Licensure

Continuing education (CE) requirements maintain certification and licensure and may vary in the US and Canada.

Check with your EMS Agency.

All courses on this site are accredited by the state of California, which in turn are certified by NREMT and NHTSA for CE in other states.

Find your license type. Various states have different titles for each level.

Levels of Qualification and Training

The National Registry of Emergency Medical Technicians (NREMT) registers Emergency Medical Service (EMS) providers at four levels: First Responder, EMT-Basic, EMT-Intermediate, and EMT-Paramedic. Some states, however, do their own certification and use numeric ratings from 1 to 4 to distinguish levels of proficiency.

Certification is an external verification of the competencies that an individual has achieved and typically involves an examination process. While certification exams can be set to any level of proficiency, in health care they are typically designed to verify that an individual has achieved minimum competency to assure safe and effective patient care.

Licensure represents permission granted to an individual by the State to perform certain restricted activities. Scope of practice represents the legal limits of the licensed individual’s performance. States have a variety of mechanisms to define the margins of what an individual is legally permitted to perform. (See Glossary of Terms for more....)

These four circles represent overlapping and complementary forms of public protection. Individuals should not perform any role for which they are not educated, certified, licensed, AND credentialed.

 
Credentialing is a local process by which an individual is
permitted by a specific entity (Medical Director) to practice in a
specific setting (EMS agency). Credentialing processes vary in
sophistication and formality.

Scope of Practice vs. Standard of Care

Scope of practice does not define a standard of care, nor does it define what should be done in a given situation (i.e., it is not a practice guideline or protocol).  It defines what is legally permitted to be done by some or all of the licensed individuals at that level, not what must be done. Table I describes some of the differences between scope of practice and standard of care.

In reality, only a few licensure levels are practical.  The support of the educational infrastructure (developing educational standards, national accreditation, national certification, continued competency requirements, etc.) requires a tremendous expenditure of resources and is only viable if there are a finite number of levels. Therefore, the challenge is to create a system that meets the diverse needs of the country, while keeping the number of licensure levels to a minimum number.

For the purpose of this model, one licensure level is substantially different from other licensure levels in:

• Skills
• Practice environment
• Knowledge
• Qualifications
• Services provided
• Risk
• Level of supervisory responsibility
• Amount of autonomy
• Judgment/critical thinking/decision making.

Specialty certifications are sometimes used to accommodate smaller differences in some or all of the above.

LEVEL 1 - Emergency Medical Responder (EMR) or First Responder

The lowest-level workers—First Responders—are trained to provide basic emergency medical care because they tend to be the first persons to arrive at the scene of an incident. Many firefighters, police officers, and other emergency workers have this level of training.

The primary focus of the Emergency Medical Responder is to initiate immediate lifesaving care to critical patients who access the emergency medical system.  This individual possesses the basic knowledge and skills necessary to provide lifesaving interventions while awaiting additional EMS response and to assist higher level personnel at the scene and during transport. Emergency Medical Responders function as part of a comprehensive EMS response, under medical oversight.  Emergency Medical Responders perform basic interventions with minimal equipment.

Educational Requirements: One of the eligibility requirements for licensure at this level requires successful completion of an accredited Emergency Medical Responder training program.

Level 2 Emergency Medical Technician (EMT) or EMT-Basic

The EMT-Basic, also known as EMT-1, represents the first component of the emergency medical technician system. An EMT-1 is trained to care for patients at the scene of an accident and while transporting patients by ambulance to the hospital under medical direction. The EMT-1 has the emergency skills to assess a patient’s condition and manage respiratory, cardiac, and trauma emergencies.

The primary focus of the Emergency Medical Technician is to provide basic emergency medical care and transportation for critical and emergent patients who access the emergency medical system. This individual possesses the basic knowledge and skills necessary to provide patient care and transportation. Emergency Medical Technicians function as part of a comprehensive EMS response, under medical oversight. Emergency Medical Technicians perform interventions with the basic equipment typically found on an ambulance. The Emergency Medical Technician is a link from the scene to the emergency health care system.

Educational Requirements: One of the eligibility requirements for licensure at this level requires successful completion of an accredited Emergency Medical Technician course.

Level 3 - Advanced Emergency Medical Technician (AEMT) or EMT-Intermediate

The EMT-Intermediate (EMT-2 and EMT-3) has more advanced training that allows the administration of intravenous fluids, the use of manual defibrillators to give lifesaving shocks to a stopped heart, and the application of advanced airway techniques and equipment to assist patients experiencing respiratory emergencies.

The primary focus of the Advanced Emergency Medical Technician is to provide basic and limited advanced emergency medical care and transportation for critical and emergent patients who access the emergency medical system.  This individual possesses the basic knowledge and skills necessary to provide patient care and transportation. Advanced Emergency Medical Technicians function as part of a comprehensive EMS response, under medical oversight.  Advanced Emergency Medical Technicians perform interventions with the basic and advanced equipment typically found on an ambulance. The Advanced Emergency Medical Technician is a link from the scene to the emergency health care system.

Educational Requirements: One of the eligibility requirements for licensure at this level requires successful completion of an accredited Advanced Emergency Medical Technician course.

Level 4 - Paramedic

EMT-Paramedics (EMT-4) provide the most extensive prehospital care. In addition to carrying out the procedures already described, paramedics may administer drugs orally and intravenously, interpret electrocardiograms (EKGs), perform endotracheal intubations, and use monitors and other complex equipment.

The Paramedic is an allied health professional whose primary focus is to provide advanced emergency medical care for critical and emergent patients who access the emergency medical system. This individual possesses the complex knowledge and skills necessary to provide patient care and transportation. Paramedics function as part of a comprehensive EMS response, under medical oversight. Paramedics perform interventions with the basic and advanced equipment typically found on an ambulance. The Paramedic is a link from the scene into the health care system.

Educational Requirements: Because of the amount of complex decision making, one of the eligibility requirements for licensure requires successful completion of a nationally accredited Paramedic program at the Certificate or Associates Degree level.

EMS Personnel Scope of Practice Models

EMS skills and knowledge represent a continuum of complexity and risk.  As the licensure level increases, the knowledge required to practice safely, the skill complexity (the difficulty in acquiring and maintaining skill competency), and the potential for harm increase. Communities must assess their needs and the resources they are willing and able to invest in out-of-hospital emergency care.