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EMT and Paramedic Certification

By Ashley Boyce, allied health world staff writer

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What are the various levels of emergency medical certification and licensure?

Being certified at any EMT level would imply a comprehensive mastery of the previous levels of training. More advanced emergency medical skills are learned through progressing through the four EMT levels: EMT-Basic, EMT-Intermediate 1985, EMT-Intermediate-1999, and Paramedic. Some states require intermediate level EMTs to have much of the same emergency medical training that would typically be reserved for paramedics. However, the specific skills associated with the various levels of EMT certification granted on a national level by the NREMT are honored by most states when issuing licensure. There are a total of five levels of certification in emergency medical training granted by each state’s board of emergency medical services: The four levels of EMT certification, plus certified first responder which is a lower level of certification for introductory emergency medical training. The training requirements for these five levels of certification are:

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Certified First Responder certification requires between 40 and 60 hours of emergency medical training that qualifies students to assist emergency medical technicians. First responder training would include basic first aid to treat soft tissue injuries and broken bones. They would also be trained in infection control as well as packaging injured patients for safe transport by securing them to the gurney and loading them safely into the ambulance.
EMT, Paramedic and Emergency CertificationEMT-Basic (EMT-B)certification requires that the EMT receive between 120 and 150 hours of emergency medical training. This qualifies them to treat an injured person at the scene of an accident, and while the patient is being transported by ambulance to the hospital. This would include training in the use of an automatic external defibrillator (AED), assessment and management of cardiac or respiratory problems through CPR, and the treatment of some less severe traumatic injuries.

EMT-Intermediate 1985 (EMT-I/85) certification represents a more advanced level of basic emergency medical training and enhanced assessment skills. This would include training in a few more invasive emergency medical procedures including the use of airway management devices and supervised IV cannulation. EMTs at this level would also be trained to administer certain medications.
EMT-Intermediate 1999 (EMT-I/99) certification is for EMTs with the level of training that is most closely related to that of a paramedic. This certification is usually earned in 350 hours and would include needle-decompression of tension pneumothorax to relieve air pressure in the lungs allowing for full lung expansion. Certification at this level would also imply primary training in reading EKGs, supervised endotracheal intubation, and use of drugs to control heart arrhythmia.
EMT-Paramedic (EMT-P) certification represents the most advanced emergency medical training available. This training would involve 3-6 months of on-the-job training, 800-900 hours of instructional training, and 300-400 hours of clinical training for a total of 18-24 months. This training would include advanced airway management through use of endotracheal intubation, training in the use of as many as 50 drugs, administering drugs by way of intramuscular and subcutaneous injection, assessing and treating internal injury including hemorrhage, and cardiac monitoring using EKG machines.
Learn more about EMT and paramedic training.

What licensure is required to work as an EMT or Paramedic?

EMTs and paramedics must apply for and receive state-specific licensure in order to be employed. A paramedic or EMT holding state licensure has fulfilled all education and training requirements, passed background checks, and demonstrated their competency through an examination process. The exam for state licensure consists of both a written component and a hands-on component in which applied skills are tested. Each state has its own board of emergency medical services responsible for licensure at the various levels of EMT training. These state boards are the final authority on granting licensure. The only exceptions to the requirement for state-granted licensure are made for EMTs in the military or those who work exclusively on federal land.


State-specific licensure is needed because the requirements for the various levels of EMT training set by many states are beyond those set by the NREMT. For example some states are less lenient in considering prior criminal offenses, and some require the EMT to be affiliated with a licensed EMS agency.

The board of emergency medical services for each state is the only body that can revoke an EMT’s license in the event of disciplinary problems or failure to follow correct procedure when taking action at the scene of an emergency call.

Most states’ boards of emergency medical services require state licensure to be renewed every two years.

What is NREMT certification?

The National Registry of Emergency Medical Technicians certification is an optional step that many EMTs and paramedics take, but it is not requirement for practicing emergency medicine. NREMT certification, however, ensures three things: Courses specific to the respective EMT level have been completed successfully, the EMT has passed criminal background checks, and competency has been verified by passing the NREMT Certification Examination.

NREMT certification is a good option for some EMTs and paramedics since in some states NREMT certification grants eligibility for state licensure. Getting NREMT certification can sometimes be accomplished more quickly than state licensing, so for EMTs and paramedics in states that grant licensure to those holding NREMT certification without requiring further state-specific testing, this will get them out into the field faster.

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The NREMT exam is the final step towards national certification, maintaining certification, or gaining advanced certification as an EMT or paramedic through the NREMT. This exam tests the competency of EMS providers at all levels. The exam can be taken at one of any number of authorized testing facilities across the country after first registering with the NREMT and receiving from them an Authorized to Test Letter. This letter of authorization confirms that all other requirements for certification are met prior to testing. Information on NREMT certification, exam preparation, and testing locations can be found at www.nremt.org.


What is required in terms of recertification and renewal of state licensure?

Those who choose to maintain their certification through the NREMT will renew it every two years. All EMTs and paramedics are required to renew their state licensure every two years in order to be allowed to continue practicing. The license renewal process is structured to ensure an EMT remains competent over the course of their career. License renewal is granted to those EMTs who have been actively working in an emergency medical capacity, have satisfied continuing education requirements, and have passed testing for license renewal.

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