Unless the context otherwise requires, the definitions contained in this Chapter shall govern the provisions of this Commission:

(a) Administrator means the Administrator or his/her designee of the DPHSS Office of EMS Administrative Office created under this Chapter.

(b) Advanced Cardiac Life Support (ACLS) is a course of instruction designed to prepare students in the practice of advanced emergency cardiac care.

(c) Advance Emergency Medical Technician (AEMT) provides basic and limited advanced emergency medical care and transportation for critical and emergent patients who access the emergency medical system. This individual possesses the basic knowledge and skills necessary to provide patient care and transportation. Advanced Emergency Medical Technicians function as part of a comprehensive EMS response, under medical oversight. Advanced Emergency Medical Technicians perform interventions with the basic and advanced equipment typically found on an ambulance. The Advanced Emergency Medical Technician is a link from the scene to the emergency health care system.

(d) Ambulance is any conveyance on land, sea or air used or is intended to be used for the purpose of responding

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to emergency life-threatening situations and providing emergency transportation services.

(e) Basic Cardiac Life Support (BLS/CPR) is a course of instruction designed to prepare students in cardiopulmonary resuscitation techniques.

(f) Certificate or Certification means authorization in written form issued by the Administrator to provide emergency medical assistance on the scene, enroute, and at designated emergency medical facilities.

(g) Commission means the Guam Emergency Medical
Services Commission created under this Chapter.

(h) Continuing Education means education required for the renewal of a certificate or registration.

(i) Department of Transportation (DOT) is a federal agency mandated to establish minimum standards for provisions of care for victims.

(j) Department (DPHSS OEMS) is the Guam Department of Public Health and Social Services (DPHSS) Office of EMS.

(k) E-911 means “”Enhanced”” 911.

(l) Education Program Standards means DOT and NHTSA approved National EMS Educational Standards that shall be met by state-recognized EMS education programs.

(m) Emergency means any actual or self-perceived event which threatens the life, limb, or well-being of an individual in such a manner that immediate medical or public safety care is needed.

(n) Emergency Ambulance Service means the transportation of injured/ill patients by ambulance and the administration of emergency medical services to injured/ill patients before or during such transportation.

(o) Emergency Medical Dispatcher (EMD) – An emergency medical dispatcher is a professional telecommunicator tasked with the gathering of information

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related to medical emergencies, the provision of assistance and instructions by voice prior to the arrival of emergency medical services (EMS), and the dispatching and support of EMS resources responding to an emergency call. The term “”emergency medical dispatcher”” is also a certification level and a professional designation, certified through the Association of Public-Safety Communications Officials- International (APSCOI) or the National Academies of Emergency Dispatch.

(p) Emergency Medical Responder (EMR) provides immediate lifesaving care to critical patients who access the emergency medical services system. EMRs have the knowledge and skills necessary to provide immediate lifesaving interventions while awaiting additional EMS resources to arrive. EMRs also provide assistance to higher- level personnel at the scene of emergencies and during transport. Emergency Medical Responders are a vital part of the comprehensive EMS response. Under medical oversight, Emergency Medical Responders perform basic interventions with minimal equipment.

(q) Emergency Medical Service Facility is a facility that is certified and operated under the Government Code of Guam, and is equipped, prepared, and staffed to provide medical care for emergency patients appropriate to its classification that evaluates and stabilizes a medical condition of a recent onset and severity, including severe pain, psychiatric disturbances, or symptoms of substance abuse, that would lead a prudent layperson possessing an average knowledge of medicine and health to believe that the person’s condition, sickness, or injury is of such a nature that failure to get immediate medical care could result in death or dismemberment.

(r) Emergency Medical Technician (EMT) provides out of hospital emergency medical care and transportation for critical and emergent patients who access the emergency medical services (EMS) system. EMTs have the basic knowledge and skills necessary to stabilize and safely transport patients ranging from non-emergency and routine

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medical transports to life threatening emergencies. Emergency Medical Technicians function as part of a comprehensive EMS response system, under medical oversight. Emergency Medical Technicians perform interventions with the basic equipment typically found on an ambulance. Emergency Medical Technicians are a critical link between the scene of an emergency and the health care system.

(s) Emergency Medical Services (EMS) means services designated by the Commission as providing emergency medical assistance on the scene, enroute, and at designated EMS facilities.

(t) Emergency Medical Services Commission is the Guam Emergency Medical Services Commission as created under Article 1, Public Law 14-11.

(u) Emergency Medical Services Coordinator is an individual designated to serve as a liaison officer for EMS inter-agencies, i.e., Guam Memorial Hospital Authority, Department of Public Works – Office of Highway Safety, Guam Community College, Civil Defense, and EMS/Rescue Bureau of the Guam Fire Department. The person shall coordinate didactyl and clinical instructions and oversee the student clinical activities

(v) EMS Education Center is a state-recognized provider of initial courses, EMS continuing education topics, and/or refresher courses that qualify individuals for state and/or National Registry EMR, EMT, AEMT, and Paramedic or EMD provider certification.

(w) EMS Education Group is a state-recognized provider of EMS continuing education topics and/or refresher courses that qualify individuals for initial or renewal of a state and/or National Registry EMR, EMT, AEMT, and Paramedic or EMD certification.

(x) EMS Medical Director, for the purposes of these rules, is a Guam licensed physician in good standing who authorizes and directs, through protocols and standing orders, the performance of students-in-training enrolled in a DOT

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and NHTSA National EMS Education Standard recognized program and/or EMS license holders who perform medical acts, and who is specifically identified as being responsible to assure the performance competency of those EMS Providers as described in the DOT and NHTSA National EMS Educational Standards.

(y) EMSC Program means the Emergency Medical
Services for Children Program.

(z) EMS Provider means an individual who holds a valid emergency medical service provider certificate issued by the state and/ or NREMT, and includes Emergency Medical Responder, Emergency Medical Technician, Advanced Emergency Medical Technician, and Paramedic.

(aa) First Responder Homeland Security Act of 2002 refers to “”emergency response providers”” that includes, federal, state, and local government emergency public safety, law enforcement, emergency response, emergency medical, and related personnel, agencies, and authorities.

(bb) First Responder means those individuals who in the early stages of an incident are responsible for the protection and preservation of life, property, evidence, and the environment, including emergency response providers as defined in Section 2 of the Homeland Security Act of 2002 (6 U.S.C. § 101), as well as emergency management, public health, clinical care, public works, and other skilled support personnel (such as equipment operators) that provide immediate support services during prevention, response, and recovery operations.

(cc) Initial Certification means a first time application for and issuance by the state and/or NREMT of a certificate at any level as an EMS provider. This shall include applications received from persons holding any level of EMS certification issued by the NREMT who are applying for either a higher or lower-level certificate.

(dd) Initial Course is a course of study based on the
DOT and NHSTA approved curriculum that meets the

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National EMS Education Standard requirements for issuance of a certificate or registration for the first time.

(ee) Initial Registration means a first time application for and issuance by the DPHSS Office of EMS of a registration as an EMD, EMR, EMT, AEMT or Paramedic. This shall include applications received from persons holding any level of EMS certification issued by the state and/or NREMT who are applying for registration.

(ff) Letter of Admonition is a form of disciplinary sanction that is placed in an EMS provider’s file, and represents an adverse action against the certificate holder.

(gg) License or Licensure is an authorization in written form issued by the Administrator to a person to furnish, operate, conduct, maintain, advertise, or otherwise engage in providing EMS Services.

(hh) License means certificate or certification.

(ii) Mass Casualty Incident is defined as an incident in which EMS resources, such as personnel and equipment, are overwhelmed by the number and severity of casualties.

(jj) Medical Direction On-Line means advice, assistance, supervision, and control provided from a state designated regional medical facility staffed by emergency physicians supplying professional support through radio, telephonic, or any written or oral communication for on-site and in-transit basic and advanced life support services given by prehospital field personnel.

(kk) National Registry Emergency Medical Technician (NREMT) is an individual who has a current and valid EMT license issued by the DPHSS Office of EMS who meets the requirements established under Chapter 84, Public Law 14-
11, who is authorized to provide basic emergency medical care in accordance with the rules pertaining to EMS Practice and Medical Director Oversight, and meets the specialized training requirements as established by the U.S. DOT and NHTSA in the National EMS Educational Standards EMT Level. For the purposes of these rules, EMT includes the

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historic EMS Provider level of EMT. This definition will apply to this term or any future changes established by the U.S. DOT.

(ll) National Continued Competency Program (NCCP) is constructed using methodology similar to that of the American Board of Medical Specialties.

(mm) National Highway Traffic Safety Administration (NHTSA) is a U.S. DOT agency leading the federal role in the creation of national standard curricula for EMRs, EMT-Bs, AEMTs and Paramedics defining the necessary components and training of an EMS System.

(nn) National Registry Advance Emergency Medical Technician (NRAEMT) is an individual who has a current and valid AEMT license issued by the DPHSS Office of EMS who meets the requirements established under Chapter 84, Public Law 14-11, who is authorized to provide advance emergency medical care in accordance with the rules pertaining to EMS Practice and Medical Director Oversight, and meets the specialized training requirements as established by the U.S. DOT and NHTSA in the National EMS Educational Standards for the AEMT Level. This definition will apply to this term or any future changes established by the U.S. DOT.

(oo) National Registry Emergency Medical Responder (NREMR) is an individual who has successfully completed the training and examination requirements for emergency medical responders and who provides assistance to the injured or ill until more highly trained and qualified personnel arrive.

(pp) National Registry of Emergency Medical Technicians (NREMT) is a national non-governmental organization that certifies entry-level (EMR, EMT, AEMT and Paramedic) and ongoing competency of EMS providers.

(qq) National Registry Paramedic (NRP) is an individual who has a current and valid Paramedic license issued by the DPHSS Office of EMS who meets the requirements established under Chapter 84, Public Law 14-

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11, who is authorized to provide critical advance emergency medical care in accordance with the rules pertaining to EMS Practice and Medical Director Oversight, and meets the specialized training requirements as established by the U.S. DOT and NHTSA in the National EMS Educational Standards for the Paramedic Level. This definition will apply to this term or any future changes established by the U.S. DOT.

(rr) Non-Emergency Medical Transport – Non- emergency medical transportation is a form of medical transportation which is provided in non-emergency situations to people who require special medical attention, e.g., para- transits, vans w/ wheelchair access and passenger service vehicles.

(ss) Office of Emergency Medical Services is the Administrative Office of EMS within the Department of Public Health and Social Services.

(tt) Paramedic is an allied health professional whose primary focus is to provide advanced emergency medical care for critical and emergent patients who access the emergency medical system. This individual possesses the complex knowledge and skills necessary to provide patient care and transportation. Paramedics function as part of a comprehensive EMS response, under medical oversight. Paramedics perform interventions with the basic and advanced equipment typically found on an ambulance. The Paramedic is a link from the scene into the health care system.

(uu) Pediatric Advance Life Support (PALS) is a course instruction designed to prepare students in the practice of advance pediatric emergency cardiac care.

(vv) Practical or Psychomotor Skills Examination is a skills test conducted at the end of an initial course and prior to application for national certification or state licensure.

(ww) Provisional Certification is a certification, valid for not more than one (1) year, that may be issued by the state

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and/or NREMT to an EMS PROVIDER applicant seeking certification.

(xx) Provisional Registration is a registration, valid for not more than one (1) year, that may be issued by the state and/or NREMT to an EMT applicant seeking registration.

(yy) Refresher Course is a course of study based on the U.S. Department of Transportation approved curriculum that contributes in part to the education requirements for renewal of a license or registration.

(zz) Registered Emergency Medical Responder (REMR) is an individual who has successfully completed the training and examination requirements for EMRs based on a U.S. DOT and NHSTA National EMS Education Standard recognized program who provides assistance to the injured or ill until more highly trained and qualified personnel arrive, and who is registered with the DPHSS Office of EMS.

(aaa) Rules Pertaining to EMS Practice and Medical Director Oversight means rules adopted by the EMS Administrator and/or Medical Director of DPHSS and the Office of EMS upon the advice of the EMS Commission that establishes the responsibilities of Medical Directors and all authorized acts of EMS license holders.

(bbb) Shall means compliance is mandatory.

(ccc) Tele-Communicator operates communication equipment to receive incoming calls for assistance, and dispatches personnel and equipment to the scene of an emergency; and operates a telephone console to receive incoming calls for assistance.

(ddd) Treatment Protocol means written guidelines (also known as Off-line Medical Direction) approved by the EMS Medical Director providing pre-hospital personnel with a standardized approach to commonly encountered patient problems that is related to medical or trauma, thus encountering immediate care.

SOURCE: Gov’t Code Article 1, Chapter 6, Title XLVII, codified by the Compiler as Chapter 84 of Title 10, Guam Code Ann.. Subsections (m), (n), (o), (p), and (q) added by P.L. 23-077:2 (Mar. 6, 1996).

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Amended by P.L. 31-146:2 (Nov. 17, 2011). Subsections (mm) and (nn) added by P.L. 34-168:3 (Dec. 29, 2018). Repealed and reenacted by P.L. 36-121:2 (Nov. 9, 2022).