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Bureau of Emergency Medical Services
Documents & Forms

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Advanced Life Support | Annual Awards |
Automated External Defibrillators | EMS Best Practices |
Licensing | Preparedness Topics | Research and Quality Management/TEMSIS |
Training, Education and Practical Exams | Trauma System

Advanced Life Support

Preplanned Medical Standby Coverage Plan
Clinical Practice Inquiry Form

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Annual Awards

NOTE: The 2017 NH Fire Service & Emergency Medical Services Committee of Merit Awards & Recognition Program will be held at the Concord City Auditorium on September 25, 2017. Nominations are being accepted NOW through June1, 2017. For questions regarding the awards process, please contact Kathy Doolan, Captain, EMS Operations.
Throughout the year, as you wish to recongize an agency or individual during future award events, there is an "EMS Accolades Report" submission form that can be used to "bookmark" the recognition for the next year's award event. The Divisions' Resource Center address is: . An email will be sent to our staff and we will be in touch with more details.

NH Annual EMS Awards: Nomination Form

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
EMS Lifetime Achievement Award
Pamela Mitchell/Richard Connolly Memorial EMS Achievement Award
Lawrence A. Volz EMS Heroism Award

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Automated External Defibrillators (AED)

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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EMS Best Practices
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Brochure: Licensing Laws and Rules
EMS Instructor/Coordinator License Initial & Renewal Application
New or Lapsed EMS Provider License Application (downloadable pdf version)
EMS Provider License -Renewal/Upgrade Application (online application - must have LIN#)
EMS Provider License Renewal/Upgrade/Change of Unit (downloadable pdf version)
EMS License Waiver Requirements
EMS Unit License Application
EMS Vehicle License Application
Law Enforcement Provider License Information
Ambulance Equipment/Inspection Sheets
-Wheelchair Van-For-Hire Company Application
-Wheelchair Van-For-Hire Van Application
-Wheelchair Van-For-Hire Van Inspection Sheet
Protocol Rollout / Exam 2015
SAMPLE Apprentice Provider Affiliation Forms

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Preparedness Topics

Avian Influenza (Bird Flu) Facts
EMS Mitigation and Planning Resources
EMS Response and Recovery Resources
Guide to Infection Prevention in EMS
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
USFA Fire and Emergency Services Preparedness Guide for the Homeland Security Advisory System

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Research & Quality Management / TEMSIS

How-To: Playing Streaming WebEx Recordings of Elite Trainings
TEMSIS Elite Training Schedule

TEMSIS Elite Transition Memorandum

TEMSIS Elite Transition FAQs
TEMSIS Elite Service Leader vs. Provider Sessions
TEMSIS Elite Service Leader Setup Guide
TEMSIS Elite Transition Training Practice Scenarios
Elite Piloting Feedback Log

Improving Basic Cardiac Care in NH EMS - Aspirin Administration in 2014
Basic Cardiac Care in NH Follow-Up
Basic Stroke Care in NH
Basic Stroke Care in NH Follow-Up

TEMSIS Users Manual
TEMSIS - How to Use the Incident List

TEMSIS Report Writer-Basic Transitional Report Guide

TEMSIS - Procedures List Change Memo
TEMSIS - Procedures Changes Reference List Old to New
TEMSIS - Procedures Changes Reference List New to Old
TEMSIS - Procedures Changes Refrence List Details and 3rd Party Vendors

TEMSIS - Adding Zones or Districts to your Service to Display and Collect on the EMS Incident Report
TEMSIS - Town Names will be Updated Effective April 15th, 2015
TEMSIS - Town Name Before and After April 15th, 2015 Comparison

TEMSIS (V2.2.1) Required NEMSIS Elements and Values These are all the elements and values required and/or allowed to be submitted by third party software into the TEMSIS system.
TEMSIS (V2.2.1) ALL Elements and Values Collected Includes all required and optional NEMSIS elements and values and custom elements only available to users who directly enter into TEMSIS.

NEMSIS Data Dictionary Version 2.2.1
NEMSIS Version 2.2.1 Extended Data Definitions

TEMSIS Comparison of Field Bridge Options
Field Bridge Express License Request and Agreement
Field Bridge License Request and Agreement
How to Set Up Field Bridge Express

Internet Best Practices Expert
TEMSIS and Browser Use Update - August 19, 2015
TEMSIS Security Internet Explorer
TEMSIS Security Mozilla Firefox

NH Statewide Comprehensive EMS Survey

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Training, Education and Practical Exams

ALS Exam Registration (online application)
Authority to Establish Courses
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 (EMT) Practical Exam Sheets - Updated 12/2015 (Without Spinal Immobilization)
EMS Course Request - (online application)
EMS Reciprocity Information
Emergency Medical Responder (EMR) Practical Exam Sheets
I/C Resource: Skills Assessment-Personnel/Equipment
Intranasal Naloxone Administration Skill Sheet
Medical Professional Challenge: EMR - Under Review
Medical Professional Challenge: EMT - Under Review
Medical Professional Challenge: AEMT - Under Review
Medical Professional Challenge: Paramedic - Under Review
Memo for Out-of-State Educational Programs
NHFA General Admissions Application Form
Practical Examination Coduct & Removal
Practical Examination Dress Code
Request for Examination (BLS)
Request for Duplicate Certification

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Trauma System

Trauma Hospital Assignment ApplicationAdobe Acrobat Reader Symbol
Trauma Hospital Application WorksheetAdobe Acrobat Reader Symbol
Trauma Medical Review Committee Newsletter - Winter 2016Adobe Acrobat Reader Symbol
Trauma System FAQ's
Current NH Trauma System Plan
NH Guidelines for the Imaging of the Trauma Patient
NH Trauma System MapAdobe Acrobat Reader Symbol - Updated 6/2017
NH Trauma System Map - PediatricAdobe Acrobat Reader Symbol - Updated 6/2017
Welcome to the Trauma Medical Review Committee

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