EMS Clinicians

The MLREMS Prehospital Care Bundles are created to provide a simple framework to help EMS Clinicians identify the most critical elements when caring for a patient. These bundles do not replace protocol, but are designed to assist quality assurance and improvement activities as we work collectively to optimize the delivery of prehospital medicine. As the science and evidence changes, so will these care bundles.

Acute Coronary Syndrome

Anaphylaxis

Generalized Weakness & Dizziness

Care of the Agitated or Combative

Care of the Mentally Ill or EDP

Cerebrovascular Accident

Congestive Heart Failure Exacerbation

Geriatric Fall

Major Trauma

Orthopedic Injury Immobilization

Pain Management

Post Intubation Management

Return of Spontaneous Circulation (ROSC)

Seizure

Suspected Opioid Overdose

Syncope

Systemic Infection

MLREMS emphasizes a competency-based approach to ensure the safe and effective practice of advanced airway management consistent with the MLREMS Policy on Drug-Assisted Airway Management. The Drug-Assisted Airway Management (DAAM) credential, formerly known as the RSI credential, is a regional one and required for EMS clinician use of the NYS Collaborative “Rapid Sequence Induction” Protocol.

DAAM Providers as of 12.17.2025

RSI Checklist

Program Eligibility

Paramedics are eligible to enter the credentialing process if they meet all of the following:

• Active and unrestricted paramedic certification for at least two years
• Continuous practice in the MLREMS Region for the six months prior to the testing date
• No ongoing clinical quality concerns with the MLREMS Quality & Patient Safety Committee

Paramedics should begin the process only after discussing their intent to apply with both their Clinical Care Coordinator/ALS Chief and Agency Medical Director.

Credentialing Process

1. Application Submission
• The application includes three components:
• Completion of the applicant questionnaire
• Completion of the agency/clinical leadership evaluation by the Clinical Care Coordinator/ALS Chief and/or Medical Director
• Review and final approval of the agency evaluation by the Medical Director
• While there is no required number of intubations for eligibility, the number of intubations performed and success rates are part of the clinical evaluation. Agencies should gather this data as part of the application process.
2. Deidentified Regional Review
• All applications will undergo a de-identified review by the Regional Airway Collaborative/DAAM Committee to determine selection for advancement to the cognitive testing step.
3. Cognitive Testing
• Eligible paramedics will take a written examination covering DAAM concepts, decision-making, and pharmacology. As passing score is required to advance.
• To assist in preparation, the following educational modules are available:
• DAAM Clinical Judgment
• DAAM Procedure
• DAAM Pharmacology
• All paramedics considering pursuing the DAAM credential are encouraged and expected to review this content to gain a clear understanding of expectations.
4. DAAM Education
• Paramedics passing the initial cognitive exam will participate in synchronous education sessions, including case reviews and simulation, facilitated by members of the Airway Collaborative in preparation for the simulation-based assessment.
5. Simulation-Based Assessment
• Participants must demonstrate competency in DAAM procedures and decision-making during high-fidelity simulation testing.

The MLREMS Advanced Practice and Specialty Care Transport (SCT) Paramedic Programs provide a set of expectations and process for the training, credentialing, clinical care, and quality improvement for the management of patients who will benefit by treatments and/or management of conditions for which initial paramedic education may be limited and/or state ALS Protocols are silent or limited in providing clinical guidance.

MLREMS Advanced Practice Paramedics are credentialed at the agency level using regional best practices and who, with additional training and meeting established competency for the individual skill, may manage one or more of the following: the continuation of blood products, the management of chest tubes, infusions and transport ventilators in select patients. The MLREMS Advanced Practice Paramedic Credentialing policy can be found below, as well as other resources such as clinical guidelines, education and competency assessments.

MLREMS Specialty Care Transport (SCT) Paramedics are credentialed at the regional level following Flight Paramedic or Critical Care Transport certification and successful completion of a competency-based program administered by the Division of Prehospital Medicine at the University of Rochester. SCT Paramedics are provided with advanced training and scope of practice to safely manage complex critically ill patients undergoing interfacility transport. The MLREMS Specialty Care Transport Paramedic Credentialing policy can be found below, as well as other materials such as clinical guidelines and practice resources.

SCT Clinical Guidelines

Advanced Practice Paramedic Credentialing Policy

Specialty Care Transport Paramedic Credentialing Policy

APP and SCT Education and Competencies

Clinical Competency – Sapphire IV Pump

Clinical Competency – Chest Tube

Clinical Competency – Hamilton T1 Ventilator

Clinical Competency – Invasive Hemodynamic Monitoring

Blood Transfusion Orders (DOH 5210)

Blood Transfusion Record (DOH 5209)

Paramedic clinicians are credentialed using the MLREMS Credentialing of Paramedic Practitioners policy. It is the ALS agency’s responsibility to follow this policy and within five business days notify the Program Agency of a Paramedic that is newly credentialed for independent practice or removed from independent practice at the agency using this form.

The role of the ALS Preceptor is integral to the successful credentialing of Paramedic Clinicians. Agency leaders should refer to the MLREMS ALS Preceptor Credentialing policy and ALS Preceptor Recommendation Form as needed.

Agencies are expected to have at least one leader registered within the New York State Health Commerce System to receive important updates as well as provide a means to verify a clinician’s certification. Instructions on how to obtain access can be found here.

MLREMS has taken a centralized, evidence-based approach to provide consistent emergency services guidance surrounding the practice of incident rehabilitation. The following resources are available:

MLREMS Emergency Incident Rehabilitation Policy

MLREMS Incident Rehab Log

Rehab Unit Packet

Treatment Group Packet