Banner Image - Paramedics and Firestations Banner Image - Arrowhead Regional Medical Center and Loma Linda University Medical Center Banner Image – Emergency Medical Service Banner Image - Helicopter Rescue Banner Image – Loma Linda University Medical Center Helicopter Banner Image - Great American Shakeout Drill Banner Image - Ambulance at a Fire Banner Image – Airplane Accident Rescue Banner Image - Firefighters at Accident Scene Banner Image – Firefighter at Apartment Fire Banner Image - Boyscout Training with Helicopter Crew Banner Image - Mercy Air Rescue Banner Image – Winter Rescue Banner Image - Training Exercise Banner Image – Training Exercise Banner Image - Mercy Air Loading Patient into Helicopter Banner Image - Helicopter on Ground Loading Patient Banner Image – Highway Car Accident Banner Image - Highway Car Accident Banner Image – Mercy Air Helicopter Banner Image - Paramedics with Gurney Banner Image - Patient with Bloody Leg Banner Image – Red Cross Banner Image – Swift Water Rescue Banner Image – H-82 Flying Banner Image – Two Helicopter Rescue Banner Image – Blue Helicopter Rescue

1425 South "D" Street
San Bernardino, CA 92415-0060
(909) 388-5823
(909) 388-5825  FAX

(909) 388-5819
7:30 am to 4:00 pm*

Help Desk Support
ePCR-Credentialing-Patient Registry

Hospital HUB Help Desk

EMS Administrator
Tom Lynch

Medical Director

Reza Vaezazizi, MD

Governing Board
Janice Rutherford

Robert A. Lovingood, Vice Chair
James Ramos, Chair
Curt Hagman
Josie Gonzales

Business Operating Hours:
Monday-Friday 7:30 am to 4:30 pm*


*Excluding Holidays

2016 Remaining Holidays:
November 11, 24 & 25,
December 23, 26 & 30

Mission Statement

To ensure an effective system of quality patient care and coordinated emergency medical response by planning, implementing and evaluating an effective emergency medical services system including fire department and public ambulances, prehospital providers and hospitals, including specialty care hospitals, such as trauma and cardiac care hospitals.


Release Date
AEMT Course Record5/10/2012
AEMT Skills Verification Form1/1/2007
AEMT Training Program Approval Packet (NEW)2/19/2015
ALS Provider Agency Changes in Personnel Quarterly Report Form1/30/2012
Application for Approval as an ICEMA Designated Cardiovascual STEMI Receiving Center (SRC)11/1/2014
Application for Approval as an ICEMA Designated Neurovascular Stroke Receiving Center (NSRC)11/1/2014
Automated External Defibrillator (AED) Annual Usage Report Form - Public Safety7/1/2015
Automated External Defibrillator (AED) Site Notification Form7/1/2015
Automated External Defibrillator (AED) Use Notification Form7/1/2015
California Department of Public Health (CDPH) Hospital Emergency Program Flexibility Form for Temporary Permission9/26/2014
Change of Address or Employer Reporting Form3/1/2012
Continuing Education Class Log Monthly Report Form3/1/2012
Continuing Education Class Roster Form (NEW)1/8/2015
Continuing Education Provider (CEP) Application for Approval Form1/24/2012
Coroners Worksheet of Death - EMS Report of Death Protocol Reference #120109/13/2012
CSAM Evaluation Form9/29/2011
DNR Do Not Resuscitate Form - Prehospital EMS Providers Official State Document1/1/2009
Drug Shortage Waiver Request Form5/16/2013
Duplicate Card Application1/17/2013
EMD Center Application9/24/2015
EMR Course Record5/12/2012
EMR Training Program Approval Packet7/1/2013
EMT / AEMT Supplemental CE Form9/11/2014
EMT Course Record10/2/2015
EMT Skills Verification Form10/13/2011
EMT Training Program Approval Packet (NEW)2/19/2015
EMT-P Course Completion Record12/3/2014
EMT-P Training Program Approval Packet3/30/2016
Fireline Paramedic Deployment Notification Form (ICEMA Reference #6090)6/8/2015
Hospital Hub and/or Specialty Registry - Request for Access to View ePCRs10/4/2016
Live Scan Locations in Inyo County4/29/2014
Live Scan Locations in Mono County8/2/2011
Live Scan Locations in San Bernardino County8/24/2016
Live Scan Request Form - Advanced Emergency Medical Technician (AEMT) Certification2/22/2016
Live Scan Request Form - Emergency Medical Responder (EMR) Certification2/16/2016
Live Scan Request Form - Emergency Medical Technician (EMT) Certification2/16/2016
MICN Course Record9/10/2012
MICN Training Program Approval Packet9/10/2012
Personnel Authorized to Verify Skills Competency Request Form5/12/2015
POLST Form - Physician Orders for Life-Sustaining Treatment (EMSA #111B)1/1/2016
Provision of Medical Control - Information Form (for New Providers only)6/8/2016
Provision of Medical Control - Information Update Form6/8/2016
Quarterly Declaration8/8/2013
Special Event Ambulance Providers - SE Treatment Log Form8/9/2012
Specialty and Optional Scope Program Approval Application (ICEMA Reference #6060)7/1/2015
Submersion Incident Report Form SIRF (For Reporting all Drowning or Near Drowning Incidents in San Bernardino County)9/17/2013

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