1. (a) Purpose. The purpose of this section is to establish the minimum continuing education (CE) requirements necessary for emergency medical services (EMS) personnel to maintain certification. These requirements are intended to keep the certificant knowledgeable of current techniques and practice, maintain the quality of emergency medical services provided to the public, and encourage improvement in the skill and competence of EMS personnel.

2. (b) Hour requirements. CE is a requirement of §157.45 of this title (relating to Recertification). A contact hour shall consist of 50 consecutive minutes of attendance and participation in an approved CE experience. Credit hours for CE activities will only be awarded for the two-year time period in which they are completed; and if participating in a graded activity, only if the individual receives a grade of "C" or better, or "Pass" in a "Pass/Fail" grading system.

   1. (1) Emergency care attendants (ECA) shall be required to document 20 contact hours of CE every two years, with a total of 40 contact hours within the four-year certification period.
   2. (2) Emergency medical technicians (EMT) shall be required to document 40 contact hours of CE every two years, with a total of 80 contact hours within the four-year certification period.
   3. (3) EMT-intermediates (EMT-I) shall be required to document 60 contact hours of CE every two years, with a total of 120 contact hours within the four-year certification period.
   4. (4) EMT-paramedics (EMT-P) shall be required to document 80 contact hours of CE every two years, with a total of 160 contact hours within the four-year certification period.
3. (c) Content requirements. Candidates at each certification level shall at a minimum accrue hours in department-approved CE in the following content areas.

4. (d) CE course approval criteria. A CE provider shall meet the following criteria.

   1. (1) The program shall be pre-approved by the department.
   2. (2) The program shall be at least one contact hour in length.
   3. (3) Learner objectives shall be written and be the basis for determining content and evaluation.
   4. (4) The target audience for the program shall be identified.
   5. (5) The content shall be relevant to identified topic areas, and be related to and consistent with, program objectives.
   6. (6) The instructor shall be knowledgeable and competent in the subject matter taught. There shall be documentation of the instructor's expertise in the content area.
   7. (7) Learning experiences shall be appropriate to achieve the objectives of the program. Principles of adult education shall be used in the design of the program.
   8. (8) A schedule shall be provided which identifies the content areas covered and the number of contact hours awarded in each content area.
   9. (9) Facilities and educational resources shall be adequate to implement the program.
   10. (10) A written test with a minimum of a "Pass/Fail" grading system which covers the entire scope of learner objectives will be provided except for conferences and authorship.
   11. (11) The grading system shall be appropriate for the type of program presented.

   12. (12) A program evaluation tool shall be utilized which provides the participant an opportunity to comment on:

       1. (A) achievement of the objectives;
       2. (B) teaching effectiveness of each instructor;
       3. (C) relevance of content presented to stated objectives;
       4. (D) effectiveness of teaching methods; and
       5. (E) appropriateness of physical facilities and educational resources.

5. (e) Types of CE programs and additional specific criteria necessary for consideration of CE approval.

   1. (1) Department-approved CE programs endorsed by national and state accrediting organizations.

   2. (2) Ongoing CE programs provided by department-approved EMS initial training programs, licensed EMS providers, registered first responder organizations, hospitals accredited by the Joint Commission for the Accreditation of Healthcare Organizations (JCAHO), or accredited educational institutions that have met the course approval criteria in subsection (d) of this section.

      1. (A) Approved EMS certification training programs that are categorized by the department as an Annual Program or JCAHO accredited hospitals, may receive approval for a two-year ongoing CE program upon completion and approval of a biennial CE application.
      2. (B) Licensed EMS providers or registered first responder organizations who have a documented quality assessment plan with CE as part of their improvement plan and have a state certified coordinator, instructor, or medical director who is responsible for the CE program, may receive approval for a two-year ongoing CE program upon completion and approval of a biennial CE application.

   3. (3) National or state standardized courses and conferences.

      1. (A) National and state standardized courses such as Advanced Cardiac Life Support (ACLS), Basic Trauma Life Support (BTLS), Prehospital Trauma Life Support (PHTLS), Pediatric Advanced Life Support (PALS), and Pediatric Prehospital Provider Course (PPPC), all of which must have an adequate evaluation tool which covers the entire scope of objectives taught as part of the program, will be listed with pre-approved credit hours assigned. An approved CE activity list of these programs shall be maintained by the department.
      2. (B) National and state conferences may be preapproved based solely on the merit of content and subject matter experts and placed on the approved CE activity list with credit hours assigned.

   4. (4) Directed activities, single or multiple offering, which is not included in paragraphs (1)-(3) of this subsection.

      1. (A) A program which is offered one or more times, such as a workshop, or seminar, shall complete all criteria listed in subsection (d) of this section and shall be approved prior to the delivery of the single activity or the initial delivery of the multiple offering activity.
      2. (B) Instructors of these programs are not required to be state-certified instructors or coordinators, but shall have expertise in the content areas taught.
      3. (C) If the CE application is for a multiple-offering activity, then approval may be given for up to a two-year time period.

   5. (5) Formal refresher courses. A refresher course shall:

      1. (A) be provided by a department-approved EMS initial training program;
      2. (B) meet the CE course approval criteria as in subsection (d) of this section;
      3. (C) meet at least the minimum content area hour requirements for the applicable certification level as in subsection (c) of this section; and
      4. (D) offer skills proficiency verification.

   6. (6) Independent study. Independent study such as CE articles in professional journals, ongoing serial productions or interactive computer programs shall:

      1. (A) be pre-approved by the department;
      2. (B) be developed by a professional group such as an educational institution, corporation, professional association or other approved provider of continuing education;
      3. (C) involve the learner by requiring an active and appropriate response to the educational materials presented;
      4. (D) provide a test as in subsection (d)(10) of this section; and
      5. (E) provide a record of completion which complies with subsection (f) of this section concerning records indicating completion of the program.

   7. (7) Authorship.

      1. (A) A candidate may receive CE credit for development and publication of a manuscript in a periodical.
      2. (B) The number of CE credit hours awarded for each article shall be determined by the department.
      3. (C) CE credit will be awarded in the appropriate content areas as related to the manuscript.
      4. (D) Credit for publication will be awarded only once per two-year CE time period and the candidate must, upon audit, submit a letter from the publisher indicating acceptance or a copy of the published work.

   8. (8) Academic courses.

      1. (A) Upon review by the department, a candidate may receive CE credit for academic courses within the specified content areas for each level of certification.
      2. (B) Completion of academic course work shall be credited on the basis of up to 15 CE contact hours for each semester hour successfully completed, within appropriate content areas. Less than 15 hours may be awarded if the academic course content is only partially applicable to content areas.
      3. (C) When approved, the candidate shall receive notification from the department of acceptance of academic hours and amount of CE credit awarded.
   9. (9) Instruction in approved initial training and continuing education courses. EMS personnel instructing in an approved initial training course or in an approved CE program may apply the contact hours of actual teaching to the appropriate content areas during the two-year CE period.

   10. (10) CE by optional examination.

       1. (A) Candidates may receive CE credit for passing the National Registry of Emergency Medical Technicians written and practical examination for their current level of EMS personnel certification.
       2. (B) Passing the examination shall be credited on the basis of 20 contact hours for EMT level, 30 contact hours for EMT-I level, and 40 contact hours for EMT-P level. CE credit for passing the National Registry examination shall be an option only once during the four-year certification period.

6. (f) Records for the CE provider.

   1. (1) Records of programs shall be kept by the CE provider for a minimum period of five years from the date of completion.
   2. (2) Records shall include target audience, objectives and content areas with corresponding number of hours, outline of instructor qualifications, dates of instruction, teaching methods, evaluation tools, and a list of participants.
   3. (3) The CE provider shall furnish each participant documentation of completion specifying the CE provider, title, date and location of program, content areas and contact hours, and grades or Pass/Fail, if applicable. Documentation shall be identified on a course certificate, completion document, or a verification letter on official letterhead.

7. (g) Reporting requirements. Continuing education requirements shall be fulfilled and reported on a two-year cycle. Implementation of this section was effective on September 1, 1994.

   1. (1) Certificants with a certification expiration date before September 1, 1996, shall comply with the two-year reporting requirements after becoming recertified.
   2. (2) Certificants with a certification expiration date after September 1, 1996, shall comply with the two-year reporting requirements for the last two years of the current certification period.
   3. (3) Certificants with a certification expiration date on or after September 30, 1998, shall be responsible for reporting at both two-year cycles in their four-year certification period.

8. (h) Activities which are not acceptable as CE. The following activities do not fulfill the requirements necessary to receive continuing education credits:

   1. (1) CPR courses designed for lay persons;
   2. (2) orientation programs sponsored by the employing agency to provide specific information about the work setting, policies and procedures, on-the-job training, and equipment demonstration;
   3. (3) organizational activity such as serving on committees, councils, or professional organizations;
   4. (4) any program or activity which is not preapproved in accordance with this section;
   5. (5) any experience which does not fit into the content areas specified for each level of certification; and
   6. (6) activities which have been completed more than once during the two-year CE time period.

9. (i) Responsibilities of individual certificant.

   1. (1) It is the responsibility of certificants to select and participate in CE activities that will meet their educational needs in conjunction with the direction of their EMS medical director and/or provider, where appropriate. In addition, it is the responsibility of the certificant to determine if the continuing education is approved by the department.
   2. (2) Each certificant shall be responsible for maintaining their own CE records. These records shall document completion as evidenced by course certificates, verification letters written on official letterhead, or academic transcripts, to include notification from the department of the number of hours accepted, and shall include faculty names, titles, dates, content, number of clock hours, and grades of "Pass/Fail," if applicable. The burden of proof of CE participation/completion shall rest solely on the certificant.
   3. (3) These records shall be maintained by the certificant for a minimum of five years from the date of the application for recertification. Copies of documentation shall be submitted to the department within 15 days, if requested upon audit.
   4. (4) If participation is in a program in which grades are provided, a grade equivalent to a "C" or better shall be required or "Pass" on a "Pass/Fail" grading system to receive credit for CE.
   5. (5) Certificants attending approved national or state conferences/courses shall be responsible for distributing the CE hours within the appropriate content areas for the level of certification if the content areas have not been preassigned.

10. (j) Audit.

    1. (1) The department shall randomly audit certificant's continuing education summary forms. Audits shall be conducted in a timely fashion on at least the minimum number of summary forms necessary to make the audit statistically valid. The department shall also randomly audit a statistically valid sampling of actual teaching during CE programs.
    2. (2) The department may audit the summary form of a specific certificant in response to a complaint, or if there is reason to suspect that a certificant may have falsified CE documentation. The department may also audit actual teaching during CE programs in response to a complaint, or if there is reason to suspect that a CE provider may not be providing their CE program in accordance with the submitted outline and objectives.
    3. (3) Falsification of CE documentation shall be cause for probation,suspension, or decertification as in §157.51 of this title (relating to Criteria for Emergency Suspension, Suspension, Probation, and Decertification of an EMS Certificate); §157.19 of this title (relating to Emergency Suspension, Suspension, Probation, Revocation of a License, and Administrative Penalty); and §157.64 of this title (relating to Criteria for Suspension, Probation, and Decertification of Course Coordinator, Program Instructor, and/or Examiner Certification).
    4. (4) The department may audit any records of the CE provider.
    5. (5) If any deficiencies are found during an audit, pre-approval for the remaining period shall be revoked. After deficiencies have been corrected, each CE presentation shall have pre-approval for the remainder of the two-year period or until such time as the on-going program status has been reinstated.

11. (k) Failure to complete required CE.

    1. (1) A certificant who has failed to complete the requirements for the initial two-year CE time period will be granted a 90-day extension period to complete and submit the required CE. Failure to complete and submit the CE requirements within that time frame shall be cause for emergency suspension until CE requirements are met.
    2. (2) A certificant who has failed to complete and submit all the CE requirements prior to the expiration of their certification may apply for late recertification in accordance with §157.45(d) of this title (relating to Recertification).

Source Note:The provisions of this §157.38 adopted to be effective April 6, 1994, 19 TexReg 2053; amended to be effective December 29, 1995, 20 TexReg 10772.