Basic Life Support First Response Agency Application
- Basic Life Support Application Packet, revised April 2009 (PDF, 168KB, 14pg)
Thank you for you agency's interest in obtaining an agency code as a Basic Life Support First Response (BLSFR) agency. This packet of information and policies should assist you to understand your role as a BLSFR Service, however your first step if you have not already done so, should be to contact your regional EMS system for information on participating as an EMS provider agency. (See attached list of Regional EMS Councils).
Once your agency is municipally authorized and providing BLSFR service on a regular and ongoing basis, please submit the required documentation detailed below and your service will be issued an appropriate EMS Agency Code number.
Please review the policy statements included with this packet; 02-05, 06-04, 08-02, 09-03. These polices are very relevant to your BLSFR service activities. The Department has additional polices, which you may also find helpful, on our WEB site's Bureau of EMS Policy Statements and SEMAC Advisories page.
Your submission of documentation for an Agency Code Number needs to contain the following:
- Evidence that your agency has municipal authority and is providing "primary EMS on a regular and ongoing basis". Your agency must be publicly dispatched and providing emergency medical care as defined by Article 30 of Public Health Law. A current letter from your municipality is required stating that your agency is authorized to respond to provide EMS. The letter must also confirm that your agency is publicly dispatched and routinely responding as a part of your local EMS system. The letter must be provided by, and on the letterhead of, your City, Town, Village or Municipal District and must be signed by the executive officer (Mayor, Town Supervisor, chief executive, district chairman, etc.).
- A description of the BLS First Response activities you provide. This should include the specifics of your response plan, method of dispatch and operating frequency, confirmation of adherence to State and Regional BLS protocols, number and type of response vehicles, equipment carried on your response vehicles, and number of personnel with level of training of your agency members.
- Identify the principal and alternate transporting ambulance service(s), by name and DOH agency code #, dispatched to the incidents to which you respond. Provide a copy of the written EMS participation agreement(s) you have executed with these services.
- Document your method of QA/QI for all patient care given by your agency. Many BLSFR agencies have found that their local ambulance service will gladly include your QA/QI review with their own or you may instead participate in a county or regional QA program if one is available.
- Document the geography to which your agency responds, providing a description of the territory to which you are publicly dispatched. Use city, village, town, district, or other municipal boundaries. If you are not publicly dispatched, or you respond primarily within a private or industrial facility, your agency is not eligible for a DOH EMS agency ID number. Agencies providing EMS to College or University Campus' with volunteer (unpaid) members are eligible but must provide a letter from their Regional Emergency Medical Services Council. The letter must affirm that your service is recognized as a component of the local EMS system including participation in regional QI activities.
- Once your service has completed the application package and included the required supporting documents (proofs of municipal authority, public dispatch and written participation agreement with an ambulance service), your service will need to obtain a letter of endorsement from your Regional Emergency Medical Services Council (REMSCO). Your REMSCO must indicate in writing they have reviewed your response plan and endorse your BLSFR activities, affirming your participation in the local EMS system.
A list of the items you need to document or enclose with your application is provided on the back of the application form. Please review the checklist provided.
NOTE: If your agency ONLY intends to provide Automatic External Defibrillation (AED) to the public and NO other routine public BLS medical response, you may follow the instructions on the enclosed policy statement 09-03 entitled Public Access Defibrillation. PAD only participating services do not require an agency code number. Contact your Regional EMS Council for additional information regarding PAD.
If you have questions about completing this application, please feel free to contact our Operations Section at 518-402-0996 ext-2.
Please Note: Having an EMS Agency Code # issued to your agency may not entitle your service for training expenditures reimbursement, special funding or eligibility into a Pilot CME based certification refresher program.
This application packet should contain:
Forms Used in EMS Agency Application
Additional Reference Material for Basic Life Support First Response Agencies
- DOH-2828 EMS Agency Personnel Roster (PDF, 12KB, 1pg.)
- Notice to Agencies Seeking Funding for EMS Course Tuition
- BLSFR Application For Agency Code Number Checklist (PDF, 15KB, 1pg.)
- EMS Agency Participation Agreement template
- DOH Policy Statement 02-05 Prehospital Care Reports (PCRs)
- DOH Policy Statement 02-05 Prehospital Care Reports (PCRs) (PDF, 143KB, 5pg.)
- DOH Policy Statement 06-04 BLS-FR Services Information
- DOH Policy Statement 06-04 BLS-FR Services Information (PDF, 110KB, 5pg.)
- DOH Policy Statement 09-03 Public Access Defibrillation
- DOH Policy Statement 09-03 Public Access Defibrillation (PDF, 138KB, 5pg.)
- Regional EMS Councils Listing