For the purpose of implementing § 84110, the following certification procedures shall apply:

(a) Certification Application. There shall be four (4) levels of emergency medical service personnel: Emergency Medical Responder (EMR); Emergency Medical Technician (EMT); Advance Emergency Medical Technician (AEMT); and Paramedic.

(b) An application for certification shall be made under oath on a form to be approved by the Commission and

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provided by the Administrator, and shall require the applicant to provide documentation as proof of eligibility as established in the Guam EMS Rules and Regulations in compliance with the U.S. Department of Transportation.

(c) Emergency Medical Responder:

(1) Training: Training for EMRs is offered at the local level by approved training programs. A list of approved training programs may be obtained through the Department of Public Health and Social Services (DPHSS) via telephone, mail, or from its web page. Training hours consist of Ninety-six (96) hours, broken down into Eighty (80) classroom and laboratory hours and Sixteen (16) hours of supervised clinical experience.

(2) Testing: In order to practice as an EMR, an individual is certified after passing the National Registry of Emergency Medical Technician (NREMT) written and skills exams.

(3) Certification: After passing the written and skills certification exams, applicants must obtain a criminal background check, provide documentation of current BLS/CPR certification, provide a current photo ID (Guam driver’s license or U.S. Passport), and pay the fee established in the fee schedule. The applicant may then be certified through the Office of EMS which issues an EMR certification card (they are also known as the certifying entity). Certification is valid for two (2) years from the date of issue.

(4) Recertification: Every two (2) years, an EMR must provide the certifying entity with proof of sixteen (16) hours of refresher course work or sixteen (16) hours of EMS approved continuing education units (CEUs), and have documented competency in ten (10) skills. EMR shall also maintain current NREMT certification and BLS certification. Applicants must pay the fee established in the fee schedule and provide proof of completion of these requirements in order for the

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certifying entity to recertify an EMR.

(5) Reciprocity: Individuals from out-of-state who meet the following criteria and complete the application requirements of a certifying entity are eligible for certification:

(A) possess a current and valid National
Registry EMR certificate;

(B) possess a current and valid out-of-state or
National Registry EMR certificate; or

(C) paramedic license, or have documentation of successful completion of an out- of-state EMR training course within the last two (2) years that meets Guam’s EMR training requirements.

(6) Scope of Practice: An EMR is trained and certified in basic life support practices. Basic life support (BLS) means emergency first aid and CPR procedures which, at a minimum, include recognizing respiratory and cardiac arrest and starting the proper application of CPR to maintain life without invasive techniques until the patient can be transported or until advanced life support (ALS) is available.

(d) Emergency Medical Technician:

(1) Training: Training for EMTs is offered at the local level by approved training programs. A list of approved training programs may be obtained through the DPHSS via telephone, mail, or from its web page. Training hours consist of 120 hours, broken down into
110 classroom and laboratory hours and ten (10) hours of supervised clinical experience.

(2) Testing: In order to practice as an EMT, an individual is certified after passing the NREMT written and skills exams.

(3) Certification: After passing the written and skills certification exams applicants must obtain a

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criminal background check, provide documentation of current BLS/CPR certification, provide a current photo ID (Guam driver’s license or U.S. Passport), and pay the fee established in the fee schedule. The applicant may then be certified through the Office of EMS which issues an EMT certification card (they are also known as the certifying entity). Certification is valid for two (2) years from the date of issue.

(4) Recertification: Every two (2) years, an EMT must provide the certifying entity with proof of forty (40) hours of refresher course work or forty (40) hours of EMS approved continuing education units (CEUs), and have documented competency in ten (10) skills. EMTs shall also maintain current NREMT certification and BLS certification. Applicant must pay the fee established in the fee schedule and provide proof of completion of these requirements in order for the certifying entity to recertify an EMT.

(5) Reciprocity: Individuals from out-of-state who meet the following criteria and complete the application requirements of a certifying entity are eligible for certification:

(A) possess a current and valid National
Registry EMT certificate;

(B) possess a current and valid out-of-state or
National Registry EMT certificate; or

(C) paramedic license, or have documentation of successful completion of an out- of-state EMT training course within the last two (2) years that meets Guam’s EMT training requirements.

(6) Scope of Practice: An EMT is trained and certified in basic life support practices. Basic life support (BLS) means emergency first aid and CPR procedures which, at a minimum, include recognizing respiratory and cardiac arrest and starting the proper application of CPR to maintain life without invasive

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techniques until the patient can be transported or until advanced life support (ALS) is available. Automated external defibrillator (AED) training is now part of the basic scope of practice.

(7) Optional Skills: EMTs may obtain additional training to supplement their standard scope of practice. EMTs may become locally-approved to use certain medications and skills. The local EMS Medical Director for each agency determines the use of these optional scope items.

(e) Advance Emergency Medical Technician:

(1) Training: Training for AEMTs is offered at the local level by approved training programs. A list of approved training programs may be obtained through the DPHSS via telephone, mail, or from its web page. The required training hours for AEMTs is 228. The minimum number of hours for each portion of the training program is listed below, although most programs may exceed this amount:

(A) Didactic and lab/skills: 168 hours

(B) Field Internship: 60 hours

(C) TOTAL 228 hours

(2) Testing: In order to practice as an AEMT, an individual is certified after passing the NREMT written and skills exams.

(3) Certification: After passing the written and skills certification exams applicants must obtain a criminal background check, provide documentation of current BLS/CPR certification, provide a current photo ID (Guam driver’s license or U.S. Passport), and pay the fee established in the fee schedule. The applicant may then be certified through the Office of EMS which issues an AEMT certification card (they are also known as the certifying entity). Certification is valid for two (2) years from the date of issue.

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(4) Recertification: Every two (2) years, an AEMT must provide the local EMS agency with proof of completion of fifty (50) hours of EMS approved continuing education units (CEUs), and provide documented competency in six (6) skills. AEMTs shall also maintain current NREMT certification and BLS certification. Applicants must pay the fee established in the fee schedule and provide proof of completion of these requirements in order for the certifying entity to recertify an AEMT.

(5) Reciprocity: An individual who possesses or has possessed a valid AEMT or Paramedic license from another state or holds a current NREMT AEMT or Paramedic certification may be eligible for certification.

(6) Scope of Practice: AEMTs are certified in the use of advanced life support (ALS) skills. ALS includes all EMT skills, intravenous infusion, perilaryngeal airway, and eight (8) medications (jurisdictional scope of practice may vary).

(7) Optional Skills: In addition to the EMT scope of practice, AEMTs may practice additional skills and administer certain medications. These additional optional skills and medications may be utilized and are approved by the local EMS agency and the EMS Medical Director. The AEMT is typically employed by public safety agencies, such as fire departments, and by private ambulance companies.

(f) Paramedic:

(1) Training: Training for Paramedics is offered at the local level by approved training programs. A list of approved training programs may be obtained through the DPHSS via telephone, mail, or from its web page. The minimum number of hours for each portion of the training program is listed below, although most programs exceed these amounts:

(A) Didactic and lab/skills: 672 hours

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(B) Hospital and clinical training: 120 hours

(C) Field Experience: 288 hours

(D) Field internship with 20 patient contacts and at least 120 hours

(E) TOTAL 1,200 hours

(2) Testing: In order to practice as a paramedic, an individual must pass the NREMT written and skills exams. Tests are scheduled as needed on a program requirement; and an individual can contact the EMS Authority for further information.

(3) Licensure: Guam law requires an individual to be licensed by the EMS Authority in order to practice as a paramedic. Individuals seeking licensure should apply directly to the EMS Authority. After passing the written and skills certification exams, applicants must obtain a criminal background check, provide documentation of current BLS/CPR certification, provide a current photo ID (Guam driver’s license or U.S. Passport), and pay the fee established in the fee schedule. The applicant may then be licensed through the Office of EMS which issues a Paramedic License card (they are also known as the certifying entity). Certification is valid for two (2) years from the date of issue.

(4) Credentialing: In addition to licensure, a paramedic must be locally credentialed by an approved EMS agency in order to practice on Guam. Credentialing is orientation to local protocols and training in any local optional scope of practice for the particular local EMS agency jurisdiction, as well as skill and knowledge verification by an affiliated EMS agency and EMS Medical Director. Paramedics must apply for credentialing directly to the local EMS agency. All provider credentialing shall be approved by the EMS agency Medical Director.

(5) License Renewal: Paramedics must complete a minimum of sixty (60) hours of approved continuing

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education units (CEUs) every two (2) years to maintain licensure. Paramedics shall also maintain current NREMT certification and BLS certification. Applicant must pay the fee established in the fee schedule and provide proof of completion of these requirements in order for the certifying entity to recertify a Paramedic.

(6) Reciprocity: Individuals who possess a current paramedic certificate from the National Registry of EMTs or valid state Paramedic License are eligible for paramedic licensure on Guam when they submit proof of successful completion of a field internship and complete all license requirements.

(7) Scope of Practice: Paramedics are trained and licensed in the use of advanced life support (ALS) skills. ALS includes all EMT and AEMT skills, use of laryngoscope, endotracheal and nasogastric intubation, Valsalva’s Maneuver, needle thoracostomy, administration of twenty-one (21) drugs, and other skills.

(8) Optional Skills: The EMS Authority can approve the use of additional skills and administration of additional medications by paramedics upon the request of a local EMS medical director.

(g) Temporary Certification: The Office of EMS shall approve temporary certification of an applicant if the applicant has completed an approved training program within twelve (12) months of the date of application and has never taken the written and practical examination of the National Registry of Emergency Medical Technicians for that level of practice but otherwise meets the requirements, has filed a complete application with the Office of EMS, and has paid all required fees. If the applicant fails to apply for, or to take, the next succeeding examination or fails to pass the examination or fails to receive a certificate, all privileges under this Section shall automatically cease upon written notification sent to the applicant by the Office of EMS. A temporary certificate for each level of practice may be issued only once to each person. Prior to practicing under temporary certification, applicants

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shall notify the Office of EMS in writing of any and all employers under whom they will be performing services.

(h) Extension of Licenses for Members of the Armed
Forces, National Guard, and Reserves.

(1) Notwithstanding any other law to the contrary, any license held by a Member of the Armed Forces, National Guard, or a Reserve component that expires, is forfeited, or deemed delinquent while the Member is on active duty and deployed during a state or national crisis shall be restored under the restoration requirements provided in this Section.

For the purposes of this Section, “”local or national emergency”” includes, but is not limited to:

(A) a situation requiring the proper defense of nation or state;

(B) a federal or state disaster or emergency; (C) a terrorist threat; or
(D) a homeland security or homeland defense event or action.

(2) The licensing authority shall restore a license upon the payment of the current renewal fee if the Member:

(A) requests a restoration of the license within one hundred twenty (120) days after being discharged or released from active duty deployment;

(B) provides the licensing authority with a copy of the Member’s order calling the Member to active duty deployment, and the Member’s discharge or release orders; and

(C) if required for renewal, provides documentation to establish the financial integrity of the licensee or to satisfy a federal requirement.

(3) This Section:

(A) shall not apply to a Member who is on scheduled annual or specialized training, or to any person whose license is suspended or revoked, or who

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otherwise has been adjudicated and is subject to disciplinary action on a license; and

(B) shall also apply to a Member whose license is current, but will expire within one hundred twenty (120) days of the Member’s discharge or release from active duty deployment.

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 (a) amended by P.L. 36-121:10 (Nov. 9, 2022) and subsections (c),(d),(e), (f), and (g) repealed and reenacted by P.L. 36-
121:11 (Nov. 9, 2022).