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Bureau of Emergency Medical Services
Documents & Forms

All documents and forms have been saved in Adobe Acrobat Reader Adobe Acrobat Reader Symbol format.

Advanced Life Support | Annual Awards |
Automated External Defibrillators  | Licensing |  
Preparedness Topics | Research and Quality Improvement | 
Training, Education and Practical Exams  | Trauma System
 

Advanced Life Support

2009 Patient Care Protocols
Current Approved Medication List (7/13/09)
Sample Protocol Exam
Paramedic Re-entry

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Annual Awards

The 2010 nominations will be open for submissions between December 1, 2009 and June 1, 2010. Please fill out and submit the 2010 Nomination form for consideration by the 2010 EMS Annual Award Committee. The awards are presented at the Fire and EMS Committee of Merit ceremony held in the fall at the Capitol Center for the Arts in Concord, NH.
Please note the new deadline is June 1, 2010.

Bound Tree Corporation EMS Unit of the Year Award
David F. Dow Memorial EMS Provider of the Year Award
David J. Connor Memorial EMS Appreciation Award - "The Connor Honor"
EMS Educator of the Year Award
Pamela Mitchell/Richard Connolly Memorial EMS Achievement Award
Lawrence A. Volz EMS Heroism Award

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Automated External Defibrillators (AED)

AED Incident Report Form
AED Registry Form
AED Vendor Listings
Frequently Asked Questions
HeartSafe Communities
Public Access Defibrillation in New Hampshire Schools
Resource for AED Materials

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Licensing

EMS Instructor/Coordinator License Renewal Application
EMS Instructor/Coordinator License Initial Application
EMS Provider License Application
EMS Vehicle License Application
Equipment/Inspection Sheets
Licensing Laws and Rules
Protocol Exam Instructions
Non-transporting EMS Unit License Application
Transporting EMS Unit License Application

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Preparedness Topics

Avian Influenza (Bird Flu) Facts
EMS Mitigation and Planning Resources
EMS Response and Recovery Resources
Hospital Driving Directions
Meningitis Fact Sheet
Mutual Aid Assessment
NH Influenza Pandemic Health Preparedness & Response Plan
NH Public Health Emergency Preparedness & Response Plan
National Incident Management System (NIMS) Training Synopsis
Sample EMS Unit Mutual Aid Agreement
Swine Influenza (H1N1) Facts
USFA Fire and Emergency Services Preparedness Guide for the Homeland Security Advisory System

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Research and Quality Improvement

Sample Drop Off and Refusal Forms - Provided by Pam Drewniak, District C-5 and Dick Cooper, Portsmouth Regional Hospital. The Division of Fire Standards and Training & Emergency Medical Services neither endorses nor recommends these forms but provides them as a sample for your use.
TEMSIS Data Dictionary
TEMSIS Implementation Plan
TEMSIS A System Overview and Helpful Tips for TEMSIS Users
Internet Best Practices Expert
TEMSIS Security Internet Explorer
TEMSIS Security Mozilla Firefox

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Training, Education and Practical Exams

ALS Testing Information
ALS Training Equipment Request Form

Authority to Establish Courses
BLS Equipment Request
BLS Practical Examination Evaluator Application - Initial
BLS Practical Examination Evaluator Application - Renewal
Clinical / Field Internship Affiliation Form
Course Completion Roster
Course Completion Roster Addendum
Emergency Medical Technician - Basic (Practical Exam Sheets)
EMT-I National Registry Re-Registration Procedure
EMS Reciprocity Information
Exam-In-Lieu Refresher Process
First Responder (Practical Exam Sheets)
NHFA General Admissions Application Form
Practical Examination Coduct & Removal
Practical Examination Dress Code
Request for Examination
Request for Duplicate Certification
Synopsis of Bureau Approved Training Programs

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Trauma System

Interactive Materials Available for Loan
NH Trauma System Map

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New Hampshire Department of Safety | 33 Hazen Drive | Concord, NH 03305
TDD Access: Relay NH 1-800-735-2964
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