All providers in our system must undergo credentialing to practice by the system Medical Director. CREDENTIALING is a process where providers who have the appropriate accreditation, licensure, and/or certification are granted authority by the EMS System Medical Director to represent the System and to practice to the extent of his/her licensure. After the credentialing process is completed, the successful candidate will be required to complete the employment process including drug screening and functional employment testing.
All Credentialed Providers within the EMS System are allowed to provide care under the direction of the Medical Director. The Medical Director delegates the authority to make medical decisions and provide clinical care. Delegated authority to provide medical care is a requirement of the Missouri Bureau of Emergency Medical Services. Credentialing is the final approval of the System and the Medical Director that ensures an individual's competency to care for patients as part of the Emergency Medical Services System. An individual is "Credentialed to Practice" when he or she successfully meets and maintains the defined Credentialing requirements.
Every Provider that delivers medical care within the System must be initially credentialed (for example when they are new to the System or just receive a new State Certification or Licensure) and must maintain their credentials in order to continue providing care at a designated level.
Emergency Medical Technician – Basic (EMT-B)
Initial Credentialing Requirements
Current EMT-B licensure by Missouri Bureau of Emergency Medical Services
Current NREMT certification as EMT-Basic
Current certification as AHA CPR provider
Completion of the System Clinical Operating Guidelines Exam
Successful completion of all System education requirements
Maintenance Requirements
Maintenance of EMT-B licensure by Missouri Bureau of Emergency Medical Services
Current certification as AHA CPR provider
Successful completion of all System education requirements
Advanced Emergency Medical Technician
Initial Credentialing Requirements
Current EMT-I licensure by Missouri Bureau of Emergency Medical Services
Current NREMT certification as EMT-Advanced
Current certification as AHA CPR provider
Completion of the System Clinical Operating Guidelines Exam
Successful completion of all System education requirements
Maintenance Requirements
Maintenance of EMT-I licensure by Missouri Bureau of Emergency Medical Services
Current certification as AHA CPR provider
Successful completion of all System education requirements
Emergency Medical Technician – Paramedic (EMT-P)
Initial Credentialing Requirements
Current EMT-P licensure by Missouri Bureau of Emergency Medical Services
Current certification as AHA CPR provider
Current AHA Advanced Cardiac Life Support (ACLS) certification
Pre-Hospital Trauma Life Support (PHTLS) certification (highly recommended)
Pediatric Advanced Life Support (PALS) certification (highly recommended)
Completion of System Clinical Operating Guidelines Exam
Successful completion of all System education requirements
Maintenance Requirements
Maintenance of EMT-P licensure by Missouri Bureau of EMS
Current certification as AHA CPR provider
Current AHA Advanced Cardiac Life Support (ACLS) certification
Pre-Hospital Trauma Life Support (PHTLS) certification (highly recommended)
Pediatric Advanced Life Support (PALS) certification (highly recommended)
Successful completion of all System education requirements
Registered Nurse - Prehospital (RN)
Initial Credentialing Requirements
Current RN licensure by Missouri Board of Nursing
Current certification as either an EMT-B or EMT-P
Current certification as AHA CPR provider
Current AHA Advanced Cardiac Life Support (ACLS) certification
Pre-Hospital Trauma Life Support (PHTLS) certification (highly recommended)
Pediatric Advanced Life Support (PALS) certification (highly recommended)
Completion of System Clinical Operating Guidelines Exam
Successful completion of all System education requirements
Maintenance Requirements
Maintenance of RN licensure by Missouri Board of Nursing
Current certification as AHA CPR provider
Current AHA Advanced Cardiac Life Support (ACLS) certification
Pre-Hospital Trauma Life Support (PHTLS) certification (highly recommended)
Pediatric Advanced Life Support (PALS) certification (highly recommended)
Successful completion of all System education requirements
Once credentialed each provider is authorized as follows:
Emergency Medical Technician – Basic (EMT-B)
All treatments as delineated in the Clinical Operating Guidelines EXCEPT administration of medications with the following exceptions:
Assisting the patient in taking his own medications
Assisting the EMT-P in PREPARATION of ALS medications under his/her direct supervision
Assisting in administration of aspirin to chest pain patients (unless contraindicated)
Assisting in administration of albuterol SVN (asthma/COPD)
Performance of the following procedures
Acquisition of 12 lead EKG
Administration of oxygen
Insertion of i-Gel, Combitube & King LTS-D airways + use of CPAP
Insertion of oropharyngeal or nasopharyngeal airway
Application of Auto pulse
Operation of AED
Advanced Emergency Medical Technician (Advanced EMT)
All treatments as delineated in the Clinical Operating Guidelines as designated for Advanced EMT administration
Assisting the EMT-P in PREPARATION & ADMINISTRATION of ALS medications under his/her DIRECT supervision
Independent administration of the following medications:
ASA
Nitroglycerin (NTG)
IV solution infusions (NS, D5W, LR, etc)
Epinephrine 1:1,000 IM (anaphylaxis/respiratory distress)
Epinephrine 1:10,000 IV (cardiac arrest)
Dextrose 50%
Naloxone
Ondansetron (Zofran)
Albuterol/ Atrovent SVN
Performance of the following procedures
All procedures approved for EMT-B
Insertion of i-Gel, Combitube & King LTS-D airways + use of CPAP
Insertion of IV line placement
Emergency Medical Technician – Paramedic (EMT-P)
All treatments and procedures as delineated in the Clinical Operating Guidelines
Performance of the following procedures
All procedures approved for EMT-B & Advanced EMT
Endotracheal intubation
IV insertion & IO placement
All formulary medication administration
Electrical cardioversion
Needle decompression
Defibrillation
Registered Nurse – Prehospital (RN)
All treatments and procedures as delineated in the Clinical Operating Guidelines
Performance of the following procedures
All procedures approved for EMT-B (Basic)
Endotracheal intubation
IV initiation
Medication administration
Electrical cardioversion
Needle decompression
Defibrillation
DECREDENTIALING involves revocation of System privileges to practice as licensed. This may occur for several reasons:
Violation of one of the “Five Deadly Sins” as delineated in the Introduction section of the Clinical Operating Guidelines
Falsification of a patient care document
Intentionally withholding care from a patient
Intentionally harming a patient
Providing care while impaired by alcohol or drugs
Failure to remediate and/or participate in required education and/or review
Inability to maintain state licensure/certification as required by Missouri BEMS
After a determination of “No Confidence” by System Medical Director
This will be only after documentation of multiple poor or detrimental performance indicators by System Medical Director, Administrator, Operations Supervisor, or Field Training Officers (FTO)