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WYOMING OFFICE OF EMERGENCY MEDICAL SERVICES APPLICATION FOR TRAINING AND CERTIFICATION
PARAMEDIC TRAINING PROGRAM2020 Paramedic Program Applicant Checklist
Questionnairecomplete?
Applicationcomplete?
Two lettersofreference? (May be sent separately)
Resume?
Copiesofcurrentcertifications?
CPRuptodate?
NationallyRegistered?
AppliedtoLCCC?
Registered?
Math0920orequivalent?
English1010orequivalent?
Vaccinationsortiters–
Heb B
TB (<1year)
MMR
Tetanus (<10years)
Varicella
CallCharles Retzat307.778.1149or307.275.2755withquestions
To be eligible for consideration for the 2019 LCCC Paramedic Training Program, all applications must be postmarked by
November 1st, 2019. Any applications received postmarked after this date will not be considered.
LCCC does not discriminate based upon any protected status. Please see lccc.wy.edu/NDS.
Item Points Currently licensed in Wyoming as an EMT 5 Current NREMT-B certification 20 Current licensure at AEMT level or higher 5 At least 3 years’ experience in EMS or a related field 10 At least 1 year experience in EMS or healthcare 5 Applied to and accepted at LCCC 5
WYOMING OFFICE OF EMERGENCY MEDICAL SERVICES APPLICATION FOR TRAINING AND CERTIFICATION
PARAMEDIC TRAINING PROGRAM
2020 Paramedic Program Applicant Checklist
PARAMEDIC PROGRAM SELECTION CRITERIA
The Paramedic Program Selection Committee will be the individuals to consider the applications submitted by prospective students. The following point scale will be utilized. Only completed applications will be considered. Applications with requirements not met at the time of selection may be provisionally admitted pending fulfillment of ALL requirements. Applicants who submit a completed application will be contacted to schedule a date and time to complete the entrance examination and interview board. Scores from the entrance examination and interview board will be combined with the score from the application point scale below. All persons submitting an application will be notified of their admission status following the selection process.
Laramie County Community College is committed to providing a safe and nondiscriminatory educational and employment environment. The college does not discriminate on the basis of race, color, national origin, sex, disability, religion, age, veteran status, political affiliation, sexual orientation or other status protected by law. Sexual harassment, including sexual violence, is a form of sex discrimination prohibited by Title IX of the Education Amendments of 1972. The college does not discriminate on the basis of sex in its educational, extracurricular, athletic or other programs or in the context of employment.
The college has a designated person to monitor compliance and to answer any questions regarding the college's nondiscrimination policies. Please contact: Title IX and ADA Coordinator, Suite 205, Clay Pathfinder Building, 1400 E College Drive, Cheyenne, WY 82007, 307.778.1217, [email protected].
WYOMING OFFICE OF EMERGENCY MEDICAL SERVICES APPLICATION FOR TRAINING AND CERTIFICATION
PARAMEDIC TRAINING PROGRAMWYOMING OEMS SYSTEM FUNCTIONAL POSITION DESCRIPTIONS FOR EMT-PARAMEDIC
EachcandidatemustsuccessfullycompletetheWyomingOfficeofEMSapprovedTrainingCurriculumandachieveapassingscoreonthepracticalandwrittencertificationexaminations.
Thecandidatemustbeatleasteighteen(18)yearsofagewhenapplyingforEMT,EMT-I(Intermediate),orParamedicCertification,orwithinsix(6)monthsoftheconclusionoftheDivisionapprovedEMTTrainingProgram.
Thecandidatemustpossesstheabilitytocommunicateverballyandviatelephoneandradioequipment.
Thecandidatemustpossesstheabilitytointerpretwrittenandoralinstructions;mustpossesstheabilitytousegoodjudgmentandremaincalminhighstresssituations;mustpossesstheabilitytobeunaffectedbyloudnoisesandflashinglights;mustpossesstheabilitytofunctionefficientlythroughouttheentireworkshiftwithoutinterruption.
Thecandidatemustpossesstheabilitytointerviewpatients,familymembersandbystanders;possesstheabilitytodocument,inwriting,allrelevantinformationinprescribedformatinlightoflegalramificationsofsuch;possesstheabilitytoconverseinEnglishwithco-workersandhospitalstaffastothestatusofpatients.
Thecandidatemustpossessgoodmanualdexteritywiththeabilitytoperformtasksrelatedtothedeliveryofthehighestqualityofpatientcare;mustpossesstheabilitytobend,stoopandcrawlonuneventerrain;possesstheabilitytowithstandvariedenvironmentalconditionssuchasextremeheat,cold,andmoisture,andpossesstheabilitytoworkinlowlightandconfinedspaces.
Laramie County Community College is committed to providing a safe and nondiscriminatory educational and employment environment. The college does not discriminate on the basis of race, color, national origin, sex, disability, religion, age, veteran status, political affiliation, sexual orientation or other status protected by law. Sexual harassment, including sexual violence, is a form of sex discrimination prohibited by Title IX of the Education Amendments of 1972. The college does not discriminate on the basis of sex in its educational, extracurricular, athletic or other programs or in the context of employment.
The college has a designated person to monitor compliance and to answer any questions regarding the college's nondiscrimination policies. Please contact: Title IX and ADA Coordinator, Suite 205, Clay Pathfinder Building, 1400 E College Drive, Cheyenne, WY 82007, 307.778.1217, [email protected].
WYOMING OFFICE OF EMERGENCY MEDICAL SERVICES APPLICATION FOR TRAINING AND CERTIFICATION
PARAMEDIC TRAINING PROGRAMCOMPETENCY AREAS
EMT-Basic Thecandidatemustdemonstratecompetencyinassessingapatient,handlingemergenciesutilizingBasicLifeSupport(BLS)equipment.PossesstheabilitytoperformCPR,controlhemorrhage,providenon-invasivetreatmentforinadequatetissueperfusion,splintingandspinalimmobilization,useofsemi-automaticdefibrillator,possesstheabilitytoadministerself-assistedmedications,manageenvironmentalemergenciesandemergencychildbirth.
EMT-Intermediate ThecandidatemustdemonstratecompetencyinallEMT-Basicskills.Mustbeableto,ifauthorized;provideAdvancedLifeSupport(ALS)usingintravenoustherapy,advancedairwaymanagement,medicationadministrationanddefibrillationaccordingtoguidelinesestablishedbytheWyomingOfficeofEmergencyMedicalServices.
EMT-Paramedic ThecandidatemustbecompetentinutilizingallEMT-BasicandEMT-IntermediateskillsandequipmentandbeabletoperformunderotherAdvancedLifeSupport(ALS)standardsformedicalandtraumaemergenciesconsistentwithguidelinesestablishedbytheWyomingOfficeofEmergencyMedicalServicesandunderthedirectionofaPhysician.
Description of Tasks Receivecallfromdispatcher,respondverballytoemergencycalls,readmaps,maydrivevehicletoemergencysitesusingmostexpeditiousroute,andobserveordinancesandregulations.
Determinethenatureandextentofillnessorinjury,takepulseandbloodpressure,visuallyobservechangesinskincolor,makedeterminationregardingpatientstatus,establishpriorityinemergencycare,renderappropriateemergencycare(basedoncompetencylevel),mayadministerintravenousmedicationsorfluidreplacement,ifcertifiedanddirectedbymedicalcontrol.Mayuseequipment(basedoncompetencylevelandcertification)suchas,butnotlimitedto,monitorwithdefibrillatorandperformendotrachealintubationtoopenairwaysandventilatepatients.Administermedicationsasauthorized.
Assistinlifting,carryingandtransportingpatientstoambulanceandontothemedicalfacility.Reassurepatientandbystanders.Avoidunderhasteandmishandlingofpatients.Searchformedicalidentificationemblemtoaidincare,extricatepatientsfromentrapment,assessextendofinjury,useprescribedtechniquesandappliances,radiodispatcherforadditionalassistanceorserviceandprovidelightrescueservices.Provideadditionalemergencycarefollowingestablishedprotocols.
Complywithregulationsinhandlingthedeceased;notifyauthoritiesandarrangeforprotectionofpropertyandevidenceatscene.Determineappropriatefacilitytowhichpatientwillbetransported,reportnatureandextendofinjuriesorillnesstothatfacility,andaskfordirectionfrommedicalcontroloremergencydepartment.Identifydiagnosticsignsthatrequirecommunicationwithmedicalfacility.
Assistinremovingpatientfromambulanceandintoemergencyfacility.Reportverballyandinwriting,observationsaboutandcareofpatientatthesceneandenroutetomedicalfacility.Provideassistancetomedicalstaffasrequired.Replacesupplies,checkallequipmentforfuturereadiness,maintainemergencyvehicleinoperablecondition,ensurescleanlinessandorderlinessofequipmentandsupplies,anddecontaminatesvehicleinterior.
LCCC does not discriminate based upon any protected status. Please see lccc.wy.edu/NDS.
WYOMING OFFICE OF EMERGENCY MEDICAL SERVICES APPLICATION FOR TRAINING AND CERTIFICATION
PARAMEDIC TRAINING PROGRAMAPPLICATION INSTRUCTIONS
ThankyouforyourinterestintheLaramieCountyCommunityCollegeParamedicProgram.
Pleaseensurethatyoufilloutthisapplicationinitsentirety.Failuretodosomayresultinyourapplicationnotbeingaccepted.
Thefollowingitemsmustbeincluded and returnedwithyourapplication:
CompletedApplication(EnsureyouprovideALLREQUIREDsignatures)
WrittenInterview Questions
• Theinterviewquestionnaireisincludedinthispacket.Youmayusetheincludedspacestocompleteyouranswers;however,wehighlyrecommendthatyoutypetheanswerstoyourquestionsinaseparatedocumenttoallowyoutoprovidemoredetail.
CopyofCurrentCPRCard
CopyofCurrentEMT Certification or higher
CopyofCurrentvaccinations
CopyofCurrentACLSCard(If Applicable)
CopyofCurrentPALSCard(If Applicable)
Anyotherobtainedcertifications,
applicable transcripts and other documents
found on the checklist page.
Please remember to apply for admission to Laramie County Community College in conjunction with the completion of this
application if you are not currently an LCCC student. Applying to LCCC can be completed at:
http://www.lccc.wy.edu/admissions/index.aspx
Please return the completed application and all required documents by November 1st, 2019 to:
LaramieCountyCommunityCollege ParamedicTrainingProgram,TC109
1400E.CollegeDrive Cheyenne,WY82007
WYOMING OFFICE OF EMERGENCY MEDICAL SERVICES APPLICATION FOR TRAINING AND CERTIFICATION
PARAMEDIC TRAINING PROGRAMAPPLICATION
APPLICANT INFORMATION
Name(Last, First, MI):
DateofBirth: SSN: Phone:
DriverLicense#: DriverLicenseState: Male Female
CurrentAddress:
City: State: ZIPCode:
PREVIOUS TRAINING
EMTBasicClassLocation:
DateofCompletion: NREMT#andExpiration(If Certified):
EMT-A or EMT-IClassLocation(If Applicable):
DateofCompletion: NREMT#andExpiration(If Certified):
ModulesCompleted:
AreyoucurrentlyWyomingStateCertified? Yes No State#:
AFFILIATION
AreyoucurrentlyaffiliatedwithanEMSAgency? Yes No
NameofService:
Address:
City: State: ZIPCode:
NameofSupervisor: Phone:
CRIMES AGAINST A PERSON, FELONY STATEMENT AND LICENSING ACTION
Haveyoueverbeenconvictedofacrimeagainstaperson? Yes No
Haveyoueverbeenconvictedofafelony? Yes No
Haveyoueverbeensubjectedtolimitation,suspensionorterminationofyourrighttopracticeinahealthcareoccupation orvoluntarilysurrenderedahealthcarelicenseinanystateortoanagencyauthorizingthelegalrighttowork? Yes No
If you answered “yes” to any of the questions above, please provide details below. You must also provide official documentation of the current status and disposition of the case.
LCCC does not discriminate based upon any protected status. Please see lccc.wy.edu/NDS.
WYOMING OFFICE OF EMERGENCY MEDICAL SERVICES APPLICATION FOR TRAINING AND CERTIFICATION
PARAMEDIC TRAINING PROGRAMAPPLICATION (continued)
CERTIFICATION OF ELIGIBILITY (SIGN ONLY ONE)
Eachstudentand/orcandidateforWyomingOfficeofEmergencyMedicalServicescertificationmustsignone(1) ofthetwo(2)followingstatements.
Bycheckingthisboxandsubmittingthisapplication,IherebycertifythatIhavereadandunderstandtheFunctionalJobDescriptionofanEMT(Includedinthispacket).IhavenoconditionswhichprecludemefromsafelyandeffectivelyperformingallthefunctionsofthelevelofEMTforwhichIamseekingtrainingandastateofWyomingEMSCertification.
NameofCandidate(Please Print):Signature: Date:
Bycheckingthisboxandsubmittingthisapplication,IherebycertifythatIhavereadandunderstandthefunctionalJobDescriptionofanEMT.Iwillbesubmittingarequestforanaccommodation(s)fortheWyomingOEMSadministeredCertificationExamination(s).IunderstandthatifIamenrolledinatrainingcourse,ImustcontacttheWyomingOEMSnolaterthansix(6)weekspriortotheWyomingOEMSadministeredWrittenCertificationExaminationforthispurpose.IfIhavealreadycompletedtraining,mywrittenrequestforaccommodation(s)mustaccompanythisapplication.
NameofCandidate(Please Print):Signature: Date:
STATEMENTS / AUTHORIZATION
Bycheckingthisboxandsubmittingthisapplication,Iherebycertifythatallstatementsmadeonthisapplicationaretrueandcorrect.FalsestatementsmayresultinremovalfromtheprogramordenialofauthorizationtotaketheNationalRegistryofEmergencyMedicalTechnicianswrittenexamination.IauthorizetheWyomingOfficeofEMStocontactsuchagenciesasmaybenecessarytoverifythisinformation.ThisshallalsoserveasareleaseforsaidagenciestoprovideinformationtotheWyomingOfficeofEmergencyMedicalServices.
NameofCandidate(Please Print):Signature: Date:
LCCC does not discriminate based upon any protected status. Please see lccc.wy.edu/NDS.
WYOMING OFFICE OF EMERGENCY MEDICAL SERVICES APPLICATION FOR TRAINING AND CERTIFICATION
PARAMEDIC TRAINING PROGRAMAPPLICATION (continued)
WRITTEN INTERVIEW QUESTIONNAIRE (continued)
1) Inyourcurrentlevelofcertification,canyougiveoneexampleofhowyouenhancedapatient’sservice/patientrelations?
2) Whatreasons/experiencesattractedyoutoacareerinEMS/Pre-hospitalmedicine?
3) Howwouldyourankthevalueofpursuingcontinuingeducation(onascaleof1-10)?Why?
4) WhatdoyouperceivearetheprimarydutiesofbeingaParamedic?
5) WhatthreecharacteristicsdoyouhavethatwillenableyoutobeasuccessfulParamedic?Explainwhyyouchoseeachcharacteristic?
6) HowdidyoufindoutabouttheParamedicProgramatLCCC?
LCCC does not discriminate based upon any protected status. Please see lccc.wy.edu/NDS.
WRITTEN INTERVIEW QUESTIONNAIRE (continued)
7) IfacceptedintotheParamedicprogram,whatprofessionalgoalswouldyouliketoachieveinthenextfiveyears?
8) Howdoyoudealwithconflict(co-workers,physicians,instructors,fellowstudents)?
9) Whatmotivatesyoutoputforthyourgreatesteffort?
10) Thinkofasituationwhereyouhadtointeractwithadifficultperson(asapeer,customer,employee,etc.).Describethecircumstancesofthesituationandhowyoudealtwiththepersonandsituationinordertoresolvetheconflict.
11) Thisprogramisintense,butintheendveryrewarding.Somecommentsfrompastgraduatesare:“study,study,study...”;“Bereadytogiveupalotoftime...”;“stayfocusedanddon’tgiveup....”Obviously,thisprogramrequiresagreatdealofstudyandclinicaltime.Whattypesofsupportdoyoufeelthatyouwillhavefromfamilyandfriends?
WYOMING OFFICE OF EMERGENCY MEDICAL SERVICES APPLICATION FOR TRAINING AND CERTIFICATION
PARAMEDIC TRAINING PROGRAMAPPLICATION (continued)
LCCC does not discriminate based upon any protected status. Please see lccc.wy.edu/NDS.
WRITTEN INTERVIEW QUESTIONNAIRE (continued)
12) AsaParamedic,doyoufeelyouwouldbeabletotakecontrolofascene,evenwhenseniorofficersorotherParamedicsarepresent?Why?
13) Thinkofasituationwhereyouhadmultipletaskstocompletewithsimilardeadlines.Describetheactionsyoutook/willtaketoensurethetimelycompletionofthetasks.
14) Describeyourroleasapatientadvocate.
15) Whyshouldweacceptyouintotheprogramoversomeoneelse?
16) Whatwouldyoudoifapsychoticpatientbecameaggressivetowardyou?
WYOMING OFFICE OF EMERGENCY MEDICAL SERVICES APPLICATION FOR TRAINING AND CERTIFICATION
PARAMEDIC TRAINING PROGRAMAPPLICATION (continued)
LCCC does not discriminate based upon any protected status. Please see lccc.wy.edu/NDS.
WRITTEN INTERVIEW QUESTIONNAIRE (continued)
17) Pleasedescribeindetailhowyouwouldhandlethesituationoutlinedbelow;• Youarriveforyourshiftandfindyourpartnersleepingonthecouchinthestation.Youproceedwith
yourunitcheck-offandintheprocessreceiveadispatchtoacardiacarrest.YourpartnercomestotheambulanceandsmellsstronglyofETOH.Theyreplythatthesmellistheirnewcolognewhenasked.Describehowyouwouldhandlethissituation.
Questions/Comments?
NameofCandidate(Please Print):Signature: Date:
EVEN IF YOU COMPLETE THIS WRITTEN APPLICATION IN ANOTHER DOCUMENT, YOU MUST STILL SIGN.
PLEASE READ THE INSTRUCTION SECTION OF THIS APPLICATION PACKET BEFORE SUBMITTING IT TO MAKE SURE YOU HAVE INCLUDED ALL REQUIRED DOCUMENTS.
or andmailto:Charles Retz LaramieCountyCommunityCollege1400E.CollegeDrive, TC 109Cheyenne,WY82007
WYOMING OFFICE OF EMERGENCY MEDICAL SERVICES APPLICATION FOR TRAINING AND CERTIFICATION
PARAMEDIC TRAINING PROGRAMAPPLICATION (continued)
LCCC does not discriminate based upon any protected status. Please see lccc.wy.edu/NDS.
Email InstructionsPlease note the pop-up window that appears after you click “EMAIL.”
1. The window will ask you to select your email client.
2. If you use Microsoft Outlook Express, MicrosoftOutlook, Eudora or Mail, click “OK” in the pop-upwindow. The form will be emailed to us. Please besure that the email address is [email protected].
3. If you use any other client, such as Yahoo or Hotmail,choose “Internet Email,” then click “OK.”
• Thecomputerwillsavetheformtoyourharddrive.
• Youmustopenyouremailaccountandattach the form to a message and email it [email protected].
4. Please contact Charles Retz at 307.778.1149 to makesuretheformwasreceivedsuccessfully.
LCCC does not discriminate based upon any protected status. Please see lccc.wy.edu/NDS.