Step 1: Email Diane Strickland ([email protected])
Step 1: Email Diane Strickland ([email protected]) that you are requesting to be able to submit an application for a new EMS agency. You will need to provide the following information:
- Desired Agency Name (the requested name must not be substantially similar to an existing EMS agency name)
- Username in the EMS License Management System of the Authorized Agent
NOTE: If the Authorized Agent for the new agency is a Georgia licensed medic, then you already have an account in the system. For Authorized Agents who have never been licensed as a medic in the state of Georgia, you will need to create an account. For information on how to find your username if you are a licensed medic or on how to create an account, click HERE.
Step 2: Submit an Application
Step 2: After we create the entity in our system and assign the above person as the Authorized Agent of the agency, the Authorized Agent will get an email from "[email protected]" that they have been added as an Authorized Agent.
Documents Required for All EMS Agencies
- A completed and notarized Authorized Agent Designation form (Click HERE ) for each Authorized Agent
- A completed and notarized Verification of Lawful U.S. Residency form (Click HERE ) for each Authorized Agent
- A clear scanned copy of the secure and verifiable document that was shown to the notary public for each Authorized Agent (Click HERE for a list of acceptable documents)
- For Corporations - a scanned copy of the Articles of Corporation
- For LLCs - a scanned copy of the Articles of Organization
Documents Required for EMS Agencies Using a Service Delivery Contract*
- A scanned and signed copy of the complete Service Delivery Contract
Minimum Personnel for EMS Agencies Not Using a Service Delivery Contract*
Agencies must designate the following at a minimum, and all must have an account in the Georgia EMS License Management System:
- ONE (1) Service Director (Person with ultimate responsibility within the service)
- ONE (1) Training Officer (Person whose primary role is training individuals within the service)
- ONE (1) Data Manager (Person who is responsible for GEMSIS data reporting validation and accuracy)
- ONE (1) Infection Control Officer (Person responsible for infectious disease control plan and procedures)
- ONE (1) Pediatric Emergency Care Coordinator (for 911 agencies) (Person responsible for coordinating pediatric-specific activities)
- ONE (1) Communications Officer (Person responsible for communication log or dispatch center)
Medical Director and Pharmacy Policies for EMS Agencies Not Using a Service Delivery Contract*
All EMS Agencies that do not use a complete Service Delivery Contract must have a current Georgia License Physician (MD, DO) as their designated Medical Director, and each Medical Director must have the following form completed:
- Completed Medical Director Agreement Form (Click HERE )
A Pharmacy is also required for EMS Agencies that will have any medications or IV fluids, and the Pharmacy and Pharmacist must be currently licensed in the State of Georgia. The following Pharmacy Documents are required:
- Completed Pharmacy Agreement Form (Click HERE ) - one for each Pharmacy
- Pharmacy Policies and Procedure as required by O.C.G.A § 26-4-116. Must be approved and signed by the Medical Director
- Formulary as approved by the Medical Director - Must be approved and signed by the Medical Director.
Data Management Policy for EMS Agencies Not Using a Service Delivery Contract*
Each EMS Agency that is not using a complete Service Delivery Contract must have a Data Management Policy that addresses the following:
The Data Management Policy MUST address the following:
- Must include which ePCR software (state-provided or 3rd party vendor) the agency is using for data submission.
- Must include Data Manager contact (This person MUST be in LMS as the Data Manager, with a phone number and email address)
- Medics must be the ones to complete the ePCRs
- Medics must complete ePCR before the end of the current shift
- Medics must comply with all validation rules (before the end of the shift)
- ePCR data must be submitted to GEMSIS Elite within 24 hours of call completion (based on eTimes.13)
- Calls must be submitted via NEMSIS V3.4 web services to GEMSIS Elite (only for 3rd party vendors)
- Agency Data Manager for NEW agencies must check data submissions daily for 2 weeks, and then weekly after that.
- Agency Data Manager for existing agencies must check data submissions weekly
- Agency Data Manager is checking data for:
- Validity score (calls less than a score of 95 must be corrected and resubmitted to GEMSIS Elite)
- The thoroughness of narratives (select a random sampling for this)
- Call volume in GEMSIS Elite matches call volume in the agency's dispatch log
- Failed Imports (failed imports must be corrected and re-submitted to GEMSIS Elite)
- Policy must be signed and dated by the Authorized Agent
Please click here to review more information on EMS data submission requirements.
Protocols for EMS Agencies Not Using a Service Delivery Contract*
Each EMS Agency that is not using a complete Service Delivery Contract must have protocols for each of the following:
- Infectious Disease Exposure Control Plan
- Cardiac Protocols:
- STEMI Treatment and Transport
- Cardiogenic Shock Treatment and Transport
- OHCA Treatment and Transport
- Stroke Protocols:
- Stroke Treatment and Transport
- Stroke Triage Tool (CPSS is the State recommended one)
- Stroke Severity Tool (FAST-ED is the State recommended one)
- Trauma Protocols:
- General Trauma Treatment and Transport - must reference the CDC Field Triage Criteria
- Other protocols for the assessment, management and transport of patients with specific traumatic injuries
- Other protocols that address each of the clinical guidelines that are listed in the current version of the NASEMSO Model EMS Clinical Guidelines (Click HERE for the January 2019 Version)
Other Requirements for EMS Agencies Not Using a Service Delivery Contract*
Each EMS Agency that is not using a complete Service Delivery Contract must also submit the following:
- Insurance Information including letter from ACCG (if Government) or ACORD 25 and if needed ACORD-101/129)
- Locations list
- Vehicles list
- Personnel list
- Dispatch Log Template - this is from your CAD system or your written dispatch log and must contain all of the elements listed in DPH Rules and Regs.
- Data Management Policy - this is a policy that addresses your ePCR software vendor and how your medics complete the ePCRs and your Data Manager checks the data.
- CLIA Certificate of Waiver (see this webpage)
EMS Agency Forms for License Management System (LMS)
Vehicle Inspection Forms
The following vehicle inspection forms will be effective starting January 1, 2023.
EMS Agency Licensure
Initial License Requirements
The Georgia Department of Public Health Rules and Regulations Chapter 511-9-2 to license, re-license, and monitor Ambulance Services, Air Ambulance Services, Medical First Responders, and Neonatal Transport Services.
An applicant for EMS Agency licensure must submit to the Office of EMS and Trauma a complete application packet along with all other required documents and fees. Forms and additional documents can be found below. Each vehicle to be operated under the license must be inspected and approved by the department and so registered by affixing a department decal at a location specified by the department.
New EMS Agency License Requests
All New EMS Agency License Requests must follow these steps, as paper applications will no longer be accepted:
*A Service Delivery Contract is a way for an EMS agency to meet all of the requirements for EMS Agency Licensure by having a contract with a currently licensed EMS Agency in Georgia to meet all of those requirements.
If your agency needs to designate a new Authorized Agent but you do not have access to the Georgia EMS License Management System, please follow the instructions on this page.
Page last updated 12/9/2022