Application for Approval of Training Center-7/2010
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Continuing Education Coordinating Board for Emergency Medical Services
Application for Approval of a Training Center
Instructions for submission: Every item on this form must be completed. If you are unable to
complete an item, you must explain why. Please submit two typed copies of all required forms,
documents, and related materials, sorted into 2 separate packets, and the non-refundable
review fee to CECBEMS;12200 Ford Road – Suite 478; Dallas, Texas 75234; Phone: 972-2474442; Fax:214-432-0545; e-mail: cecbems@cecbems.org.
Applications submitted electronically via email or on CD are preferred. A surcharge of $200
will be added to applications submitted in hard copy format. The fee must be mailed. One
copy of the Attesting Statement and the Assurances and Certifications page, which require a
signature, must be mailed or faxed.
This form is designed to download and complete on your computer by bolding choices and
entering information. You may also print the form and fill it out on a conventional typewriter.
Requirements for submitting your application:
1.
The application must arrive at CECBEMS headquarters at least three weeks prior to the
date of the first activity to receive CECBEMS approval. CECBEMS does not award
retroactive credit. For applications arriving fewer than three weeks prior to the activity
date will be charged a late fee as follows:
Applications submitted 2 weeks from course date - 50% of application fee
Applications submitted 1 week from course date - 100% of application fee
2.
Be sure you have included every item requested. Reviewers cannot assess an incomplete
application. Failure to include all items requested will delay the approval process.
3.
Respond to every item on the application or explain why you cannot provide the
information requested. Failure to respond to all items will delay the approval process.
4.
Neatness counts! Reviewers will have fewer questions if the application is neatly
presented with all information easy to locate and read.
Note: You must submit post-activity materials--the list of participants for each activity*, a
summary of participant evaluations, and appropriate fees within 30 days after the activity. You
must maintain this information on file for five years after the activity is offered. Failure to submit
this information may result in withdrawal of approval.
Notice: New Reporting Process Effective July 15, 2002
Beginning July 15, 2002, participant list must be submitted to CECBEMS headquarters in
electronic format using one of the options outlined on the CECBEMS Web site. This format will
require that you input the following information about each participant: first name, last name, e-mail,
city, state of licensure, level of licensure/type of license, license number, license expiration date and, if appropriate,
NREMT# and next NREMT re-registration date. Be sure to get this information from participants. You are
required to keep on file for five years telephone, address, and test scores for each participant.
Telephone, address and test scores information must be provided for audit purposes at
CECBEMS’ request.
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Application for Approval of Training Center-7/2010
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Section I – Description of Continuing Education Activity:
Bold or underline the activities that you will offer at your training center (if
applicable):
06-CECB-F2-0550 CPR Pro for Professional Rescuers (Initial Course)
06-CECB-F2-0551 CPR Pro for Professional Rescuers Refresher
06-CECB-F2-0581 ASHI ACLS (Initial Course)
06-CECB-F2-0582 ASHI ACLS Refresher
06-CECB-F2-0496- ASHI PALS Course
06-CECB-F2-0497– ASHI PALS Renewal
06-CECB-F2-0583- ASHI Instructor Development Course (ASHI IDC)
07-AMHA-F3-0033 – AHA Stroke Prehospital Care
05-AMHA-F3-0012 – AHA PALS Online
04-AMHA-F3-0002 – AHA HeartCode ACLS Anywhere
- AHA ACLS Provider
- AHA ACLS Renewal
- AHA PALS Provider
- AHA PALS Renewal
6.25 Basic
4.00 Basic
16.00 Advanced
8.00 Advanced
16.00 Advanced
8.00 Advanced
13.00 Educator
1.25 Advanced
11.5 Advanced
14 Advanced
Section II – Training Center
Name of Training Center:
Department:
Street:
City, State, Zip:
Contact Person:
Telephone:
Fax#:
E-mail:
Web site:
Include as Attachment A a letter of support from the medical director for the training
center.
Section III -- Type Of Organization (bold the appropriate category):
Educational Institution
Agency or Association
Corporation
Hospital
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Other (describe):
Application for Approval of Training Center-7/2010
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Section IV -- Co-Sponsoring Organization: This Section may not be applicable.
Complete this section if you offer activities in collaboration with another organization.
Name:
Street:
City, State, Zip:
Telephone:
Fax:
E-mail:
Section V – Training Center Director or Coordinator
Name:
Address:
City, State, Zip
Telephone:
Fax:
E-mail:
Section VI -- Fees (Choose the appropriate fee for this activity.) Review fees are nonrefundable:
Fees: Initial review:
Participant Fees:
$200
$1.50 for each EMS participant up to a maximum
of $15 per offering of an activity.
Failure to report participant names and pay the fee within thirty days
after an activity will result in loss of approval for the activity.
CECBEMS policy does not allow discounts on fees.
Section VII -- Verification Of Attendance:
Describe your plan for verifying attendance at each session of the activity:
NOTE: You must maintain a record of participants’ attendance for a minimum of five
years.
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Section VIII– Knowledge and Skills Verification
Describe your plan for providing a reasonably secure, closed book, written examination
of an appropriate length for the content domain. What percentage of the exam items must
be answered correctly to earn a passing score?
Describe your plan for providing a skills verification test. How will you determine a
passing score on this test?
NOTE: You must maintain a record of participants’ written exam for a minimum of five
years.
Section IX – Course Certificate
Include as Attachment B a copy of the course certificate for this activity. The certificate
should contain the following information:
Name of CE provider and CE provider number
Student’s name
Activity title
Date(s) of activity
Location of activity
Number and category of CEH
CECBEMS activity number
Name and signature of the program coordinator
Student’s license number, state of licensure
Student’s NREMT number (if student is NREMT)
The following statements:
This continuing education activity is approved by the Continuing Education Coordinating Board for
Emergency Medical Services (CECBEMS).
You have participated in a continuing education program that has received CECBEMS approval for
continuing education credit. If you have any comments regarding the quality of this program and/or your
satisfaction with it, please contact CECBEMS at: CECBEMS - 12200 Ford Road – Suite 478
Dallas, Texas 75234 – Phone: 972.247-4442 - lsibley@cecbems.org.
CECBEMS represents only that its accredited programs have met CECBEMS’ standards for accreditation.
These standards require sound educational offerings determined by a review of its objectives, teaching
plan, faculty, and program evaluation processes. CECBEMS does not endorse or support the actual
teachings, opinions or material content as presented by the speaker(s) and/or sponsoring organization.
CECBEMS accreditation does not represent that the content conforms to any national, state or local
standard or best practice of any nature. No student shall have any cause of action against CECBEMS
based on the accreditation of the material.
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Application for Approval of Training Center-7/2010
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Section X -- Post Activity Evaluation Process:
Include as Attachment C a copy of the evaluation instrument(s) you will use to assess
participant evaluation of your activity.
Describe how information gained from participant and presenter evaluations will be used
to improve future CE activities:
Note: You must submit a summary of participant evaluations along with a list of participant names
and appropriate fees within thirty days after an activity.
Section XII – Reporting Process
Describe your plan for submitting participant names and associated demographic information to the
CECBEMS Web site:
Note: Important Notice: Participant list must be submitted online via www.cecbems.org. This online
submission will require that you input the following information about each participant: CECBEMS
activity number, date of course completion, first name, last name, email address, city of
residence, state of licensure, state license number, type/level of license, license expiration date, NREMT
registration number (if student is NREMT), NREMT reregistration date (if student is NREMT), Number of
CEH, Category of CEH. Failure to submit this information may result in withdrawal of approval.
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Section XIII –Instructor Qualifications
Use the copy-and-paste function to create a copy of this sheet for each instructor included in your
activity. You may submit a CV or resume instead of this form. For an activity with changing
faculty, submit this form or a CV or resume for each member of the planning committee or attach
a list of criteria used to select instructors.
BIOGRAPHICAL DATA FORM
Bold one:
Planning Committee Member
Instructor/Presenter
Name: (Please include degree designations):
Company/Department:
Address:
City, State, Zip:
Contact Person:
Telephone:
Fax#:
E-mail:
PRESENT POSITION (Title and brief job description):
EDUCATION: Include institution (name, city, state), major area of study, year degree awarded,
and degree for basic preparation through highest degree completed:
PROFESSIONAL EXPERIENCE: Use the space below to briefly describe your professional
experience or area of expertise (including publications) which contributes to your ability to
present the topic(s) or fulfill you assigned role on the planning committee.
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Section XIV– Marketing Materials
Describe below how your activity will be marketed. Include as Attachment D a copy or
draft of each marketing vehicle you plan to distribute. These materials must clearly state
the overall objectives for the activity; list prerequisites; identify speakers and their
expertise; clearly state fees; provide necessary information about available travel,
lodging, and meals (if appropriate); identify time, date, place, and topics; be free of
statements that are deceptive misleading, or discriminatory.
Section XV—Attesting Statement
To the best of my ability and knowledge, all the statements contained in this application
are true and accurately represent the proposed continuing education activity. I understand
that I am responsible for the maintenance of participant records for five years after each
activity. I further understand that I am responsible for submitting a list of participants, an
evaluation summary and appropriate fees within 30 days after each activity
_________________________________________________
Activity Coordinator Signature
(Insert an electronic version of your personal signature or sign and fax to 972.716.2007.)
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____________
Date
Application for Approval of Training Center-7/2010
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Section XVI--Assurances and Certifications
Download , sign, and submit via fax or email the document located at
http://cecbems.org/applications/Default.aspx on the CECBEMS Web site.
Section XVII - Complaint Review and Disciplinary Policy
Download, print, read, and file this document located at http://cecbems.org/applications/Default.aspx
should you need it for future reference.
Before you submit this application, please review the checklist below to ensure that
you have included all required items:
1.
Have you signed Section XIV—Attesting Statement?
2.
Have you signed Section XV--Assurances And Certifications?
3.
Have you responded to all parts of all Sections of the application?
4.
Have you included
a.
A letter of support from the sponsoring organization?
b.
A copy of the course certificate for this activity?
c.
A copy of the evaluation instrument(s) you will use to assess participant and presenter
evaluation of your activity?
d.
A copy or draft of each marketing material you plan to distribute?
e.
A check for the application fee?
5.
Are you prepared to collect the following information from participants? Important Notice:
Participant list must be submitted online via www.cecbems.org. This online submission
will require that you input the following information about each participant: CECBEMS activity
number, date of course completion, first name, last name, email address, city of
residence, state of licensure, state license number, type/level of license, license expiration date,
NREMT registration number (if student is NREMT), NREMT reregistration date (if student is
NREMT), Number of
CEH, Category of CEH. Failure to submit this information may result in withdrawal of
approval.
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Application for Approval of Training Center-7/2010
Public Statements about CECBEMS approval:
When you mail the application, you may use the following statement:
Continuing Education Hours have been applied for through the Continuing
Education Coordinating Board for Emergency Medical Services (CECBEMS).
When your activity has received CECBEMS approval, you must use the following
statements if any mention is made of continuing education credit for EMS personnel:
This continuing education activity is approved by the Continuing Education
Coordinating Board for Emergency Medical Services (CECBEMS).
CECBEMS#:
CEH Type:
This continuing education activity is approved by the Continuing Education Coordinating Board for
Emergency Medical Services (CECBEMS).
You have participated in a continuing education program that has received CECBEMS approval for
continuing education credit. If you have any comments regarding the quality of this program and/or your
satisfaction with it, please contact CECBEMS at: CECBEMS - 12200 Ford Road – Suite 478
Dallas, Texas 75234 – Phone: 972.247-4442 - lsibley@cecbems.org.
CECBEMS represents only that its accredited programs have met CECBEMS’ standards for accreditation.
These standards require sound educational offerings determined by a review of its objectives, teaching
plan, faculty, and program evaluation processes. CECBEMS does not endorse or support the actual
teachings, opinions or material content as presented by the speaker(s) and/or sponsoring organization.
CECBEMS accreditation does not represent that the content conforms to any national, state or local
standard or best practice of any nature. No student shall have any cause of action against CECBEMS
based on the accreditation of the material.
In addition, you may use the following description of CECBEMS. If you opt to use this
statement, you must use it in its entirety:
CECBEMS is an organization established to develop and implement
policies to standardize the review and approval of EMS continuing education
activities. The sponsoring organizations of CECBEMS are, the American
College of Emergency Physicians, National Registry of Emergency Medical
Technicians National Association of Emergency Medical Services Physicians,
National Association of State Emergency Medical Services Directors, National
Council of State Emergency Medical Services Training Coordinators, the
National Association of Emergency Medical Technicians, the National
Association of EMS Educators, and the American College of Osteopathic
Emergency Physicians.
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Appendix to Application for Approval of Training Center 4/07
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Submitting Course Completion Records to the
CECBEMS Accreditation Management System
As a condition of being granted accreditation from CECBEMS all providers agree to comply with
several requirements, including the collecting and reporting of specific pieces of data.
CECBEMS is committed to the provision of quality continuing education activities. We feel
strongly that maintenance of reliable records is paramount to recertification of practicing EMS
providers.
To make recertification easier for providers we provide a valuable resource, the CECBEMS
Accreditation Management System (AMS). The CECBEMS AMS allows continuing education
(CE) providers to report data in two ways: manual entry and XML file. Both methods require the
same data be reported, differing only in the method in which the data are reported.
Through several years of experience, we have identified the top three problems encountered with
data submissions. We have analyzed these problems and have found the following common
issues:
1. Some providers have failed to collect the required data.
All providers are required to collect and report the same data. The most common pieces of
data that providers have not collected include state license number, state license expiration
date, NREMT number and re-registration date, and time of course completion. These are key
pieces of data that are necessary to ensure EMS professionals receive credit for their CE
activities.
One reason providers of distributed learning (DL) courses have failed to collect this data is
that they do not have a learning management system in place that is designed to meet the
special requirements necessary to deliver CECBEMS accredited continuing education.
Distributed learning providers must ensure all required data, is collected in the presecribed
format prior to delivering a course with CECBEMS accreditation. Likewise, providers of
live courses must ensure their data collection procedures collect all required data during the
registration process. The manual for the CECBEMS Accreditation Management System is
available for download at http://cecbems.org/faqAnswers.aspx?RecID=56 and
http://cecbems.org/faqAnswers.aspx?RecID=54
2. Providers have collected data in ways that make retrieval and reporting difficult.
Regardless of how you collect data, you must maintain it in accordance with CECBEMS,
requirements. If the participant’s name, state of licensure, and license number are not entered
accurately each and every time a course completion is entered for that person, the course
completion information will not appear on that person’s record. Providers of live activities
sometimes use handwritten forms for collecting data. Our experience is that handwritten
information is frequently illegible. If you use this method, you need a back-up method in
place for verifying information submitted.
Providers of distributed learning activities frequently allow a participant to complete an
activity whether or not the participant has entered the required information. We strongly
recommend that you program your system to require a participant enter all required
information before launching an activity.
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Of those providers using electronic methods of capturing and storing data, many are using a
spreadsheet program such as Excel. Excel is not a database program and is designed for the
manipulation of numbers, not data. Its ability to output and share data is very limited.
A true enterprise class Database Management System, such as Microsoft SQL Server, Oracle,
or IBM DB2 is the ideal tool for capturing data. If you are using a database, be sure it is
robust enough to handle the types and amounts of data you are required to collect. Be sure it
collects and stores all required pieces of data and is set up to retrieve those pieces of data.
However you collect and maintain data, remember that a database requires precision in
formatting. The AMS is case sensitive, leading and trailing spaces will cause errors, all data
must be reported in the EXACT format prescribed in the CECBEMS Accreditation
Management System Provider Manual.
3. Providers do not have (or have not dedicated) sufficient or appropriate resources to
collect and submit the data to the CECBEMS AMS.
The CECBEMS AMS is built on the newest platform that is designed to share data between
systems via the Internet. The easiest and most efficient tool for this transfer is an Extensible
Markup Language (XML) file. XML is a W3C initiative that allows information and
services to be encoded with meaningful structure and semantics that both computers and
humans can understand. In the simplest possible terms, an XML file is a text file in a
specific format that contains individual pieces of data written to conform to a specific set of
rules or “schema”.
There are many ways to create this kind of text file, including simply typing it into notepad
(although this is not efficient for large amounts of data.) Ideally, a programmer can create a
tool that will essentially copy the required data from your database and then write the XML
file in the correct format and syntax. Once you have this tool it can be used repeatedly by
any non-programmer to create and submit the required reports to CECBEMS. For example,
one CECBEMS-approved provider has such a tool that allows any non-tech person to simply
enter the beginning and ending date of the report, enter their CECBEMS AMS log-in name
and password, and click one button to create and submit the XML file to the AMS. This is
the beauty of the XML reporting tool – build one small application and reporting will not
require technical resources from then on.
Our analysis of the troubles providers have been experiencing in successfully writing the
XML files shows that the single biggest problem has been that the technical resources
assigned to create the XML file are not sufficiently trained in XML syntax.
We want to be sure that you understand that we are not commenting on any individual’s
abilities, but rather have found that many Web Designers have not had the benefit of training
or experience in XML. Our goal here is simply to try to help providers understand that the
resources you may successfully use on a daily basis may not be the best resources to use
when confronted with the demands of business to business data transfer.
If you are having difficulty finding a resource that can successfully produce your XML file,
we suggest you ask a prospective XML programmer the following questions:
A. What database experience do you have?
B. What development environment(s) do you use? (“translation program”)
C. Can you write code directly without the development environment?
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D. What training/experience have you had with XML?
E. Are you familiar with XML syntax?
F. Have you ever transferred data between Database Management Systems using XML?
CECBEMS has budgeted for providers to receive a limited amount of technical assistance from
our AMS manager. Our experience shows that when we are dealing with an experienced XML
programmer who has read the CECBEMS AMS Manual we need to answer a few questions
and/or review a small test upload to identify problems. Subsequently, these providers are able to
upload data quickly and effectively. If you would like for CECBEMS to provide services beyond
this limited amount, we will be happy to contract with you for these services.
Providers have failed to utilize the resources we have provided them, including the AMS
Providers Manual, an XML schema (template), and an XML file example.
We encourage providers to download these resources, make them available to your XML
programmer, and refer to them when building files for submitting data to the AMS.
These resources can be found at http://cecbems.org/faqAnswers.aspx?RecID=56 and
http://cecbems.org/faqAnswers.aspx?RecID=54
CECBEMS has budgeted for providers to receive a limited amount of technical assistance from
our AMS manager. Our experience shows that when we are dealing with an experienced XML
programmer who has read the CECBEMS AMS Manual, we need to answer a few questions
and/or review a small test upload to identify potential problems. Subsequently, these providers
are able to upload data quickly and effectively. If you would like for CECBEMS to provide
services beyond this limited amount, we will be happy to arrange for you to contract for these
services.
CECBEMS also offers limited technical assistance to providers who are submitting data via
manual entry. Again, when we are dealing with someone who has read the manual carefully, we
are able to identify potential problems quickly and subsequent submissions have uploaded
smoothly. As with XML users, if you would like for CECBEMS to provide services beyond this
limited amount, we will be happy to arrange for you to contract for these services.
Summary
1.
Collect the information listed below from each participant in the prescribed format.
This is not optional. Failure to collect this information could result in loss of
accreditation.
CECBEMS activity number, date of course completion, first name, last name, email
address, city of residence, state of licensure, state license number, type/level
of license, license expiration date, NREMT registration number (if student is NREMT),
NREMT reregistration date (if student is NREMT), Number of CEH, Category of CEH.
2.
Put a process in place to ensure that data is complete and accurate.
3.
Read the CECBEMS AMS manual carefully and forward it to your technical
support people and anyone else in your organization who will be involved in data
collection and/or submission.
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4.
Utilize the limited technical support offered by CECBEMS to resolve initial
technical issues.
5.
Schedule regular data uploads to comply with deadlines for reporting post-activity
materials.
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