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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 unless otherwise noted.

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 2018 NH Fire Service & Emergency Medical Services Committee of Merit Awards & Recognition Program will be held on September 24, 2018. Nominations are being accepted NOW through June1, 2018. For questions regarding the awards process, please contact Kathy Doolan, Captain, EMS Operations.
Throughout the year, as you wish to recognize 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: https://apps.nh.gov/blogs/irc/?page_id=1043 . 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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Licensing

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 Training Officers: Scope of Practice Skills Sheet (for skill verification)
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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TEMSIS / Emergency Services Data Management

TEMSIS/ Elite Training Videos for Providers and Service Leaders
TEMSIS Elite Service Leader vs. Provider Sessions
TEMSIS Elite Service Leader Setup Guide
TEMSIS Elite Transition Training Practice Scenarios

TEMSIS Transfer Feature Overview
Elite Browser Caching-Microsoft
Elite Browser Caching-Safari

TEMSIS Monthly Stakeholder Meeting Recordings:
(You can copy the link and past it into your internet browser address bar)

December 2017 Link: https://recordings.join.me/x8-waWINyE6Tpzq-xQx4Bg
January 2018 Link: https://recordings.join.me/ZkIc0SF7_EWDKaQj_WexmA
February 2018 Link: https://recordings.join.me/zUr88WePo0uPCRACDMdNng
March 2018 Link: https://recordings.join.me/juoTrrM-zEu7aYeedZulJQ

 

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Training, Education and Practical Exams

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 - Under Review
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 Conduct & 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 3/2018
NH Trauma System Map - PediatricAdobe Acrobat Reader Symbol - Updated 3/2018
Welcome to the Trauma Medical Review Committee
2018 New Hampshire Trauma Registry Data DictionaryAdobe Acrobat Reader Symbol

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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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