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Tidewater EMS Council, Inc.

ALS Sanctioning Policies & Procedures

Revised and Approved: March 8, 2022
Operational Medical Directors Committee
Effective April 1, 2022

TITLE: Regional Practice Policy for ALS Personnel (Intermediate and Paramedics) *This policy does not apply to AEMT's.
          PURPOSE: To establish a policy regarding ALS personnel wishing to practice within the Tidewater EMS region.
          SCOPE: Intermediate and Paramedic Personnel possessing certification as a Virginia Intermediate or Paramedic must complete the following “regional sanctioning” requirements before being allowed to practice as such in the Tidewater EMS (TEMS) region:

1) The individual must affiliate with a TEMS agency.

2) The agency fills out and submits, via email, the signed ALS Sanctioning Contract to This email address is being protected from spambots. You need JavaScript enabled to view it..

3) “Provisional sanctioning” within the TEMS region is granted to the individual who successfully completes the regional written exam with an 80% or above, which is valid for one year from the date the exam was passed.

4) Individuals who are granted provisional sanctioning will complete a ‘Practical Skills Checkoff’ and an appropriate preceptor field internship prior to the sanctioning board interview. Following completion of these steps, the agency OMD or designee submits the 'Practical Skilss Checkoff' to This email address is being protected from spambots. You need JavaScript enabled to view it. with a request to schedule the sanctioning board interview. Individual candidates will NOT contact TEMS to schedule sanctioning board interviews.

5) ALS candidates who successfully complete all regional requirements receive a certificate from the TEMS office acknowledging such completion. The agency’s OMD must continue to approve the individual’s practice at the level consistent with current state certification.


TITLE: Regional ALS Written Examination Guidelines
          PURPOSE: To establish a specific policy for the written test process.
          SCOPE: Intermediate and Paramedics eligible to sit for the Regional ALS Final Examination.

1) Written examination test questions are developed by the Education and Training Committee and approved by the Operations Medical Directors. All questions are related to the latest edition of the TEMS Regional Medical Protocols.

2) The agencies training staff must proctor all written examinations in person.

3) If a candidate cannot make his scheduled exam time, it is important to contact the agency's training staff to reschedule.

4) Once the written exam has begun, no student will be allowed to leave and return. If a candidate leaves during the exam, the exam shall be submitted as complete.

5) The candidate may set up their profile in advance of taking the exam by clicking https://www.tidewaterems.org/alsboards

  • ◉  First time users, click the “Create new account” button.
  • ◉  Once logged in, the above link connects to the screen of the Sanctioning Exam, click "Enroll Me".
  • ◉  Return users, log in using the previously made credentials.

6) When ready to take the test, access the link above; click on the exam and the proctor enters the password provided by TEMS.

7) A minimum score of 80% must be attained on the written exam to be considered as passing. Written results are valid for 12 months.

8) Three attempts are allowed.

  • ◉  Candidates who fail the written test must wait 14 calendar days prior to retesting.
  • ◉  Candidates who fail the second attempt should consider asking for help from the training staff prior to retesting. A minimum of 14 days must lapse before testing the third time.
  • ◉  Candidates who fail the third time must confer with the agency OMD and undergo remediation prior to restarting the testing cycle. Proof of the formal remediation is required to restart the testing cycle. Formal remediation is defined as “the CE requirements for the certification level of the individual” and to be determined by the agency and their OMD. For example, if the individual is a paramedic, the candidate would take a paramedic refresher program of 48 hours.

9) Under no circumstances will copies of test questions be provided to instructors or students. If a student has a problem with a question, they should flag the question during the exam or speak to the training staff proctor after the exam is complete and submitted. The Education and Training Committee and TEMS staff will review frequently missed questions for accuracy. The final arbitrator for test questions is the Operational Medical Directors Committee.


TITLE: Regional ALS Practical Skills Verification Guidelines
          PURPOSE: To establish a specific policy for the practical skills verification process.
          SCOPE: ALS providers desiring sanctioning by the Tidewater EMS (TEMS) Region, if applicable.

1) The practical skills verification criteria is based on the National Paramedic Curriculum and regional protocols consistent with the certification level.

2) The Agency (OMD approved) training representative or designee serves as the practical skills verification coordinator.

3) The student must successfully complete this section to receive a “pass” for the practical skills verification. This includes Virginia Office of EMS requirements for patient contacts and competencies for the level at which they are testing and all field internship objectives.

4) Students must pass both the written and practical skills portion of the sanctioning process within 12 months before being eligible to sit for the sanctioning board interview.

5) Those students who do not successfully complete the practical skills verification are referred to the agency OMD for remediation prior to continuing the sanctioning process. If not completed within 12 months, the candidate must restart the sanctioning process, starting with the written exam.

6) Individuals with provisional sanctioning status can ride as the AIC on BLS calls, but must be precepted on all ALS calls.

*A sample form may be downloaded here.


TITLE: Sanctioning Board Interview Guidelines
          PURPOSE: To establish a specific policy for the oral board interview process.
          SCOPE: Intermediates and Paramedics eligible to sit for the oral board interview.

1) A sanctioning board interview panel conducts the interview for each Intermediate and Paramedic applying for regional sanctioning. The interview takes at a minimum 1 hour. (Note: The sanctioning board interview is required only once during Intermediate or Paramedic training.)

2) The sanctioning board interview is conducted after an ALS candidate has successfully completed all sanctioning requirements including the regional written exam, practical skills verification, any required field internship and is approved by the agency OMD. The agency OMD or designee will contact Tidewater EMS (TEMS) to schedule the sanctioning boards. The individual technician will NOT contact TEMS to schedule the interview.

3) The sanctioning board interview panel, at a minimum, consists of at least one operational medical director, at least one peer representative approved by the agency OMD or designee, and a representative from the TEMS Council. An OMD will chair the sanctioning board interview panel. The candidate's OMD or designee has the final decision on sanctioning the individual. The candidate's OMD must be present for the interview unless other arrangements have been made with another OMD on the sanctioning board interview panel.

4) The sanctioning board interview panel, by questions and interactions with the candidate, judges the individual's overall knowledge of pertinent medical information, regional medical protocols, and the ability to carry out the responsibilities of an ALS provider. It is recommended that the interview consist of rhythm identification (lead 2 and 12 lead) and multiple scenarios (Cardiac Arrest; Pediatric; Trauma; Medical: Anaphylaxis, Sepsis, COPD/Asthma, Chest Pain, etc.)

5) If the candidate is unsuccessful in the sanctioning board interview process, retraining and retesting for the oral board interview is required. Required retraining is determined by the agency OMD based on the recommendations of the sanctioning board interview panel. If training and remediation extends past 12 months, the agency's training representative can ask TEMS for an extension to avoid restarting the entire process.

6) The outcome of the sanctioning board interview is documented by the TEMS representative and kept on file.

7) ALS candidates who successfully complete all regional sanctioning requirements receive a certificate from the TEMS office acknowledging such completion.

8) The local agency’s OMD must continue to approve the individual’s practice at the level consistent with the current state certification and with regional sanctioning criteria.

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