UTSW/BioTel Policy: Return-to-Duty Requirements for Paramedics Returning to Clinical Duty Following Prolonged Absence

Purpose: To establish a protocol for the re-credentialing of former active duty UTSW/ BioTel credentialed paramedics for return to clinical activity.

1. OBJECTIVES:
1. Identify candidates for paramedic re-credentialing.
2. Establish a competency-based program that facilitates the re-acclimation of previously credentialed paramedics to the knowledge, skills, abilities and responsibilities of an active paramedic.
3. Provide a process of competency verification by EMS Supervisors, Chief Officers and the BioTel Medical Directors.
2. SCOPE:
   1. This protocol applies to all paramedics seeking re-credentialing with a UTSW/BioTel EMS agency after a period of clinical inactivity.
3. DEFINITIONS:
1. Clinical Activity: The provision of emergency medical evaluation and treatment as a component of the paramedic’s routine job description, i.e. providing clinical care on a regular basis on an engine or ambulance.
2. Within System Paramedic: A previously credentialed paramedic who has remained within the BioTel system in a role other than providing primary patient evaluation and treatment.
3. Re-Instatement Paramedic: A previously credentialed paramedic who meets the following criteria:
1. Held valid credentialing at time of leave.
2. Has been clinically inactive for less than 6 months.
3. Is not currently undergoing any remediation program implemented by the UTSW Medical Directors Council (MDC).
4. Re-Entry Paramedic: A previously credentialed paramedic who meets the following criteria:
1. Held valid credentialing at time of leave.
2. Has been clinically inactive for 6 or greater, but less than 24, months.
3. Is not currently undergoing any remediation program implemented by the UTSW Medical Directors Council (MDC).
5. Late Re-Entry Paramedic: A previously credentialed paramedic who meets the following criteria:
1. Held valid credentialing at time of reassignment.
2. Has been clinically inactive for 24 or more months.
3. Is not currently undergoing any remediation program implemented by the UTSW Medical Directors Council (MDC).
6. Paramedic Re-Entry Program (PREP): A program through which Re-Entry Paramedics will undergo training and evaluation of clinical and procedural skills prior to re-instatement of credentials and return to active duty.
7. PREP Review Committee: A committee whose purpose is to recommend candidates for the PREP and to continually monitor the progress of performance of both candidates and preceptors.
1. For Re-Entry Paramedics, the committee shall comprise:
1. EMS Chiefs or their designees.
2. For Late Re-Entry Paramedics, the committee comprise:
1. EMS Chiefs or their designees; and
2. Designated BioTel EMS Medical Directors.
4. IDENTIFICATION OF CANDIDATES FOR RE-CREDENTIALING:
1. Candidates for the PREP include, but are not limited to, those paramedics who have been out of clinical practice for any of the following reasons:
   1. Military service;
   2. Injury or illness;
   3. Maternity;
   4. Administrative re-assignment.
5. SELECTION PROCESS:
1. Application: A State of Texas certified or licensed paramedic meeting the above criteria may submit in writing to the Chief of EMS a written application for entry into the PREP.
2. In the case of a Re-Instatement Paramedic (less than 6 months of clinical inactivity), provided that the paramedic meets all other requirements for functioning within the BioTel EMS System, no further action needs be taken unless it is felt to be indicated by the Chief of EMS.
3. Screening: For entry into the PREP, members of the PREP Review Committee will review the Candidate’s eligibility based on, but not limited to, the following criteria:
1. Verification of State paramedic certification;
2. Verification of previous credentials with a UTSW / BioTel EMS Agency;
3. Prior counseling or disciplinary actions;
4. Other work history or supporting documents provided by the Agency;
5. Review of activities performed during leave from clinical duty.
4. Recommendation: Following review of the Candidate’s eligibility, the PREP Review Committee will recommend the candidate for acceptance consideration into the PREP. If approved by the PREP review committee, the candidate will be placed into the PREP.
5. Removal from the PREP:
1. In such circumstances as the Field Preceptors, EMS Chiefs or Medical Directors have concerns regarding the Candidate’s ability to successfully complete the PREP, a letter requesting removal from the PREP may be brought to the PREP Review Committee.
2. Such a letter and supporting documents will be reviewed by the PREP Review Committee, after which a determination will be made as to the Candidate’s further participation in the PREP, or corrective action as per the determination of the Committee.
6. PROGRAM COMPONENTS:
1. Continuing Education: All CE activities occurring during clinical inactivity.
2. BioTel Protocols Refresher Course: A refresher course based on the UTSW/BioTel Treatment Guidelines at the time of acceptance into the PREP.
3. BioTel Protocols Exam: An examination based on the content of the UTSW/BioTel Treatment Guidelines at the time of acceptance into the PREP.
4. Skills Refresher: A refresher course and examination of clinically important skills, as determined by the BioTel EMS Medical Direction Team.
5. Field Evaluation: Supervised and evaluated paramedic shifts with senior EMS field supervisors.
6. PREP Review Committee Review: A final review by the PREP Review Committee based on appropriate completion of the above items, with final recommendation to the EMS Chiefs.
7. RE-CREDENTIALING REQUIREMENTS:
1. Clinical inactivity less than 6 months:
1. Continuing Education: Satisfactory completion of all missed continuing education and operational drills and updates within 30 days of re-instatement.
2. Protocols: May elect to take Protocols Refresher Course, at the Candidate’s discretion.
3. Skills: No requirement.
4. Field evaluation: No requirement.
5. The paramedic will not be restricted from patient care duties during this time period.
2. Clinical inactivity 6 to 11 months:
1. Continuing Education: Satisfactory completion of all missed continuing education and operational drills and updates.
2. BioTel Protocols: Successfully pass the BioTel Protocols exam.
1. The candidate may elect to take a Protocols Refresher Course prior to examination.
2. Should the Candidate fail the protocol examination, they will be placed into a Protocols Refresher Course.
3. Skills: The candidate may elect to take a Skills Refresher Course.
4. Field evaluation: No requirement.
5. The paramedic will be restricted from assignment until all requirements have been met.
3. Clinical inactivity 12 to 23 months:
1. Continuing Education: Satisfactory completion of all missed continuing education and operational drills and updates.
2. Protocols: Successfully complete Protocols Refresher Course and Protocols Exam.
3. Skills: Successfully complete skills review and examination.
4. Field evaluation: 3 to 5 preceptor-evaluated ride-outs.
5. The paramedic will be restricted from assignment until all requirements have been met.
4. Clinical inactivity 24 to 35 months:
1. Continuing Education: Satisfactory completion of all missed continuing education and operational drills and updates.
2. Protocols: Successfully complete Protocols Refresher Course and Protocols Exam.
3. Skills: Successfully complete skills review and examination.
4. Field evaluation: 10 preceptor-evaluated ride-outs.
5. The paramedic will be restricted from assignment until all requirements have been met.
5. Clinical inactivity 36 months or longer – Out of system:
1. Return to paramedic school
6. Clinical inactivity 36 Months to 7 Years – Within system:
1. Discretion of UTSW Medical Director’s Council.
7. Clinical inactivity longer than 7 years – Within system:
1. Return to paramedic school.
8. SUMMARY TABLE
   

   	Re-Entry Paramedics			Late Re-Entry Paramedics
   	0 to 6 mo.	6 to 11 mo.	12 to 23 mo.	24 to 35 mo.	36 mo. to 7 years (Within system)	More than 36 mo. (Out of system) More than  7 years (Within system)
   Continuing Education	30 days to complete	Complete prior to return to duty	Complete prior to return to duty	Complete prior to return to duty
   Protocol Exam		Complete prior to return to duty	Complete prior to return to duty	Complete prior to return to duty	Discretion of UTSW Medical Director’s Council	Return to paramedic school
   Protocol Refresher		Complete if failure to pass protocol exam	Complete prior to return to duty	Complete prior to return to duty
   Skills Exam			Complete prior to return to duty	Complete prior to return to duty
   Preceptor Ride-Outs (shifts)			3 to 5	10