Form Dhec 2353 PDF Details

Are you an employer looking for guidance on filling out South Carolina's Form Dhec 2353? You've come to the right place! This comprehensive blog post will provide you with detailed instructions and information about completing the form, so that you can accurately and effectively submit it. We'll cover topics such as general information on Form Dhec 2353, essential steps to consider when submitting the form, and tips for successfully filing this important document. So let's get started--rest assured that by the end of this blog post, you'll have a clear understanding of how to properly fill out a Form Dhec 2353.

QuestionAnswer
Form NameForm Dhec 2353
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesD 2353 is any fill the form before paramedics

Form Preview Example

SC DHEC Division of EMS & Trauma

State In-Service Training Re-Certiication Form for Paramedic

SC State Certiication Number

 

SSN (Last 4 #s)

SC

 

 

 

 

 

 

 

SC State Expiration Date

 

 

 

 

 

 

Last Name

E-Mail Address

National Registry Certiication Number

National Registry Cert. Exp. Date

First Name

Date of Birth (mm/dd/yyyy)

Mailing Address

City, State, Zip Code

Home Phone Number (Including Area Code)

Cell Phone Number (Including Area Code)

In-Service Training (IST) 2011 Option

Section IA & 1B: Paramedic Traditional Refresher Requirement

(Must satisfy all refresher requirements every two years)

 

 

Paramedic "Traditional" Refresher Requirement

 

 

 

 

 

 

 

 

 

(1A) 1st two-year period

 

(1B) 2nd two-year period

Date

Method

Hours

Topics

Hours

Method

Date

 

 

6

Preparatory

6

 

 

 

 

 

 

 

 

 

 

 

6

Airway Management

6

 

 

 

 

 

 

 

 

 

 

 

10

Trauma

10

 

 

 

 

 

 

 

 

 

 

 

18

Medical

18

 

 

 

 

 

 

 

 

 

 

 

6

Special Considerations

6

 

 

 

 

 

 

 

 

 

 

 

2

Operations

2

 

 

 

 

 

 

 

 

 

 

 

48

Total

48

 

 

If a formal Paramedic Refresher course was completed, please attach a copy of the course completion certiicate for each two-year period.

Section 1A & 1B:

A maximum of 10 hours can be applied from Distributive Education toward refresher requirements and must be CECBEMS or DHEC approved.

DHEC 2353 (09/2011)

SOUTH CAROLINA DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL

Section IC & 1D: Paramedic Refresher Requirement (Must satisfy all refresher requirements every two years)

Paramedic Refresher Requirement

(1C) 1st two-year Period

 

(1D) 2nd two-year period

Date

Method

Hours

Divisions

Hours

Method

Date

 

 

 

 

Airway, Breathing and Cardiology

 

 

 

 

 

 

 

A 16 hour ACLS course meets all objectives for this division

 

 

 

 

 

 

 

Mandatory Core (Must cover ALL topics)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Provide ventilatory support for a patient

 

 

 

 

 

8

Provide care to a pt experiencing cardiovascular compromise

8

 

 

 

 

 

 

Attempt to resuscitate a patient in cardiac arrest

 

 

 

 

 

 

 

Provide post resuscitation care to a cardiac arrest patient

 

 

 

 

 

 

 

Flexible Core

 

 

 

 

 

 

 

Assess & provide care for an adult pt in respiratory distress

 

 

 

 

 

8

Use oxygen delivery system components

8

 

 

 

 

 

 

Perform techniques to assure a patient airway

 

 

 

 

 

 

 

Assess & provide care to a pt experiencing non-traumatic chest pain/discomfort

 

 

 

 

 

 

 

Medical Emergencies

 

 

 

 

 

 

 

A 16 hour AMLS course meets all objectives for this division

 

 

 

 

 

 

 

Mandatory Core (Must cover ALL topics)

 

 

 

 

 

 

 

Assess & provide care to a pt experiencing an allergic reaction

 

 

 

 

 

3

Assess & provide care to a near-drowning patient

3

 

 

 

 

 

 

Assess a patient with possible overdose

 

 

 

 

 

 

 

Flexible Core

 

 

 

 

 

 

 

Assess & provide care to a pt w/ altered mental status

 

 

 

 

 

 

 

Assess & provide care to a pt experiencing a seizure

 

 

 

 

 

5

Assess & provide care to a pt w/a behavioral problem

5

 

 

 

 

 

 

Assess & provide care to a pt w/a history of diabetes

 

 

 

 

 

 

 

Assess & provide care to a pt exposed to heat and cold

 

 

 

 

 

 

 

Assess & provide care to a pt w/suspected communicable disease

 

 

 

 

 

 

 

Trauma

 

 

 

 

 

 

 

A 16 hour PHTLS, BTLS, ITLS meets all objectives

 

 

 

 

 

 

 

Mandatory Core (Must cover ALL topics)

 

 

 

 

 

 

 

Perform a rapid trauma assessment

 

 

 

 

 

 

 

Assess & provide care to a pt w/suspected spinal injury

 

 

 

 

 

5

Provide care to a pt w/an open abdominal injury

5

 

 

 

 

 

 

Assess a patient with a chest injury

 

 

 

 

 

 

 

Assess a patient with a head injury

 

 

 

 

 

 

 

Provide care to a pt with shock/hypoperfusion

 

 

 

 

 

 

 

Flexible Core

 

 

 

 

 

1

Provide care to a pt w/a painful, swollen, deformed extremity

1

 

 

 

 

 

 

Assess and provide care to a pt with a burn injury

 

 

 

 

 

 

 

Obstetrics & Pediatrics

 

 

 

 

 

 

 

A 16 hour PEPP, PPC, PALS course meets all objectives

 

 

 

 

 

 

 

Mandatory Core (Must cover ALL topics)

 

 

 

 

 

 

 

Assess & provide care to an infant/child w/cardiac arrest

 

 

 

 

 

8

Assess & provide care to an infant/child w/shock/hypoperfusion

8

 

 

 

 

 

 

Assess & provide care to an infant/child w/respiratory distress

 

 

 

 

 

 

 

Assess & provide care to an infant/child w/trauma

 

 

 

 

 

 

 

Flexible Core

 

 

 

 

 

 

 

Assess & provide care to an infant/child w/suspected abuse or neglect

 

 

 

 

 

 

 

Assess & provide care for the obstetric patient

 

 

 

 

 

8

Provide care to the mother immediately following delivery of a newborn

8

 

 

 

 

 

 

Assess & provide care to an infant/child w/a fever

 

 

 

 

 

 

 

Provide care to a newborn

 

 

 

 

 

 

 

Operational Tasks: Flexible Core

 

 

 

 

 

2

Use body mechanics when lifting & moving pts

2

 

 

 

 

 

 

Communicate with patient while providing care

 

 

 

 

48

Totals

48

 

 

Section 1C & 1D:

A maximum of 10 hours can be applied from Distributive Education toward refresher requirements and must be CECBEMS or DHEC approved.

DHEC 2353 (09/2011)

Section II A & B: Continuing Education Requirement (Must satisfy all CE requirements every two years)

24 hours of Continuing Education Required every Two-Years

DATE

Topics of Training

(2A) First two-year period

Method of Instruction

Hours

DATE

Topics of Training

(2B) Second two-year period

Method of Instruction

Hours

Sections 1 & 2:

May be satisied every two years by successful completion of the National Registry Paramedic

 

"Assessment" Exam. Documentation of successful examination must be within 60 days of the

 

end of each two-year cycle.

 

 

 

Section 2A & 2B:

A maximum of 12 hours can be applied from Distributive Education toward CE requirements and must be

 

CECBEMS or DHEC approved.

 

Hour for hour credit can be applied from each of the following: ABLS, ACLS, AMLS, BTLS, ITLS, NALS,

 

PALS, PEPP, PHTLS, PPC, etc.

 

 

A maximum of 12 hours can be applied from Emergency Driving, Dispatch Training or Teaching CPR.

 

A maximum of 12 hours can be applied from any one topic area.

 

 

Hour for hour credit can be applied from college-level courses relating to EMS.

 

DHEC 2353 (09/2011)

Section III A & B: Veriication of Skill Competence (Must satisfy every two years)

 

 

Paramedic Skill Competence

 

 

 

 

 

(3A) 1st two-year period

 

(3B) 2nd two-year period

Date

Method

Skill

Method

Date

 

 

Patient Assessment/Management

 

 

Medical

Trauma

Ventilatory Management Skills/Knowledge

Simple Adjuncts

Supplemental Oxygen Delivery

Alternative Airways

(PTL, Combi-Tube, etc.)

Endotracheal Intubation (adult & pediatric)

Chest Decompression

Transtracheal Jet Ventilation/Cricothyrotomy

Cardiac Arrest Management

Megacode & ECG Recognition

Therapeutic Modalities

Monitor/Deibrillator Knowledge

(Set-up, routine maintenance, pacing)

Hemorrhage Control & Splinting Procedures

IV Therapy & IO Therapy

Medicaton Administration

Spinal Immobilization

Seated & Supine Patients

OB/Gynecologic Skills/Knowledge

Other Related Skills/Knowledge

Radio Communications

Report Writing & Documentation

As the Medical Control Physician for this EMT, I do hereby afix my signature attesting to continued competence in all skills out-lined above.

____________________________________________________________________________________________

Signature of Medical Control Physician (Must be original signature) + Date Signed

Section IV: Other Required Credentials

BLS (CPR) Credential

 

SC State Criminal Background Check

Attach a copy of a valid / current BLS Credential

 

 

Expiration date must be GREATER

 

Attach a copy of your lBT

than your SC state EMT expiration date

 

ingerprint receipt

BLS card MUST be one of the following:

 

You may call IBT at

 

 

AHA: BLS for the Healthcare Professional

 

866-254-2366

 

to make an appointment

ARC: CPR for the Professional Rescuer

 

 

 

ASHI: CPR Pro

 

SC DHEC EMS ORI #: SC920111Z

ACLS Credential

Attach a copy of a valid / current ACLS Credential

Expiration date must be GREATER

than your SC state EMT expiration date

ACLS card MUST be one of the following:

AHA: ACLS

ASHI: ACLS

I hereby afirm that all statements on the SC EMT-Paramedic Recertiication form are true & correct, including the copies of cards, certiicates, and other required veriication. It is understood that false statements or documents may be suficient cause for revocation of my EMT credential by SC DHEC. It is also understood that SC DHEC may conduct a full audit of all recertiication activities listed on this form at any time.

________________________________________________________________________________________________________________________

Signature of IST Training Director or EMS Service Director + Date Signed

Signature of EMT Recertiication candidate + Date Signed

DHEC 2353 (09/2011)