Emergency medical responder levels by U.S. state
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
edit- 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
edit- 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
edit- 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.
- EMT-Paramedic[4]
Arkansas
editCalifornia
edit- 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.)
- Emergency Medical Technician (EMT)[7]
- Advanced Emergency Medical Technician* (AEMT)[7]
- Paramedic[7]
- Critical Care Paramedic Endorsement for Paramedic Level* (It is offered in and recognized in some counties in California.)
Colorado
edit- Emergency Medical Responder (EMR)[8]
- Emergency Medical Technician (EMT)
- EMT with intravenous authorization (EMT- IV is not a separate certification level but an authorization by an agency physician medical director after verification of approved education and skills competency)[9]
- Advanced EMT (AEMT)
- EMT-Intermediate (EMT-I)
- Paramedic[10][11]
- Paramedic with Critical Care endorsement (P-CC)
- Paramedic with Community Paramedic endorsement (P-CP)
Colorado EMS Scope of Practice and Education Standard Comparison Archived 2017-02-15 at the Wayback Machine
Connecticut
edit- Emergency Medical Responder (EMR)[12]
- Emergency Medical Technician (EMT)[12]
- Advanced Emergency Medical Technician (AEMT)[12]
- 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)
Delaware
edit- First Responder
- EMT-Basic
- EMT-Paramedic[13]
District of Columbia
edit- Emergency Medical Responder (EMR)*
- Emergency Medical Technician (EMT)*
- Advanced Emergency Medical Technician (AEMT)*
- Emergency Medical Technician-Intermediate (EMT-I) (no new licenses granted)
- Paramedic*
Florida
editGeorgia
edit- EMT-R (similar to NREMT EMR)
- EMT
- EMT-Intermediate/85 (no new licenses granted)
- Cardiac Technician (no new licenses granted since 1998, similar to the NREMT-I/99)
- Advanced-EMT
- Paramedic (at least 504 classroom hours plus 320 clinical hours)[15]
Hawaii
edit- EMT (analogue to Advanced EMT)
- Paramedic (also known as Mobile Intensive Care Technician or MICT)[16]
Idaho
edit- Emergency Medical Responder (EMR-2011)[17]
- Emergency Medical Technician (EMT-2011)
- Advanced Emergency Medical Technician-85 (AEMT-85) (No new licenses granted)
- Advanced Emergency Medical Technician-2011
- Paramedic-2011
Illinois
edit- Emergency Medical Responder (EMR)
- EMT-Basic
- Advanced EMT
- Paramedic[18]
Indiana
edit- Emergency Medical Responder (EMR)
- EMT (Emergency Medical Technician)
- Advanced EMT
- Paramedic[19]
Iowa
edit- First Responder
- EMT-Basic
- EMT-Intermediate (analogous to EMT-Intermediate/85)
- EMT-Advanced
- EMT-Paramedic (analogous to EMT-Intermediate/99)
- Paramedic Specialist (analogous to EMT-Paramedic)[20][21]
- Critical Care Paramedic Endorsement for Paramedic
Transition to new levels began January 2011, and finished in March 2015.[22]
- Emergency Medical Responder (EMR)
- Emergency Medical Technician (EMT)
- Advanced Emergency Medical Technician (AEMT)
- Paramedic
- Critical Care Paramedic Endorsement for Paramedic level certification
Kansas
edit- Emergency Medical Responder (EMR) - Formerly known as First Responder
- Emergency Medical Technician (EMT)
- Advanced Emergency Medical Technician (AEMT)
- Paramedic (EMT-P)[23]
Kentucky
editLouisiana
edit- EMR-Emergency Medical Responder
- EMT-Emergency Medical Technician
- AEMT-Advanced EMT
- Paramedic (formerly EMT-P)[26]
Maine
edit- Emergency Medical Responder
- Ambulance Attendant (no new licenses granted since 1996)
- EMT
- Advanced AEMT
- EMT-Critical Care (no new licenses after 1998)
- Paramedic[27]
Maryland
editMassachusetts
edit- EMS First Responder (EFR)
- EMT-Basic
- EMT-Advanced
- EMT-Paramedic[30]
Michigan
edit- Emergency Medical Responder (EMR) (Also Medical First Responder)
- Emergency Medical Technician (EMT) (formerly EMT - Basic)
- Advanced Emergency Medical Technician (AEMT) (analogous to EMT-Intermediate/85)
- Paramedic (formerly EMT-Paramedic)[31]
Minnesota
editMississippi
edit- Medical First Responder
- EMT-Basic
- EMT-Intermediate/99 (no new licenses granted at this level since 2002, however previous holders can continue to renew theirs)
- AEMT
- EMT-Paramedic[34]
Missouri
edit- EMT-Basic
- Advanced EMT (AEMT)
- EMT-Paramedic[35]
Montana
edit(Endorsements are listed below each level, are optional and can be achieved in any order and combination.)
- EMR-Emergency Medical Responder
- Monitoring
- EMT-Emergency Medical Technician
- Airway
- IV and IO administration
- IV and IO maintenance
- Medication
- Advanced EMT
- Paramedic
- Critical Care Transport
Nebraska
edit- Emergency Medical Responder
- EMT-Basic
- AEMT
- EMT-Paramedic[36]
Nevada
edit- First Responder
- EMT
- Advanced EMT
- Paramedic
- CCT-Paramedic
- EMS RN
New Hampshire
edit- First Responder
- EMT
- Advanced EMT
- EMT-Paramedic[37]
New Jersey
editNew Mexico
edit- EMS First Responder
- EMT-Basic
- EMT-Intermediate
- EMT-Paramedic[42]
New York
edit- Certified First Responder
- EMT-Basic
- AEMT
- AEMT-Intermediate (replaced with AEMT; discontinued)
- AEMT-Critical Care (discontinued)
- AEMT-Paramedic[43]
North Carolina
edit- Emergency Medical Responder (EMR)
- EMT
- AEMT (Advanced EMT)
- Paramedic[44]
North Dakota
edit- First Responder
- Advanced First Aid Ambulance (no new licenses)
- EMT (analogous to EMT-Basic; only used for providers under the age of 18 and providers requesting reciprocity from another state)
- EMT-Basic
- AEMT-Advanced EMT
- EMT-Paramedic[45]
Ohio
edit- Emergency Medical Responder (EMR)
- Emergency Medical Technician (EMT)
- Advanced EMT (AEMT)
- Paramedic[46]
Oklahoma
editOregon
edit- Emergency Medical Responder (EMR)(National Curriculum)
- EMT (National Curriculum)
- Advanced EMT (National Curriculum)
- EMT Intermediate (State Curriculum)
- Paramedic (National Curriculum) (requires a college degree)[48]
Pennsylvania
edit- Emergency Medical Services Vehicle Operator (EMSVO)
- Emergency Medical Responder (EMR)
- Emergency Medical Technician (EMT)
- Advanced Emergency Medical Technician (AEMT)
- Paramedic (P)
- Prehospital Registered Nurse (PHRN)
- Prehospital Physician Extender (PHPE)
- Prehospital Physician (PHP)
- Medical Command Physician (MCP)
- EMS-Instructor (EMS-I) (Additional endorsement)
Puerto Rico
edit- EMT-Provisional License (Student)
- EMT-Basic
- EMT-Paramedic
Rhode Island
edit- Emergency Medical Responder (EMR)
- Emergency Medical Technician (EMT)
- Advanced Emergency Medical Technician (AEMT)
- Advanced Emergency Medical Technician Cardiac (AEMT-C) (State Specific)
- Paramedic[49]
South Carolina
edit- EMT-Basic
- EMT-Advanced
- EMT-Paramedic[50]
South Dakota
editTennessee
edit- Emergency Medical Responder (EMR)
- Emergency Medical Technician (EMT)
- Advanced Emergency Medical Technician (AEMT)
- Paramedic
- Critical Care Paramedic (now officially endorsed by the state)[53]
Texas
editUtah
edit- Emergency Medical Responder (EMR)[56]
- Emergency Medical Technician (EMT)[56]
- Advanced Emergency Medical Technician (AEMT)[56]
- Paramedic[56]
Now have been phased out of the state of Utah:
- 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)[56]
- EMT-Intermediate Advanced (analogous to EMT-Intermediate/99, phased out by Sept. 30, 2013 )[56]
Vermont
edit- Vermont Emergency First Responder (VEFR)
- Emergency Medical Responder (EMR)
- Emergency Medical Technician (EMT)
- Advanced Emergency Medical Technician (AEMT)
- Paramedic[57]
- Advanced Paramedic[58] (Critical Care Paramedics endorsed under the pre-2015 state curriculum are grandfathered at this level)
- Critical Care Paramedic[59] (Requires IBSC CCP-C or FP-C certification or UBMC CCEMT-P course)
Virginia
edit- 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.)
- Paramedic[60]
Washington
edit- Emergency Medical Responder (EMR)
- EMT
- AEMT (Advanced EMT)
- Paramedic[61]
West Virginia
edit- Emergency Medical Responder
- EMT-Mining (specialty certification)
- EMT-Basic
- Advanced Care Technician
- EMT-Paramedic
- Mobile Critical Care Paramedic[62]
Wisconsin
editSource:[63]
- EMR (Emergency Medical Responder)[64]
- EMT (Emergency Medical Technician)
- AEMT (Advanced Emergency Medical Technician)
- EMT-Intermediate (Emergency Medical Technician Intermediate)
- Paramedic
- Critical Care Paramedic Endorsement[65]
- TEMS (Tactical Emergency Medical Service Endorsement) Primarily for SWAT teams
Wyoming
edit- 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.[66]
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