System tracking of individual CEUS by hR2mHk


									                                   WISCONSIN EMS TRAINING RECORD
                                   EMT-Intermediate Refresher Requirements

                            FOR THE JULY 1, 2012 THROUGH JUNE 30, 2014 BIENNIUM

Name:                                                  License Number:

Continuing education is a personal responsibility! You should evaluate your skills and knowledge to determine
any areas of weakness and then plan for educational opportunities within your scope of practice that improve
your individual competence. Some service medical directors may require preapproval of your refresher
education so check with your service before pursuing educational opportunities.

Continuing education may be obtained by completing a 48-hour formal Intermediate or Paramedic refresher
course through an approved training center or by completing 48 hours of continuing education that meet the
following topics and hours below (you may add additional sheets as necessary):

CPR and ACLS may not be counted in any category as they are required in addition to CEU hours!

Topic/Course Name – CPR may not be included in any category          Date of Completion                  Hours
                                                                    Within the above license period

Advanced medical assessment                                                                           (min. 4 hrs.)

Advanced trauma assessment                                                                            (min. 4 hrs.)

Airway                                                                                                (min. 2 hrs.)

Pharmacology                                                                                          (min. 2 hrs.)

Venous access and medication administration                                                           (min. 2 hrs.)

Cardiology                                                                                            (min. 2 hrs.)

12 lead interpretation                                                                                (min. 1 hr.)

OB                                                                                                    (min. 1 hr.)

Operations                                                                                            (min. 2 hrs.)

WMD/Preparedness                                                                                      (min. 2 hrs.)

EMT-Intermediate Training Record                                                                               Page 1
Pediatric medical/trauma assessment and treatment (may be
gained through completion of a PALS/ALS PEPP course                                                      (min. 8 hrs.)
within the biennium)

Flexible content                                                                                         (min. 18 hrs.)


Flexible CEUs may be obtained through any format. It is highly suggested that CEUs be obtained through any of the
      Courses approved by the Continuing Education Coordinating Board for Emergency Medical Services (CECBEMS)
      Conferences sponsored by recognized Wisconsin organizations or hospitals
      In-house training approved by the EMS service medical director

You must retain proof of attendance and course completion for at least 5 years. CEUs will be randomly audited and, if
selected, you will be required to submit proof of attendance/course completion. Failure to provide adequate
documentation may result in the suspension of your license.

I certify that I have completed all the above continuing education hours and that I have maintained
documentation, as required. I agree to submit proof of attendance immediately up on request.

____________________________________________________                             __________________________
Signature                                                                        Date

EMT-Intermediate Training Record                                                                                   Page 2

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