Rev. 121101'13 APPLICATION FOR ACCREDITATION Section II Training Institution Qualitative Assessment Institution Name: lawman? 5:1, {in ?f?vzx.mnr?s (Zr t, Eu,- . Application Prepared By: First Name Last Name Instructions Complete in full all information requested. If you are unable to answer any area and/or question provide a written explanation for the omission. 3> Provide ?ve copies to REMS. Each section of your explanation shall be included in a Table of Contents and follow the outline below A. 0 VFR WE Please attach copies of current policies, procedures, and/or supporting documentation for each the following: 1. Program mission, goals, and objectives; ire?2. Number of EMS courses conducted annually, indicate levels (initial EMT, AEMT/Cardiac, Paramedic), and type (refresher, continuing education); 5V3. Number of students taught per course per year, for past nae-years; 9?4 The Americans with Disabilities Act applicable to EMT training accommodations; (-5. Use and secure storage of controlled substances and instruments for: administration of controlled substances in EMT training programs, in acCordance with requirements of the Department?s Division of Food and Drugs, pursuant to 6. Clinical and ?eld affiliation agreements; Affiliation agreements shall include the following: ea) Name of training program, mb) Name of organization providing clinical/?eld 313) Number of students allowed per site, d) Duration of agreement, e) Details of supervisory responsibilities, so. Forms used for clinical and ?eld internships, time and skill logs, and describe internship process students will follow; EMT training institution organizational chart that shows the relationship among students, faculty, medical director, program director/coordinator, and other personnel for each EMS training course; and Sample course outline for EMT, ABMT/Cardiac, and Paramedic level of initial EMT training provided. B. STUDENTS Please provide cepies of current policy, procedures, and/or supporting documentation for the following: Cij?l. General program requirements for student selection and admission. 2. Program requirements for student: g?a) Attendance, Absentee makeup, Student evaluationsa Rev. 121?101?13 C. PERSONNEL RESOURCES A Rhode Island accredited EMS training institutions shall have adequate and appropriately credentialed staff to ensure all training and educational standards are met. Faculty Please provide copies of current supporting documentation for the following: 5148.) Relevant resumes for EMS faculty; describing training background; limited to one-page each; and 0a,, Cepy of current license certi?cation (where applicable) and job descriptions that includes detailed training program responsibilities for: /6 Medical director x2) f4) 7) EMS Director Clinical coordinator Field internship coordinator Didactic instructor aides Preceptors iffc) Preceptor policies, and describe manner by which policies are implemented. D. EVALUA TION Training course evaluation is the examination of multiple components to determine if the course was cost-efficient, educationally sound, and otherwise bene?cial. l. Progam: Please provide current Supporting documentation for the following: I A three-year accreditation evaluation plauwhich shall include: 591 Clearly de?ned goals and objectives. 5412. An annual update that will provide written evidence the educational program is meeting its objectives and the changing needs of EMS care. 3. Methods for gathering and analyzing data on the effectiveness of the program?s: pi, Curriculum, g?-ii Training equipment, medical library, and computer resources, :mi Faculty; and iv A student?s ability to function as entry-level providers upon successful completion of the training course. Eli-6b) Describe how EMS training program evaluations are used for continuous quality improvement, and to plan the future direction of EMT training. 2. Supervision: Describe EMS training institution?s policy by which program supervisors conduct staff?s evaluation (provide sample evaluation) as it pertains to: Preparation and availability of instructional material, 5:613) Ability to motivate class and provide a positive learning experience, etc) Audiovisual materials apprOpriate for class instruction; and aid) Effectiveness of instructional technique. Rev. 3; Medical Director ail/a) Describe manner and criteria by which medical director will review for approval curriculum and course content glib) Describe how medical director will participate in program quality assurance and quality improvement process 4. Clinical Internships (ALS programs) a) Describe how the training institution interacts with hospital staff to achieve clinical internship goals . Eb) Describe how clinical coordinator will ensure student achievement of all required clinical competencies 30) Describe how clinical coordinator will participate in the review and evaluation of overall student perfonnance, with emphasis on clinical skill competencies . Field internships (ALS programs) Describe how the training program interacts with ambulance service providers to achieve ?eld internship goals Describe how ?eld internship coordinator will ensure student achievement of all required ?eld skill competencies Describe how ?eld internship coordinator will participate in the review and evaluation of student performance with emphasis on ?eld skill competencies Describe how field internship coordinator will train, monitor, and maintain consistence of ?eld internship preceptors. . Clinical Field Sites: Describe how clinical and ?eld sites are evaluated for adequacy of skill opportunities for Intermediate and Paramedic students, optional for initial EMT training course. . Practical Skills Examination: Provide documentation of the training institution?s plan for conducting the RIBMS EMT practical certi?cation examination and related components. Key Policies are at a minimum: - The institutions hiring policy regarding examiners. The institution?s formal process for of their examination eligibility. Describe the institutions administrative process for dealing with re?test and challenge candidates. The training institution? 5 medical director (ALS'examinations only) available during practical exam periods. Me) The training institution? 3 examination team will consist of ?approved Examiners to be provided at the training institution?s expense (Chief Examiner will be provided by RIBMS). The training institution will schedule suf?cient numbers of RIEMS- -approved Examiners to complete a practical examination in a timely manner; average recommended time is 5 continuous hours. 30?) Continuous inspection, cleaning, and upgrading of practical examination required equipment. The institution?s formal administrative process for managing and scheduling examinations in relation to course completion, when will exams occur, who is responsible for oversight of candidate?s certi?cation application completion, and the timely submission of candidates applications to RIEMS. Rev. 1310113 APPENDIX A Authorization for CORI Request Instructions Complete the attached authorization for criminal background records form and forward to RIEMS, with application packet, for the following personnel: I Medical director 0 EMT program director 0 Clinical coordinator 0 Field internship coordinator - Didactic instructor/coordinator Adjunct faculty as appropriate 10