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Emergency medical responder levels by U.S. state

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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]

Contents

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.

Some states have certifications allowing other healthcare providers, such as Registered Nurses and Physician Assistants, to practice in the prehospital setting. Others require all EMS responders to obtain EMT or paramedic qualifications regardless of other licensure.

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 Archived 2017-02-15 at the Wayback Machine

Connecticut

Delaware

District of Columbia

Florida

Georgia

Hawaii

Idaho

Illinois

Indiana

Iowa

Transition to new levels began January 2011, and finished in March 2015. [24]

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: [65]

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. [68]

References

  1. ↑ "National Standard Curriculum" (PDF). National Highway Transportation Safety Administration. Archived from the original (PDF) on 2021-03-24. Retrieved 2014-09-07.
  2. ↑ "About NREMT Examinations". National Registry of Emergency Medical Technicians. Archived from the original on 2014-07-01. Retrieved 2014-09-08.
  3. ↑ "2011 Annual Report" (PDF). National Registry of Emergency Medical Technicians. p. 11. Archived from the original (PDF) on 2012-10-05. Retrieved 2012-11-11.
  4. ↑ "EMT Certification - FAQs: How do I gain certification in Arizona as an EMT-B, EMT-I, or EMT-P?". Arizona Department of Public Health Services. Retrieved 2008-03-27.
  5. 1 2 "ARKANSAS STATE BOARD OF HEALTH SECTION OF EMERGENCY MEDICAL SERVICES : RULES AND REGULATIONS FOR EMERGENCY MEDICAL SERVICES" (PDF). Healthy.arkansas.gov. Archived from the original (PDF) on August 8, 2018. Retrieved 4 August 2019.
  6. 1 2 3 "ARKANSAS STATE BOARD OF HEALTH SECTION OF EMERGENCY MEDICAL SERVICES : SCOPE OF PRACTICE" (PDF). Healthy.arkansas.gov. Archived from the original (PDF) on August 14, 2018. Retrieved 4 August 2019.
  7. 1 2 3 "EMS Statues, Regulations, and Legislation". California Code of Regulations, Title 22. California Emergency Medical Services Authority. Archived from the original on 24 November 2011. Retrieved 5 December 2011.
  8. ↑ "Emergency medical responder (EMR) registration | Department of Public Health and Environment". www.colorado.gov. Retrieved 2017-10-27.
  9. ↑ "Intravenous Therapy And Medication Administration Course Curriculum" (PDF). Colorado Department of Public Health & Environment. 2015-03-01. Archived from the original (PDF) on February 7, 2017. Retrieved 2018-03-09.
  10. ↑ "Rules Pertaining to EMS Practice and Medical Director Oversity". Colorado Department of Public Health and Environment. Archived from the original (PDF) on 2014-09-08. Retrieved 2014-09-08.
  11. ↑ "EMS Provider Certification Frequently Asked Questions". Colorado Department of Public Health and Environment. Archived from the original (PDF) on 2014-11-06. Retrieved 2014-09-08.
  12. 1 2 3 4 "Emergency Medical Services - Licensure/Certification/Exams". Connecticut Department of Public Health. Archived from the original on June 2, 2010. Retrieved 5 December 2011.
  13. ↑ "Delaware Paramedic Education". Archived from the original on December 13, 2012. Retrieved 11 November 2012.
  14. 1 2 "Emergency Medical Services Rules". Florida Administrative Code. Florida Department of State, Division of Library and Information Services. Retrieved 5 December 2011.
  15. ↑ Georgia Office of EMS and Trauma (January 1, 2024). "Scope of Practice for EMS Personnel". Archived from the original on February 13, 2025.
  16. ↑ "Georgia Office of EMS Course Approval-Initial Education for Licensure" (PDF). Ems.ga.gov. Retrieved 4 August 2019.
  17. ↑ "Certifying Emergency Medical Service Personnel". State of Hawaii. Retrieved 2008-03-27.
  18. ↑ "Idaho Emergency Medical Services Bureau". Idaho Department of Health and Welfare. Archived from the original on 8 September 2014. Retrieved 8 September 2014.
  19. ↑ "EMS Licensing". dph.illinois.gov. Retrieved 15 September 2023.
  20. ↑ "Illinois Complied Statutes".
  21. ↑ "Levels of EMS Personnel Certification" (PDF). Indiana Emergency Medical Services Commission. Retrieved 2008-03-27.
  22. ↑ "Authorized Iowa EMS Training Programs" (PDF). Iowa Department of Public Health, Bureau of Emergency Medical Services. Archived from the original (PDF) on 2006-02-24. Retrieved 2008-03-27.
  23. ↑ "Iowa EMT-Paramedic to Paramedic Specialist Transition Application" (PDF). Iowa Department of Public Health, Bureau of Emergency Medical Services. Archived from the original (PDF) on 2009-02-19. Retrieved 2008-03-27.
  24. ↑ "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.
  25. ↑ "Frequently Asked Questions". Kansas Board of Emergency Medical Services. Archived from the original on 2008-02-19. Retrieved 2008-03-28.
  26. 1 2 3 4 "Scope of Practice". Kentucky Board of Emergency Medical Services. Retrieved 10 May 2024.
  27. ↑ "Certification & Licensure". Kentucky Board of Emergency Medical Services. Retrieved 10 May 2024.
  28. ↑ "Kentucky Advanced Practice Paramedic Scope of Practice" (PDF).
  29. ↑ "Frequently Asked Questions". State of Louisiana, Department of Health and Hospitals, Louisiana Bureau of Emergency Medical Systems. Retrieved 2018-05-22.
  30. ↑ "Maine Emergency Medical System Rules" (PDF). p. 118. Archived from the original (PDF) on 2016-03-04. Retrieved 2014-09-16.
  31. ↑ https://www.miemss.org/home/ems-providers/initial-certification
  32. ↑ "Maryland EMS Clinician Descriptions" (PDF). Maryland Emergency Medical Services System. 2021-02-10 [2019-08-13]. Retrieved 2022-09-30.
  33. ↑ "Overview of Training Requirements". Massachusetts Office of Health and Human Services. Retrieved 2008-03-28.
  34. ↑ "License Packet" (.PDF). Michigan Department of Community Health, Emergency Medical Services and Trauma System. p. 4. Retrieved 2008-03-28.
  35. ↑ "Certification". Minnesota Emergency Medical Services Regulatory Board. Archived from the original on 2008-04-13. Retrieved 2008-03-28.
  36. ↑ "144E.101 - 2014 Minnesota Statutes". www.revisor.mn.gov. Retrieved 2018-03-09.
  37. ↑ "EMS Personnel Information Frequently Asked Questions (FAQ)". Mississippi State Department of Health, Emergency Medical Services. Archived from the original on 2007-11-10. Retrieved 2008-03-28.
  38. ↑ "EMT and Paramedic Licensing Information". Missouri Department of Health and Senior Services. Retrieved 13 December 2020.
  39. ↑ "Certification for Out-of-Hospital Providers". Nebraska Department of Health and Human Services. Archived from the original on 2008-05-17. Retrieved 2008-03-28.
  40. ↑ "New Hampshire EMS Provider License Application" (PDF). Department of Safety. Retrieved 2008-03-28.
  41. ↑ "Mobility Assistance Vehicle and Basic Life Support Ambulance Services" (PDF). New Jersey Administrative Code . State of New Jersey. NJAC 8:40. Archived from the original (PDF) on 2011-07-19. Retrieved 2010-01-04.
  42. ↑ "Advanced Life Support Services; Mobile Intensive Care Programs, Specialty Care Transport Services and Air Medical Services" (PDF). New Jersey Administrative Code . State of New Jersey. NJAC 8:41. Archived from the original (PDF) on 2011-07-19. Retrieved 2010-01-04.
  43. ↑ "Emergency Medical Technicians-Paramedic: Training and certification" (PDF). New Jersey Administrative Code . State of New Jersey. NJAC 8:41A. Archived from the original (PDF) on 27 January 2012. Retrieved 5 December 2011.
  44. ↑ "NEW JERSEY ADMINISTRATIVE CODE 8:41R" (PDF). New Jersey Department of Health. Retrieved 10 October 2019.
  45. ↑ "Licensing Info". New Mexico Department of Health. Archived from the original on 24 January 2013. Retrieved 11 November 2012.
  46. ↑ "Emergency Medical Services Statistical Information". New York State Department of Health. Retrieved 2008-03-29.
  47. ↑ "NC DHSR OEMS: Credentialing and Compliance". www2.ncdhhs.gov. Archived from the original on 2018-03-10. Retrieved 2018-03-09.
  48. ↑ "Training, Testing and Certification Requirements". North Dakota, Department of Health, Emergency Medical Services. Retrieved 2008-03-29.
  49. ↑ "Scope of Practice". Ohio Department of Public Safety, Ohio Emergency Medical Services. Archived from the original on 26 October 2012. Retrieved 11 November 2012.
  50. 1 2 3 4 "Licensure". EMT Licensure and Registration. Oklahoma State Department of Health. Archived from the original on 7 December 2011. Retrieved 5 December 2011.
  51. ↑ "Welcome to EMT Educational Requirements". Oregon Department of Human Services, Emergency Medical Services and Trauma Systems. Archived from the original on 2008-05-17. Retrieved 2008-03-29.
  52. ↑ "Emergency Medical Services Regulations 216-RICR-20-10-2". Rhode Island Secretary of State. State of Rhode Island. Retrieved 15 January 2021.
  53. ↑ "South Carolina Certification Process" (PDF). South Carolina Emergency Medical Services. Archived from the original (PDF) on 2008-01-02. Retrieved 2008-03-29.
  54. 1 2 "South Dakota Basic Life Support SCOPE of PRACTICE" (PDF). South Dakota Department of Health. 14 June 2018. Archived (PDF) from the original on 14 March 2019.
  55. ↑ "South Dakota Scope of Practice Guide for Advanced Life Support Personnel - EMT I/85, EMT-A, EMT I/99, EMT-P" (PDF). South Dakota Board of Medical and Osteopathic Examiners. 14 June 2018. Archived (PDF) from the original on 31 March 2022.
  56. ↑ "Critical Care Paramedic Standardized Modules and Objectives" (PDF). State of Tennessee Department of Health. Archived from the original (PDF) on 2008-02-04. Retrieved 2008-04-10.
  57. ↑ "Texas Administrative Code Rule §157.2". texreg.sos.state.tx.us. Retrieved 2018-03-09.
  58. ↑ "Requirements for initial certification/licensure". Texas Department of State Health Services. Retrieved 2008-03-27.
  59. 1 2 3 4 5 6 "EMT & Paramedic Certification". Utah EMT & Paramedic Certification. Utah Department of Health, Bureau of Emergency Medical Services. Retrieved 7 December 2011.
  60. ↑ "Vermont Statewide Emergency Medical Services Protocols" (PDF). Vermont Department of Health, Office of Emergency Medical Services. Archived from the original (PDF) on 2017-10-11. Retrieved 2018-03-09.
  61. ↑ "Licensing | Vermont Department of Health". www.healthvermont.gov. Retrieved 2024-08-06.
  62. ↑ "Transitioning to the new National EMS Scope of Practice and Education Standards". Virginia EMS Education Standards. Virginia Department of Health. Archived from the original on 13 November 2011. Retrieved 10 November 2011.
  63. ↑ "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.
  64. ↑ "EMS Education and Curriculum Materials". West Virginia Department of Health and Human Resources. Office of Emergency Medical Services. Archived from the original on 2014-04-14. Retrieved 2014-04-13.
  65. ↑ "Wisconsin EMS Scope of Practice" (PDF).
  66. ↑ "First Responder Certification Process". Wisconsin Department of Health and Family Services, Emergency Medical Services. Archived from the original on 2012-09-19. Retrieved 2012-11-11.
  67. ↑ "Critical Care Paramedic Endorsement" (PDF). Wisconsin Department of Health and Family Services, Emergency Medical Services. Archived from the original (PDF) on 2014-05-30. Retrieved 2014-04-13.
  68. ↑ "Certification Application". Wyoming Department of Health, Office of Emergency Medical Services. Archived from the original (pdf) on 2011-07-21. Retrieved 2008-03-29.
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