Emergency medical responder levels by U.S. state explained

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

Alaska

Arizona

Arkansas

California

Colorado

Colorado EMS Scope of Practice and Education Standard Comparison

Connecticut

Delaware

District of Columbia

Florida

Georgia

Hawaii

Idaho

Illinois

Indiana

Iowa

Transition to new levels began January 2011, and finished in March 2015.[22]

Kansas

Kentucky

Louisiana

Maine

Maryland

Massachusetts

Michigan

Minnesota

Mississippi

Missouri

Montana

(Endorsements are listed below each level, are optional and can be achieved in any order and combination.)

Nebraska

Nevada

New Hampshire

New Jersey

New Mexico

New York

North Carolina

North Dakota

Ohio

Oklahoma

Oregon

Pennsylvania

Puerto Rico

Rhode Island

South Carolina

South Dakota

Tennessee

Texas

Utah

Now have been phased out of the state of Utah:

Vermont

Virginia

Washington

West Virginia

Wisconsin

Source:[62]

Wyoming

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.[65]

Notes and References

  1. Web site: National Standard Curriculum . 2014-09-07 . National Highway Transportation Safety Administration . 2021-03-24 . https://web.archive.org/web/20210324182600/https://www.ems.gov/education/EMSScope.pdf . dead .
  2. Web site: About NREMT Examinations. 2014-09-08 . National Registry of Emergency Medical Technicians.
  3. Web site: 2011 Annual Report . 2012-11-11 . National Registry of Emergency Medical Technicians . 11.
  4. Web site: EMT Certification - FAQs: How do I gain certification in Arizona as an EMT-B, EMT-I, or EMT-P?. 2008-03-27 . Arizona Department of Public Health Services .
  5. Web site: ARKANSAS STATE BOARD OF HEALTH SECTION OF EMERGENCY MEDICAL SERVICES : RULES AND REGULATIONS FOR EMERGENCY MEDICAL SERVICES. Healthy.arkansas.gov. 4 August 2019.
  6. Web site: ARKANSAS STATE BOARD OF HEALTH SECTION OF EMERGENCY MEDICAL SERVICES : SCOPE OF PRACTICE. Healthy.arkansas.gov. 4 August 2019.
  7. Web site: EMS Statues, Regulations, and Legislation . California Code of Regulations, Title 22 . California Emergency Medical Services Authority . 5 December 2011 . dead . https://web.archive.org/web/20111124110104/http://www.emsa.ca.gov/laws/default.asp . 24 November 2011 .
  8. Web site: Emergency medical responder (EMR) registration Department of Public Health and Environment. www.colorado.gov. en. 2017-10-27.
  9. Web site: Intravenous Therapy And Medication Administration Course Curriculum. 2015-03-01. Colorado Department of Public Health & Environment. 2018-03-09.
  10. Web site: Rules Pertaining to EMS Practice and Medical Director Oversity . 2014-09-08 . PDF . Colorado Department of Public Health and Environment . dead . https://web.archive.org/web/20140908201754/http://www.colorado.gov/cs/Satellite?blobcol=urldata&blobheadername1=Content-Disposition&blobheadername2=Content-Type&blobheadervalue1=inline%3B+filename%3D%22Chapter+2+-+Rules+Pertaining+to+EMS+Practice+and+Medical+Director+Oversight.pdf%22&blobheadervalue2=application%2Fpdf&blobkey=id&blobtable=MungoBlobs&blobwhere=1251861886727&ssbinary=true . 2014-09-08 .
  11. Web site: EMS Provider Certification Frequently Asked Questions . 2014-09-08 . PDF . Colorado Department of Public Health and Environment . dead . https://web.archive.org/web/20141106031200/http://www.colorado.gov/cs/Satellite?blobcol=urldata&blobheadername1=Content-Disposition&blobheadername2=Content-Type&blobheadervalue1=inline%3B+filename%3D%22Certification+Frequently+Asked+Questions.pdf%22&blobheadervalue2=application%2Fpdf&blobkey=id&blobtable=MungoBlobs&blobwhere=1251808764370&ssbinary=true . 2014-11-06 .
  12. Web site: Emergency Medical Services - Licensure/Certification/Exams. Connecticut Department of Public Health. 5 December 2011.
  13. Web site: Delaware Paramedic Education. 11 November 2012.
  14. Web site: Emergency Medical Services Rules. Florida Administrative Code. Florida Department of State, Division of Library and Information Services. 5 December 2011.
  15. Web site: Georgia Office of EMS Course Approval-Initial Education for Licensure. Ems.ga.gov. 4 August 2019.
  16. Web site: Certifying Emergency Medical Service Personnel. 2008-03-27 . State of Hawaii.
  17. Web site: Idaho Emergency Medical Services Bureau. Idaho Department of Health and Welfare. 8 September 2014.
  18. Web site: EMS Licensing . dph.illinois.gov . 15 September 2023 . en.
  19. Web site: Levels of EMS Personnel Certification. 2008-03-27 . Indiana Emergency Medical Services Commission .
  20. Web site: Authorized Iowa EMS Training Programs . 2008-03-27 . Iowa Department of Public Health, Bureau of Emergency Medical Services . dead . https://web.archive.org/web/20060224072827/http://www.idph.state.ia.us/ems/common/pdf/training.pdf . 2006-02-24 .
  21. Web site: Iowa EMT-Paramedic to Paramedic Specialist Transition Application . 2008-03-27 . Iowa Department of Public Health, Bureau of Emergency Medical Services . dead . https://web.archive.org/web/20090219075942/http://www.idph.state.ia.us/EMS/common/pdf/para-transition.pdf . 2009-02-19 .
  22. Web site: IDPH - Bureau of EMS . Iowa EMS Transition . Iowa Department of Public Health . 10 November 2011 . dead . https://web.archive.org/web/20120406131149/http://www.idph.state.ia.us/ems/common/pdf/transition/transition_2011.pdf . 6 April 2012.
  23. Web site: Frequently Asked Questions . 2008-03-28 . Kansas Board of Emergency Medical Services . https://web.archive.org/web/20080219122052/http://www.ksbems.org/FAQ.htm . 2008-02-19 . dead .
  24. Web site: Scope of Practice. Kentucky Board of Emergency Medical Services. 10 May 2024.
  25. Web site: Certification & Licensure. Kentucky Board of Emergency Medical Services. 10 May 2024.
  26. Web site: Frequently Asked Questions. 2018-05-22 . State of Louisiana, Department of Health and Hospitals, Louisiana Bureau of Emergency Medical Systems.
  27. Web site: Maine Emergency Medical System Rules . 2014-09-16 . 118.
  28. Web site: 2021-02-10 . 2019-08-13 . Maryland EMS Clinician Descriptions . 2022-09-30 . Maryland Emergency Medical Services System . PDF.
  29. Web site: Overview of Training Requirements . 2008-03-28 . Massachusetts Office of Health and Human Services .
  30. Web site: License Packet. 2008-03-28 . .PDF. 4. Michigan Department of Community Health, Emergency Medical Services and Trauma System.
  31. Web site: Certification . 2008-03-28 . Minnesota Emergency Medical Services Regulatory Board . dead . https://web.archive.org/web/20080413193457/http://www.emsrb.state.mn.us/cert.asp . 2008-04-13 .
  32. Web site: 144E.101 - 2014 Minnesota Statutes. www.revisor.mn.gov. en. 2018-03-09.
  33. Web site: EMS Personnel Information Frequently Asked Questions (FAQ) . 2008-03-28 . Mississippi State Department of Health, Emergency Medical Services . dead . https://web.archive.org/web/20071110222833/http://www.ems.doh.ms.gov/ems/faq_ems_pers_info.html . 2007-11-10.
  34. Web site: EMT and Paramedic Licensing Information . Missouri Department of Health and Senior Services . 13 December 2020.
  35. Web site: Certification for Out-of-Hospital Providers . 2008-03-28 . Nebraska Department of Health and Human Services . https://web.archive.org/web/20080517154048/http://www.hhs.state.ne.us/ems/emscert.htm . 2008-05-17.
  36. Web site: New Hampshire EMS Provider License Application . 2008-03-28 . Department of Safety .
  37. Web site: Mobility Assistance Vehicle and Basic Life Support Ambulance Services . 2010-01-04 . NJAC 8:40 . State of New Jersey . . dead . https://web.archive.org/web/20110719064411/http://www.newjersey.gov/health/ems/documents/njac840r.pdf . 2011-07-19 .
  38. Web site: Advanced Life Support Services; Mobile Intensive Care Programs, Specialty Care Transport Services and Air Medical Services . 2010-01-04 . NJAC 8:41 . State of New Jersey . . dead . https://web.archive.org/web/20110719064244/http://www.newjersey.gov/health/ems/documents/njac841r.pdf . 2011-07-19 .
  39. Web site: Emergency Medical Technicians-Paramedic: Training and certification . . State of New Jersey . 5 December 2011 . NJAC 8:41A . dead . https://web.archive.org/web/20120127053350/http://www.state.nj.us/health/ems/documents/njac841ar.pdf . 27 January 2012 .
  40. Web site: NEW JERSEY ADMINISTRATIVE CODE 8:41R. New Jersey Department of Health. 10 October 2019.
  41. Web site: Licensing Info . New Mexico Department of Health . 11 November 2012 . dead . https://web.archive.org/web/20130124185314/http://nmems.org/ . 24 January 2013.
  42. Web site: Emergency Medical Services Statistical Information. 2008-03-29 . New York State Department of Health .
  43. Web site: NC DHSR OEMS: Credentialing and Compliance. www2.ncdhhs.gov. en. 2018-03-09.
  44. Web site: Training, Testing and Certification Requirements. 2008-03-29 . North Dakota, Department of Health, Emergency Medical Services.
  45. Web site: Scope of Practice . 11 November 2012 . Ohio Department of Public Safety, Ohio Emergency Medical Services . dead . https://web.archive.org/web/20121026095000/http://ems.ohio.gov/inc/curriculum_message020112.html . 26 October 2012.
  46. Web site: Licensure . EMT Licensure and Registration . Oklahoma State Department of Health . 5 December 2011 . dead . https://web.archive.org/web/20111207070211/http://www.ok.gov/health/Protective_Health/Emergency_Medical_Services/EMT_Licensure_and_Registration/index.html . 7 December 2011 .
  47. Web site: Welcome to EMT Educational Requirements . 2008-03-29 . Oregon Department of Human Services, Emergency Medical Services and Trauma Systems . dead . https://web.archive.org/web/20080517084136/http://egov.oregon.gov/DHS/ph/ems/certific/educate.shtml . 2008-05-17 .
  48. Web site: Emergency Medical Services Regulations 216-RICR-20-10-2 . Rhode Island Secretary of State . State of Rhode Island . 15 January 2021.
  49. Web site: South Carolina Certification Process . 2008-03-29 . South Carolina Emergency Medical Services . https://web.archive.org/web/20080102224153/http://www.scdhec.gov/health/ems/process.pdf . 2008-01-02 . dead .
  50. Web site: South Dakota Basic Life Support SCOPE of PRACTICE. 14 June 2018. South Dakota Department of Health. https://web.archive.org/web/20190314055202/https://doh.sd.gov/documents/EMS/BLS_ScopeofPractice.pdf. 14 March 2019. live.
  51. Web site: South Dakota Scope of Practice Guide for Advanced Life Support Personnel - EMT I/85, EMT-A, EMT I/99, EMT-P. South Dakota Board of Medical and Osteopathic Examiners. 14 June 2018. https://web.archive.org/web/20220331053510/https://www.sdbmoe.gov/media/1hwjb2pk/als-scope-of-practice-guide.pdf. 31 March 2022. live.
  52. Web site: Critical Care Paramedic Standardized Modules and Objectives . 2008-04-10 . State of Tennessee Department of Health . dead . https://web.archive.org/web/20080204165903/https://health.state.tn.us/Downloads/ems_CriticalCareStandardizedModules.pdf . 2008-02-04 .
  53. Web site: Texas Administrative Code Rule §157.2. texreg.sos.state.tx.us. 2018-03-09.
  54. Web site: Requirements for initial certification/licensure . 2008-03-27 . Texas Department of State Health Services.
  55. Web site: EMT & Paramedic Certification. Utah EMT & Paramedic Certification. Utah Department of Health, Bureau of Emergency Medical Services. 7 December 2011.
  56. Web site: Vermont Statewide Emergency Medical Services Protocols. Vermont Department of Health, Office of Emergency Medical Services. 2018-03-09.
  57. Web site: Critical Care Paramedic Update. 2015-09-05. 2018-03-09.
  58. Web site: Licensing Vermont Department of Health . 2024-08-06 . www.healthvermont.gov.
  59. Web site: Transitioning to the new National EMS Scope of Practice and Education Standards. Virginia EMS Education Standards. Virginia Department of Health. 10 November 2011.
  60. Web site: Initial Certification Process . 2008-03-29 . Washington State Department of Health, Office of Emergency Medical Services and Trauma System . dead . https://web.archive.org/web/20080515053832/http://www.doh.wa.gov/hsqa/emstrauma/initcert.htm . 2008-05-15 .
  61. Web site: EMS Education and Curriculum Materials . 2014-04-13 . West Virginia Department of Health and Human Resources . Office of Emergency Medical Services . dead . https://web.archive.org/web/20140414193309/http://www.wvoems.org/ems-programs/education-and-retention/curriculum-and-education . 2014-04-14 .
  62. Web site: Wisconsin EMS Scope of Practice .
  63. Web site: First Responder Certification Process . 2012-11-11 . Wisconsin Department of Health and Family Services, Emergency Medical Services .
  64. Web site: Critical Care Paramedic Endorsement. 2014-04-13 . Wisconsin Department of Health and Family Services, Emergency Medical Services .
  65. Web site: Certification Application . 2008-03-29 . pdf . Wyoming Department of Health, Office of Emergency Medical Services . dead . https://web.archive.org/web/20110721073939/http://www.health.wyo.gov/Media.aspx?mediaId=3173 . 2011-07-21 .

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