In the United States, the licensing of prehospital emergency medical providers and oversight of
emergency medical services are governed at the state level. Each state is free to add or subtract levels as each state sees fit. Therefore, due to differing needs and system development paths, the levels, education requirements, and scope of practice of prehospital providers varies from state to state. Even though primary management and regulation of prehospital providers is at the state level, the federal government does have a model scope of practice including minimum skills for EMRs, EMTs, Advanced EMTs and Paramedics set through the
National Highway Traffic Safety Administration (NHTSA).[1]
While states are able to set their own additional requirements for state certification, a quasi-national certification body exists in the form of the
National Registry of Emergency Medical Technicians (NREMT). The NREMT offers a national certification based on the NHTSA National Standard curriculum for the levels of EMR, EMT, Advanced EMT and Paramedic.[2] Individual states are allowed to use NREMT certification as part of their certification process, but are not required to. As of 2011, 38 states use the NREMT examination for EMT certification and 45 states use the NREMT examination for Paramedic certification.[3] These levels are denoted below using an asterisk (*). At present time, use of the NREMT examination for EMT-Intermediate 85 and 99 have not been included in this list.
Any provider between the levels of
Emergency medical technician and
Paramedic is either a form of
EMT-Intermediate or an
Advanced EMT. The use of the terms "EMT-Intermediate/85" and "EMT-Intermediate/99" denotes use of the NHTSA EMT-Intermediate 1985 curriculum and the EMT-Intermediate 1999 curriculum respectively. In addition, not all states use the "EMT" prefix for all levels (e.g. Texas uses EMT-Paramedic and Licensed Paramedic). Finally, some states have levels that have partially been phased out. While no new certifications are provided at this level, providers can sometimes be grandfathered in provided they meet recertification requirements. Any level that has been completely phased out (i.e. not used for new or continuing providers) is not listed.
In some states there are also EMS-RN's which is a Registered Nurse trained in Pre-Hospital response.
In the list, each state's certification levels are provided from most basic at the top to most advanced at the bottom.
Alabama
Emergency Medical Responder (EMR)
Emergency Medical Technician (EMT)
Advanced Emergency Medical Technician (AEMT)
Emergency Medical Technician Intermediate (EMT-I) **(Alabama is no longer certifying new EMT-Is (as of 2003). However, existing providers continue to be allowed to practice under this level of certification.)
Paramedic
Alaska
Emergency Trauma Technician (ETT) (Analogous to EMR)
Emergency Medical Technician I (EMT-I) (Analogous to EMT via NREMT)
Emergency Medical Technician II (EMT-II) (Analogous to EMT-I/85)
Emergency Medical Technician III (EMT-III) (Analogous to AEMT/85)
Advanced Emergency Medical Technician (AEMT) (Established in 2015, follows and is certified via the NREMT testing process)
Mobile Intensive Care Paramedic (MICP) (Analogous to Paramedic via NREMT)
Arizona
EMT-Basic
EMT-Intermediate. Please note: Arizona is no longer certifying new EMT-Is. However, existing certifications continue to be allowed to practice under this level of certification.
Emergency Medical Responder (Not recognized by the Arkansas Department of Health, certification issued by local EMS Authorities and/or the Arkansas Fire Training Academy)[5]
Public Safety (Acts as EMR but is separate from the NREMT Certification for it. Is issued to Firefighters and Police Officers, usually after their P.O.S.T. Certification or their Fire Academy if the individual chooses not to pursue EMT. It is also separate from individual BLS and CPR Certifications. It is officially recognized by the California EMS Authority.)
Paramedic[12] (Paramedics are Licensed professionals in Connecticut, whereas all other levels of EMS providers are certified and must participate in bi-annual continuing education following the current NREMT NCCP)
EMT-Intermediate (state specific, phased out by Sept. 30 2013 however any EMT with this certification before Sept. 30 2013 could still be an intermediate and by the next recert cycle had to switch to AEMT)[54]
EMT-Intermediate Advanced (analogous to EMT-Intermediate/99, phased out by Sept. 30, 2013 )[54]
Advanced Paramedic[56] (replaces state sponsored Critical Care Paramedic endorsement)
Virginia
Emergency Medical Responder (EMR)
Emergency Medical Technician (EMT)
Advanced Emergency Medical Technician (AEMT) (The transition from Emergency Medical Technician-Enhanced to AEMT occurred between 2013 and 2016.)
EMT-Intermediate (EMT-I) (As of January 1, 2020 no new certifications are issued. Providers certified before 2020 may still practice under EMT-I (I/99) certification level, and renew it indefinitely with completion of CME hours each cycle.)
TEMS (Tactical Emergency Medical Service Endorsement) Primarily for SWAT teams
Wyoming
EMR (Emergency Medical Responder
EMT (Emergency Medical Technician
AEMT (Advanced Emergency Medical Technician
IEMT (Intermediate Emergency Medical Technician)
Paramedic
Wyoming has adopted the National Registry model with an addition of IEMT. The IEMT has all of the skills of an AEMT with the addition of additional medications, endotracheal intubation, cardiac drugs and skills (manual defibrillator, epi 1:10000, etc.) chest darts and pain management. National Registry is NOT required, and not accepted for licensing in Wyoming.[63]
^
ab"Emergency Medical Services Rules". Florida Administrative Code. Florida Department of State, Division of Library and Information Services. Retrieved 5 December 2011.
^"IDPH - Bureau of EMS"(PDF). Iowa EMS Transition. Iowa Department of Public Health. Archived from
the original(PDF) on 6 April 2012. Retrieved 10 November 2011.
^
abcde"Administrative Regulations". Kentucky EMS Administrative Regulations. Kentucky Board of Emergency Medical Services. Retrieved 5 December 2011.
^"Frequently Asked Questions". State of Louisiana, Department of Health and Hospitals, Louisiana Bureau of Emergency Medical Systems. Retrieved 2018-05-22.
^"Scope of Practice". Ohio Department of Public Safety, Ohio Emergency Medical Services. Archived from
the original on 26 October 2012. Retrieved 11 November 2012.
^
abcd"Licensure". EMT Licensure and Registration. Oklahoma State Department of Health. Archived from
the original on 7 December 2011. Retrieved 5 December 2011.
^
abcdef"EMT & Paramedic Certification". Utah EMT & Paramedic Certification. Utah Department of Health, Bureau of Emergency Medical Services. Retrieved 7 December 2011.
^"Initial Certification Process". Washington State Department of Health, Office of Emergency Medical Services and Trauma System. Archived from
the original on 2008-05-15. Retrieved 2008-03-29.
^"Certification Application". Wyoming Department of Health, Office of Emergency Medical Services. Archived from
the original(pdf) on 2011-07-21. Retrieved 2008-03-29.