Technicians must attend annual OEC refresher courses in order to maintain their certification. The OEC refreshers cover 1/3 of the OEC curriculum each year which cycles through the entire course every three years. OEC technicians are trained to understand medical, legal and ethical issues, to use innovative methods to perform their tasks, and to be mindful of consent and refusal of care. OEC technicians are able to effectively interface with the next level of care for their patients, usually ambulances with other EMTs and paramedics; and rarely hospitals.