Washington OTEP, explained.

What OTEP is

OTEP is the Ongoing Training and Evaluation Program. It is one of two ways a Washington EMS provider can meet the education and skill maintenance requirements for recertification. Instead of each provider collecting continuing education hours on their own, the agency runs a program, approved by the county medical program director (MPD) and the Department of Health, that trains and evaluates providers on an ongoing basis.

• Competency-based: providers show knowledge and skills “to the satisfaction of the MPD or approved MPD delegate.” WAC 246-976-163
• Includes cognitive, affective, and psychomotor evaluations after each topic. DOH
• May require fewer class hours than the CME hour counts, because it is competency-based. 246-976-163(2)
• No department knowledge exam is listed for the OTEP route. 246-976-171

OTEP vs. CME

	CME method	OTEP method
Rule	WAC 246-976-162	WAC 246-976-163
Who carries the load	Each provider, documenting their own hours	The agency, running an approved program
Hours per period	EMR 15 · EMT 30 · AEMT 60 · Paramedic 150	Competency-based; may be fewer than the CME hours
Exam	Department-approved knowledge exam, plus practical skills exam	Evaluations after each topic; no department knowledge exam listed
Approval	MPD signs the provider’s recertification	MPD and DOH approve the program; MPD signs recertifications
Topics and skills	WAC 246-976-161 subsections (4) and (6)	Same list as CME

Hour counts are from WAC 246-976-161(5) and apply when the program is not competency-based.

Who can run an OTEP

Under WAC 246-976-026(2), any of these may apply:

• A licensed EMS service
• An EMS service supervisory organization (ESSO)
• A local county or regional EMS office
• A county medical program director

The application goes to the department on its form at least 90 days before the proposed start date, with a recommendation and signature from the MPD of every county the program will operate in. Training may not start until both the MPD and the department approve.

What the application must include

The supplemental information required by WAC 246-976-026(2)(d) is effectively your OTEP plan outline. The thirteen items:

1. Certification levels the program covers
2. Skills, endorsements, or specialized training included
3. EMS services participating
4. How the program meets the education requirements and covers every topic over three years
5. Sources of instructional material
6. How MPD-required specialized training is built in
7. How and when the program is reviewed against state and national standards
8. How didactic content is delivered
9. How effectiveness is evaluated, including competency testing
10. How quality improvement is incorporated
11. Records management: electronic or paper, who is responsible, how participants are notified and get copies, and retention
12. How the EMS supervisor verifies attendance, completion, and minimum requirements
13. Remediation for failed or missed courses, and when a provider must move to the CME method instead

DOH publishes an OTEP Plan Development Guidance document, the application form, and an EMS education gap tool on its OTEP development page.

Required topics (both methods)

WAC 246-976-161(4) lists the education every provider must receive each certification period, covering the state’s approved skill list for all age groups at the provider’s level. A three-year OTEP plan has to show where each of these lands.

1. Age-appropriate patient assessment
2. Airway management, including adjuncts appropriate to the certification level
3. Cardiovascular care: recognition, severity, cardiac and stroke patients, CPR, airway obstruction, electrical therapy
4. Trauma, including spinal motion restriction
5. Pharmacology, including epinephrine, naloxone, and MPD-approved medications
6. Obstetrics, pediatric, geriatric, bariatric, behavioral, mental health, and chemical dependency
7. Patient advocacy, including multicultural awareness, health equity, POLST, mandatory reporting, and disability and functional needs
8. Provider advocacy and wellness, including suicide awareness, infectious disease, and workplace safety
9. Washington law and regulations related to scope of practice, and recertification requirements
10. State, regional, and local policies, including state triage tools, regional patient care procedures, county procedures, and MPD protocols
11. Disaster preparedness: ICS, multi-patient and mass casualty incidents, disaster triage, all-hazard and public health emergencies, active shooter
12. Documentation standards, including reporting to the state EMS electronic data system, data quality, and evidence-based practice
13. Ambulance operations: emergency vehicle driving, stretcher handling, crime scene awareness, air ambulance and landing zone safety

Skill maintenance

WAC 246-976-161(6) requires skill maintenance under both methods, with an education component and demonstration to the MPD’s satisfaction. Providers must have the chance to “annually practice and demonstrate proficiency in high risk, low frequency skills.”

• Airway, respiration, and ventilation. EMR: airway management, adjuncts, bag-valve-mask, oral suctioning for all age groups. EMT and AEMT: the EMR content plus supraglottic airways where in scope or endorsed. Paramedic: all of the above plus an MPD-approved airway program across each three-year certification period, with annual adult and pediatric psychomotor skills for oral and nasal airways, supraglottic airways, endotracheal tubes, and surgical airways.
• Vascular access. AEMTs and IV-endorsed EMTs: IV and intraosseous insertion and infusion. Paramedics: the AEMT requirements plus advanced access and monitoring. With MPD approval, artificial training aids may substitute where a skill cannot be completed on patients.
• Distributed learning. The didactic portion may be delivered remotely with a cognitive assessment per module. Practical skill evaluations are in person.

Running the program

Once approved, WAC 246-976-026(3) sets the operating rules:

• Keep the program current with WAC 246-976-161.
• Use instructors and evaluators who meet WAC 246-976-031.
• Give knowledge and skill evaluations after training. Practical evaluations use department-approved or nationally recognized forms unless the MPD approves an alternative.
• Deliver education at least quarterly. Rural volunteer services may request an alternative schedule.
• Keep training records at least seven years, or longer if your retention policy says so.
• Provide skill sheets, rosters, evaluations, quizzes, and training content to participants, the department, and the MPD on request.
• Renew program approval every five years, applying at least 90 days before the start date.

Switching between CME and OTEP

Per WAC 246-976-163 and 246-976-162, a provider can change methods inside a certification period only with MPD approval and only if they:

• Have at least one year left in the cycle (for a move to OTEP)
• Will meet every 246-976-161 requirement, and the requirements of the new method, by the end of the cycle
• Submit the department’s education gap tool to the MPD
• Receive an MPD-approved education plan for any gaps

A provider who cannot meet the OTEP requirements must transition to the CME method.

What to track, in practice

Read together, the sections above describe a record set an OTEP coordinator has to be able to produce for the MPD or the department at any point in the three-year cycle:

• The plan: which topic from 246-976-161(4) is covered in which period, and the WAC reference behind each requirement
• Attendance and completion per provider, per session, verified by a supervisor
• Evaluations after each topic, with in-person skill sign-offs on approved forms
• Annual high-risk, low-frequency skill practice, plus the level-specific airway and vascular access requirements
• Remediation for missed or failed sessions, and any providers moved to CME
• All of it retained for seven years and exportable on request