being competent in the use of a glucometer and managing a patient

with a diabetic emergency. Included in the training shall be the following

topics and skills:

(1) Blood glucose determination.

(A) Assess blood glucose level.

(B) Indications.

1. Decreased level of consciousness in the suspected diabetic.

2. Decreased level of consciousness of unknown origin.

1. Medical asepsis.

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2. Refer to manufacturer's instructions for device being used.

(D) Disposal of sharps.

(E) Limitations.

1. Lack of calibration.

(F) Interpretation of results.

(G) Patient assessment.

(H) Managing a patient before and after finger stick glucose testing.

(f) In addition to the above, the content of the training course shall include a

minimum of four (4) hours of tactical casualty care (TCC) principles applied

to violent circumstances with at least the following topics and skills, and

shall be competency based:

(1) History and Background of Tactical Casualty Care:

(A) Demonstrate knowledge of tactical casualty care.

1. History of active shooter and domestic terrorism incidents.

2. Define roles and responsibilities of first responders including Law

Enforcement, Fire and EMS.

3. Review of local active shooter policies.

4. Scope of practice and authorized skills and procedures by level of

training, certification, and licensure zone.

(2) Terminology and definitions.

(A) Demonstrate knowledge of terminology.

1. Hot zone/warm zone/cold zone.

2. Casualty collection point.

3. Rescue task force.

4. Cover/concealment.

(3) Coordination Command and Control.

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(A) Demonstrate knowledge of Incident Command and how agencies are

integrated into tactical operations.

1. Demonstrate knowledge of team command, control and communication.

a. Incident Command System (ICS) /National Incident Management System

(NIMS)

b. Mutual Aid considerations.

c. Unified Command.

d. Communications, including radio interoperability.

e. Command post.

i. Staging areas.

ii. Ingress/egress.

iii. Managing priorities.

(4) Tactical and Rescue Operations.

(A) Demonstrate knowledge of tactical and rescue operations.

1. Tactical Operations - Law Enforcement.

a. The priority is to mitigate the threat.

b. Contact Team.

c. Rescue Team.

2. Rescue Operations - Law Enforcement/EMS/Fire.

a. The priority is to provide life-saving interventions to injured parties.

b. Formation of Rescue Task Force (RTF).

c. Casualty collection points.

(5) Basic Tactical Casualty Care and Evacuation.

(A) Demonstrate appropriate casualty care at your scope of practice and

certification.

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1. Demonstrate knowledge of the components of the Individual First Aid Kit

(IFAK) and/or medical kit.

a. Understand the priorities of Tactical Casualty Care as applied by zone.

(B) Demonstrate competency through practical testing of the following

medical treatment skills:

1. Bleeding control.

a. Apply Tourniquet.

i. Self-Application.

ii. Application on others.

b. Apply Direct Pressure.

c. Apply Pressure Dressing.

d. Apply Hemostatic Dressing with Wound Packing, utilizing California

EMSA-approved products.

2. Airway and Respiratory management.

a. Perform Chin Lift/Jaw Thrust Maneuver.

b. Recovery position.

c. Position of comfort.

d. Airway adjuncts.

3. Chest/torso wounds.

a. Apply Chest Seals vented preferred.

1. Drags and lifts.

2. Carries.

(D) Demonstrate knowledge of local multi-casualty/mass casualty incident

protocols.

1. Triage procedures (START or SALT).

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2. CCP - Triage, Treatment and Transport.

(6) Threat Assessment.

(A) Demonstrate knowledge in threat assessment.

1. Understand and demonstrate knowledge of situational awareness.

a. Pre-assessment of community risks and threats.

b. Pre-incident planning and coordination

c. Medical resources available.

(g) Training programs in operation prior to the effective date of this

subsection shall submit evidence of compliance with this Chapter to the

appropriate approving authority as specified in Section 100057 of this

Chapter within twelve (12) months after the effective date of this subsection.

Note: Authority cited: Sections 1797.107, 1797.109 and 1797.170, Health

and Safety Code. Reference: Sections 1797.116, 1797.170 and 1797.173,

Health and Safety Code.

§ 100076. Required Testing.

Each component of an approved program shall include periodic and final

competency-based examinations to test the knowledge and skills specified

in this Chapter. Satisfactory performance in these written and skills

examinations shall be demonstrated for successful completion of the

course. Satisfactory performance shall be determined by preestablished

standards, developed and/or approved by the EMT approving authority

pursuant to Section 100066 of this Chapter.

Note: Authority cited: Sections 1797.107, 1797.109 and 1797.170, Health

and Safety Code. Reference: Sections 1797.109, 1797.170, 1797.208 and

1797.210, Health and Safety Code.

§ 100077. EMT Training Program Course Completion Record.

(a) An approved EMT training program provider shall issue a tamper

resistant course completion record to each person who has successfully

completed the EMT course, refresher course, or challenge examination.

(b) The course completion record shall contain the following:

(1) The name of the individual.

(2) The date of course completion.

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(3) Type of EMT course completed (i.e., EMT, refresher, or challenge), and

the number of hours completed.

(4) The EMT approving authority.

(5) The signature of the program director.

(6) The name and location of the training program issuing the record.

(7) The following statement in bold print. “This is not an EMT certificate”.

maximum of two (2) years from the course completion date and shall be

recognized statewide.

(d) The name and address of each person receiving a course completion

record and the date of course completion shall be reported in writing to the

appropriate EMT certifying authority within fifteen (15) days of course

completion.

(e) Approved EMT training programs which are also approved EMT

Certifying Entities need not issue a Course Completion record to those

students who will receive certification from the same agency.

Note: Authority cited: Sections 1797.107, 1797.109 and 1797.170, Health

and Safety Code. Reference: Sections 1797.109, 1797.170 and 1797.208,

Health and Safety Code.

§ 100078. EMT Training Program Course Completion Challenge Process.

(a) An individual may obtain an EMT course completion record from an

approved EMT training program by successfully passing by pre-established

standards, developed and/or approved by the EMT approving authority

pursuant to Section 100066 of this Chapter, a course challenge examination

if s/he meets one of the following eligibility requirements:

(1) The individual is currently licensed in the United States as a Physician,

Registered Nurse, Physician Assistant, Vocational Nurse, or Licensed

Practical Nurse.

(2) The individual provides documented evidence of having successfully

completed an emergency medical service training program of the Armed

Forces of the United States within the preceding two (2) years that meets

the U.S. DOT National EMS Education Standards (DOT HS 811 077A,

January 2009). Upon review of documentation, the EMT certifying entity

may also allow an individual to challenge if the individual was active in the

last two (2) years in a prehospital emergency medical classification of the

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Armed Services of the United States, which does not have formal

recertification requirements. These individuals may be required to take a

refresher course or complete CE courses as a condition of certification.

(b) The course challenge examination shall consist of a competency-based

written and skills examination to test knowledge of the topics and skills as

prescribed in this Chapter.

examination no less than once each time the EMT course is given (unless

otherwise specified by the program's EMT approving authority).

(d) An eligible individual shall be permitted to take the EMT course

challenge examination only one (1) time.

(e) An individual who fails to achieve a passing score on the EMT course

challenge examination shall successfully complete an EMT course to

receive an EMT course completion record.

Note: Authority cited: Sections 1797.107, 1797.109 and 1797.170, Health

and Safety Code. Reference: Sections 1797.109, 1797.170, 1797.208 and

1797.210, Health and Safety Code.

TICLE 4: EMT Certification

§ 100079. EMT Initial Certification Requirements.

(a) An individual who meets one of the following criteria shall be eligible for

initial certification upon fulfilling the requirements of subdivision (b) of this

Section:

(1) Pass the cognitive examination and psychomotor examination specified

in Sections 100059 and 100059.1 of this Chapter within two (2) years from

the date of application for EMT certification and have a valid EMT course

completion record or other documented proof of successful completion of

any initial EMT course approved pursuant to Section 100066 of this Chapter

issued within two (2) years of the date of application, or

(2) Pass the cognitive examination and psychomotor examination specified

in Sections 100059 and 100059.1 of this Chapter within two (2) years from

the date of application for EMT certification and have documentation of

successful completion of an approved out-of-state initial EMT training

course that meets the requirements of this Chapter issued within two (2)

years of the date of application, or

(3) Pass the cognitive examination and psychomotor examination specified

in Sections 100059 and 100059.1 of this Chapter within two (2) years from

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the date of application for EMT certification and have a current and valid

out-of-state EMT certificate, or

(4) Possess a current and valid National Registry EMT, Advanced EMT or

Paramedic registration certificate, or

(5) Possess a current and valid out-of-state Advanced EMT or Paramedic

certificate, or

(6) Possess a current and valid California Advanced EMT certificate or a

current and valid California Paramedic license.

(b) In addition to meeting one of the criteria listed in subdivision (a), to be

eligible for initial certification, an individual shall:

(1) Be eighteen (18) years of age or older;

(2) Complete the criminal history background check requirement as

specified in Article 4, Chapter 10 of this Division. The certifying entity shall

receive the State and Federal criminal background check results before

issuing an initial certification;

(3) Complete an application form that contains this statement: “I hereby

certify under penalty of perjury that all information on this application is true

and correct to the best of my knowledge and belief, and I understand that

any falsification or omission of material facts may cause forfeiture on my

part of all rights to EMT certification in the state of California. I understand

all information on this application is subject to verification, and I hereby give

my express permission for this certifying entity to contact any person or

agency for information related to my role and function as an EMT in

California.”;

(4) Disclose any prior and/or current certification, licensure, or accreditation

actions:

(A) Against an EMT or Advanced EMT certificate, or any denial of

certification by a LEMSA, including any active investigations;

(B) Against a Paramedic license, or any denial of licensure by the Authority,

including any active investigations;

issuing entity, including denials and any active investigations; or

(D) Against any health-related license;

(5) Disclose any pending or current criminal investigations;

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(6) Disclose any pending criminal charges;

(7) Disclose any prior convictions;

(8) Disclose each certifying entity or LEMSA to which the applicant has

applied for certification in the previous 12 months; and

(9) Pay the established fee.

pursuant to Section 100344, subdivisions (c) and (d), of Chapter 10 of this

Division, within forty-five (45) days to eligible individuals who apply for an

EMT certificate and successfully complete the requirements of this Chapter.

(d) The effective date of initial certification shall be the day the certificate is

issued.

(e) The expiration date for an initial EMT certificate shall be the last day of

the month two (2) years from the effective date of the initial certification.

(f) The EMT shall be responsible for notifying the certifying entity of her/his

proper and current mailing address and shall notify the certifying entity in

writing within thirty (30) calendar days of any and all changes of the mailing

address, giving both the old and the new address, and EMT registry

number.

(g) An EMT shall only be certified by one (1) certifying entity during a

certification period.

Note: Authority cited: Sections 1797.107, 1797.109, 1797.170 and

1797.175, Health and Safety Code. Reference: Sections 1797.61, 1797.62,

1797.63, 1797.109, 1797.118, 1797.175, 1797.177, 1797.185, 1797.210

and 1797.216, Health and Safety Code.

TICLE 5: Maintaining EMT Certification

§ 10

0080. EMT Certification Renewal.

(a) In order to renew certification, an EMT shall:

(1) Possess a current EMT Certification issued in California.

(2) Meet one of the following continuing education requirements:

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(A) Successfully complete a twenty-four (24) hour refresher course from an

approved EMT training program within the 24 months prior to applying for

renewal, or

(B) Obtain at least twenty-four (24) hours of continuing education (CE),

within the 24 months prior to applying for renewal, from an approved CE

provider in accordance with the provisions contained in Chapter 11 of this

Division.

1. CE hours may be used to renew multiple licensure/certification types as

long as they are earned within the licensure/certification cycle being

renewed and were not used in a previous cycle.

(3) Complete an application form and other processes as specified in

Section 100079, subdivisions (b)(3)-(b)(9), of this Chapter.

(4) Complete the criminal history background check requirements as

specified in Article 4, Chapter 10 of this Division when changing certifying

entities. The certifying entity shall receive the State and Federal criminal

background check results before issuing a certification.

(5) Submit a completed skills competency verification form, EMSA-SCV

(01/17). Form EMSA-SCV (01/17) is herein incorporated by reference. Skills

competency shall be verified by direct observation of an actual or simulated

patient contact. Skills competency shall be verified by an individual who is

currently certified or licensed as an EMT, AEMT, Paramedic, Registered

Nurse, Physician's Assistant, or Physician and who shall be designated by

an EMS approved training program (EMT training program, AEMT training

program, Paramedic training program or CE provider), or an EMS service

provider. EMS service providers include, but are not limited to, public safety

agencies, private ambulance providers and other EMS providers.

Verification of skills competency shall be valid for a maximum of two (2)

years for the purpose of applying for recertification.

(6) Starting 24 months after the effective date of this subsection, an EMT

renewing his or her certification for the first time shall submit documentation

of successful completion of the following training by an approved EMT

training program or approved CE provider:

(A) The use and administration of naloxone or other opioid antagonist that

meets the standards and requirements of section 100075, subsection (c).

(B) The use and administration of epinephrine by auto-injector that meets

the standards and requirements of section 100075, subsection (d).

section 100075, subsection (e).

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(D) If an individual possesses a current California-issued paramedic license

or California Advanced EMT certificate, then the individual need not comply

with subsections (A)-(C), above.

(b) The EMT certifying entity shall issue a wallet-sized certificate card,

pursuant to Section 100344, subdivisions (c) and (d), of Chapter 10 of this

Division, within forty-five (45) days to eligible individuals who apply for EMT

renewal and successfully complete the requirements of this Chapter.

the current certification expiration date, the EMT Certifying entity shall make

the effective date of renewal the date immediately following the expiration

date of the current certificate. The certification will expire the last day of the

month two (2) years from the day prior to the effective date.

(d) If the EMT renewal requirements are met greater than six (6) months

prior to the expiration date, the EMT Certifying entity shall make the

effective date of renewal the day the certificate is issued. The certification

expiration date will be the last day of the month two (2) years from the

effective date.

(e) A California certified EMT who is a member of the Armed Forces of the

United States and whose certification expires while deployed on active duty,

or whose certification expires less than six (6) months from the date they

return from active duty deployment, with the Armed Forces of the United

States shall have six (6) months from the date they return from active duty

deployment to complete the requirements of Section 100080, subdivisions

(a)(2)-(a)(5). In order to qualify for this exception, the individual shall:

(1) Submit proof of his or her membership in the Armed Forces of the United

States, and

(2) Submit documentation of his or her deployment starting and ending

dates.

(3) Continuing education credit may be given for documented training that

meets the requirements of Chapter 11 of this Division while the individual

was deployed on active duty.

(4) The continuing education documentation shall include verification from

the individual's Commanding Officer attesting to the training attended.

Note: Authority cited: Sections 1797.107, 1797.109, 1797.170 and

1797.175, Health and Safety Code. Reference: Sections 1797.61, 1797.62,

1797.109, 1797.118, 1797.170, 1797.184, 1797.210 and 1797.216, Health

and Safety Code; and United States Code, Title 10, Subtitle A, Chapter 1,

Section 101.

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§ 100081. Reinstatement of an Expired California EMT Certificate.

(a) The following requirements apply to individuals who wish to be eligible

for reinstatement after their California EMT certificates have expired:

(1) For a lapse of less than six (6) months, the individual shall meet one of

the following continuing education requirements:

(A) Successfully complete a twenty-four (24) hour refresher course from an

approved EMT training program within the 24 months prior to applying for

reinstatement, or

(B) Obtain at least twenty-four (24) hours of continuing education (CE),

within the 24 months prior to applying for reinstatement, from an approved

CE provider in accordance with the provisions contained in Chapter 11 of

this Division.

1. CE hours may be used to renew multiple licensure/certification types.

Section 100079, subdivisions (b)(3)-(b)(9), of this Chapter.

(D) Complete the criminal history background check requirements as

specified in Article 4, Chapter 10 of this Division when the background

check results are not on file with the certifying entity that is processing the

reinstatement. The certifying entity shall receive the State and Federal

criminal background check results before issuing a certification.

(E) Submit a completed skills competency verification form, EMSA-SCV