Pursuant to this Chapter, all persons who furnish, operate, conduct, maintain, advertise, or otherwise engaged in providing emergency medical services as a part of the regular course of doing business, either paid or voluntary, shall hold a current valid certification issued by the Administrator of the Office of EMS to provide emergency medical services.

In order to be certified, such providers of emergency medical services shall meet the following minimum standards:

(a) Emergency Medical Services Personnel Training
Programs and Courses of Training.

(1) The Guam Community College School of Allied Health, the Guam Fire Department, the University of Guam, and other EMS training service providers approved by the DPHSS Office of EMS shall provide training courses in emergency medical responder, emergency medical technician-basic, emergency medical technician-intermediate, emergency medical technician-paramedic, and advanced life support for emergency medical services personnel. The curricula and syllabi of these courses shall be approved in advance by the Office of EMS. The curricula and syllabi of the courses of ambulance personnel shall be consistent with the scope and level of the practice of emergency medical services associated with emergency ambulance personnel certification, and the Department of Transportation, National Highway Traffic Safety

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Administration, and the National Emergency Medical
Services Advisory Council.

(2) The Guam Community College School of Allied Health, the Guam Fire Department, the University of Guam, and other EMS training service providers approved by the DPHSS Office of EMS shall consult with and get approval of the Office of EMS to determine the number and type of emergency medical services courses necessary to support the staffing requirements for emergency medical services. The basic life support training programs shall be relevant to and consistent with the training course required for certification.

(3) The Office of EMS shall develop standards for emergency medical services course instructors, and standards for emergency medical services training facilities for all basic life support personnel, advanced life support personnel, users of the automatic external defibrillator, and emergency medical dispatch personnel that shall be at least equivalent to or exceed the standards necessary to meet the requirements stated in either of the following areas: the Department of Transportation, National Highway Traffic Safety Administration or the National Emergency Medical Services Advisory Council, for the certification of basic life support personnel and advanced life support personnel.

(4) The Office of EMS will conduct annual inspections of the training facilities and evaluate the qualifications of course instructors to ensure that the standards and qualifications are consistent with the medical standards for emergency medical technician- basic, emergency medical technician-intermediate, emergency medical technician-paramedic and advanced life support emergency medical services personnel, users of the automatic external defibrillators, and emergency medical dispatch/E911 call taker personnel.

(5) Course requirements for pre-hospital

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emergency services training for National Registry Emergency Medical Responder (NREMR), National Registry Emergency Medical Technician (NREMT), National Registry Advance Emergency Medical Technician (NRAEMT), and National Registry Paramedic (NRP) shall be listed in the Guam EMS rules and regulations, as prescribed by the United States Department of Transportation, National Highway Traffic Safety Administration, and/or the National Emergency Medical Services Advisory Council.

(b) The personnel shall meet the standards for education and training established by the Administrator of the Office of EMS for certification and re-certification.

(c) Ambulances, emergency medical services facilities, private non-emergent transport vehicles, and private ambulance services primarily provide BLS transport services utilizing NREMR, NREMT, NAEMT, and NRP personnel. Private ambulance services and private non- emergent transport vehicles shall not normally respond to emergency incidents (E911 dispatches by Guam Fire Department) as first responder units, except in the following instances:

(1) When specifically requested by the EMS agency (Guam Fire Department E911 Dispatch) having jurisdiction.

(2) When the private service receives a direct request for service from a person or facility other than dispatch, in which the patient may be transported to an emergency department. In these instances, the service may respond but shall contact the appropriate emergency dispatch agency (Guam Fire Department E911 Dispatch). When a direct request is made to a private ambulance service from a location outside of a medical facility or private ambulance during non- emergency transport, the request shall be routed to E911 via instruction or call transfer for the purpose of dispatching of GFD resources or mutual aid (military or

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private ambulance service), as determined by established policies and procedures.

(3) Transfer of care by a Guam Fire Department EMT- Paramedic of an ALS patient to a private EMT- Paramedic ambulance service for transport shall only occur with Guam EMS Medical Director direct on-line medical control approval.

(4) Transfer of care by a Guam Fire Department
EMT-Basic to a private EMT-Basic ambulance service.

(d) Ambulances, emergency medical services facilities, private non-emergent transport vehicles, and private companies offering ambulance services, and related equipment, shall conform to the requirements of the Administrator of the Office of EMS for certification and re- certification.

(e) Ambulances, private companies offering ambulance services and private non-emergent transport vehicles shall be operated in Guam with insurance coverage, issued by an insurance company licensed to do business in Guam, for each and every ambulance, private non-emergent transport vehicle, and private ambulance service owned or operated by or for the licensee, providing for the payment of benefits and including, but not limited to, the following:

(1) No-fault insurance policy (motor vehicle):

(A) No-fault benefits with respect to any accidental harm arising out of a motor vehicle accident;

(B) Liability coverage for all damages arising out of bodily injury to or death of any person as a result of any one (1) motor vehicle accident;

(C) Liability coverage for all damages arising out of injury to or destruction of property, including motor vehicles and including the loss of use, thereof, as a result of any one (1) motor vehicle accident;.

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(D) Professional or Occupational Liability or Bodily Injury Insurance (other than motor vehicle) in an amount of not less than that specified by the Guam EMS Administrator as may be required in the regulations adopted by the Office of EMS.

(E) Ambulances, private companies offering ambulance services, and private non-emergent transport vehicles shall be equipped with communications equipment approved by the Administrator.

(f) Eligibility, Training and Skill Requirements for Emergency Medical Responders, Emergency Medical Technicians, Advanced Emergency Medical Technicians, and Paramedics:

(1) Student Eligibility:

(A) Emergency Medical Responder (EMR): (i) eighteen (18) years of age.
(B) Emergency Medical Technician
(EMT/Basic Life Support):

(i) eighteen (18) years of age.

(C) Advanced Emergency Medical
Technician (AEMT):

(i) eighteen (18) years of age;

(ii) high school diploma or equivalent; (iii) EMT Certificate;
(iv) BLS, ACLS and PALS Certification.

(D) Paramedic (Advanced Life Support): (i) eighteen (18) years of age;
(ii) high school diploma or equivalent; (iii) EMT Certificate;
(iv) BLS, ACLS and PALS

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Certification.

(2) Minimum Training Requirements:

(A) Emergency Medical Responder (EMR): (i) 96 hours (total minimum);
(ii) 80 hours Didactic;

(iii) 16 hours Hospital Clinicals.

(B) Emergency Medical Technician (EMT/ Basic Life Support):

(i) 120 hours (total minimum);

(ii) 110 hours Didactic & Skills Lab; (iii) 10 hours Hospital Clinicals;
(iv) Field Internship: 10 Patient
Contacts.

(C) Advanced Emergency Medical
Technician (AEMT):

(i) 306 hours (total minimum);

(ii) 208 hours Didactic & Skills Lab; (iii) 16 hours Clinical;
(iv) 24 hours Field Internship and 10
ALS Team Lead Contacts.

(D) Paramedic (Advanced Life Support): (i) 1120 hours (total minimum);
(ii) 450 hours Didactic & Skills lab; (iii) 150 hours Hospital Clinicals;
(iv) 480 hours Field Internship and 40
ALS Team Lead Contacts. (3) Minimum Scope of Practice:
(A) Emergency Medical Responder (EMR):

(i) Patient Assessment;

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(ii) Advance First Aid;

(iii) Use of adjunctive breathing aid and administration of oxygen;

(iv) Automated External Defibrillator; (v) Cardiopulmonary Resuscitation.
(B) Emergency Medical Technician (EMT/ Basic Life Support):

(i) Patient Assessment; (ii) Advance First Aid;
(iii) Use of adjunctive breathing aid and
administration of oxygen;

(iv) Automated External Defibrillator; (v) Cardiopulmonary Resuscitation;
(vi) Transport of Ill and Injured Persons.

(C) Advanced Emergency Medical
Technician (AEMT):

(i) All EMT Skills;

(ii) Perilaryngeal Airways; (iii) Laryngoscope;
(iv) Endotracheal (ET) Intubations
(Adults, Orally);

(v) Valsalva’s Maneuvers; (vi) Intravenous Infusion; (vii) Obtain Venous Blood;
(viii) Glucose Measuring and
Administration;

(ix) Medications: (Approved by Medical
Director).

(D) Paramedic (Advanced Life Support):

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(i) All EMT and AEMT Skills and
Medications;

(ii) Laryngoscope;

(iii) Endotracheal (ET) Intubations
(Orally);

(iv) Valsalva’s Maneuvers; (v) Intravenous Infusion; (vi) Obtain Venous Blood;
(vii) Glucose Measuring and
Administration;

(viii) Needle Thoracostomy and
Cricothyroidotomy;

(ix) Trans-Cutaneous Pacing and
Synchronized Cardioversion;

(x) Medications: (Approved by Medical
Director).

(4) Notable Optional Skills:

(A) Emergency Medical Responder (EMR): (i) Epi-Pens;
(ii) Naloxone.

(B) Emergency Medical Technician
(EMT/Basic Life Support):

(i) Perilaryngeal Airways; (ii) Epi-Pens;
(iii) Duodote Kits;

(iv) Intravenous Access; (v) Naloxone.
(C) Advanced Emergency Medical
Technician (AEMT):

(i) Additional Medications and Skills

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approved by the Medical Director.

(D) Paramedic (Advanced Life Support):

(i) Local EMS Agencies may add additional Medications and Skills if approved by Medical Director.

(5) Written Skills and Exams:
(A) Emergency Medical Responder (EMR): (i) Administered by the National
Registry of EMTs; or

(ii) Administered by the State EMS Office.

(B) Emergency Medical Technician (EMT/ Basic Life Support):

(i) Administered by the National
Registry of EMTs; or

(ii) Administered by the State EMS Office.

(C) Advanced Emergency Medical
Technician (AEMT):

(i) Administered by the National
Registry of EMTs; or

(ii) Administered by the State EMS Office.

(D) Paramedic (Advanced Life Support):

(i) Administered by the National
Registry of EMTs; or

(ii) Administered by the State EMS Office.

(6) Length of Certification or Licensure:
(A) Emergency Medical Responder (EMR): (i) Two (2)-Year Certification and

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Licensure.

(B) Emergency Medical Technician (EMT/ Basic Life Support):

(i) Two (2)-Year Certification and
Licensure.

(C) Advanced Emergency Medical
Technician (AEMT);

(i) Two (2)-Year Certification and
Licensure.

(D) Paramedic (Advanced Life Support):

(i) Two (2)-Year Certification and
Licensure.

(7) Refresher Course/Continuing Education:

(A) Emergency Medical Responder (EMR): (i) Eight (8)-hour Refresher Course;
(ii) Eight (8)-hours of Continuing
Education every two (2) years.

(B) Emergency Medical Technician (EMT/ Basic Life Support):

(i) Twenty (20)-hour Refresher
Course;

(ii) Twenty (20)-hours of Continuing
Education every two (2) years.

(C) Advanced Emergency Medical
Technician (AEMT):

(i) Twenty-five (25)-hour Refresher
Course;

(ii) Twenty-five (25)-hours of
Continuing Education every two (2) years. (D) Paramedic (Advanced Life Support):
(i) Thirty (30)-hour Refresher Course;

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(ii) Thirty (30)-hours of Continuing
Education every two (2) years.

(8) Certification and Licensed Provisions:

(A) Emergency Medical Responder (EMR): (i) Certified and Licensed Locally; or (ii) Reciprocity application.
(B) Emergency Medical Technician
(EMT/Basic Life Support):

(i) Certified and Licensed Locally; or

(ii) Reciprocity application.

(C) Advanced Emergency Medical
Technician (AEMT):

(i) Certified and Licensed Locally; or

(ii) Reciprocity application.

(D) Paramedic (Advanced Life Support):

(i) Certified and Licensed Locally; or

(ii) Reciprocity application.

SOURCE: Gov’t Code Article 1, Chapter 6, Title XLVII, codified
by the Compiler as Chapter 84 of Title 10, Guam Code Ann.. Amended by P.L.
31-146:2 (Nov. 17, 2011). Subsection (c) amended by P.L. 34-
168:12 (Dec. 29, 2018). Subsections (a)(5), (c) amended and (f)
added by P.L. 36-121:7-9 (Nov. 9, 2022).