In the United States, the licensing of prehospital emergency medical providers ( emergency medical technicians) (EMTs) and oversight of

emergency medical services Emergency medical services (EMS), also known as ambulance services or paramedic services, are emergency services that provide urgent pre-hospital treatment and stabilisation for serious illness and injuries and transport to definitive care. ...

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 The National Highway Traffic Safety Administration (NHTSA ) is an agency of the U.S. federal government, part of the Department of Transportation. It describes its mission as "Save lives, prevent injuries, reduce vehicle-related crashes" rela ...

(NHTSA). 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. 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. 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 EMT and

Paramedic A paramedic is a registered healthcare professional who works autonomously across a range of health and care settings and may specialise in clinical practice, as well as in education, leadership, and research. Not all ambulance personnel are p ...

is either a form of EMT-Intermediate or an

Advanced EMT Advanced emergency medical technicians (AEMT) are providers of prehospital emergency medical services in the United States. A transition to this level of training from the ''emergency medical technician-intermediate'' (''EMT-I''), which have somewh ...

. 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. *EMT-Paramedic

Arkansas

*Emergency Medical Responder (Not recognized by the Arkansas Department of Health, certification issued by local EMS Authorities and/or the Arkansas Fire Training Academy) *Emergency Medical Technician (EMT) *Advanced Emergency Medical Technician (AEMT) *Paramedic *Community Paramedic

California

*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) *Advanced Emergency Medical Technician* (AEMT) *Paramedic *Critical Care Paramedic Endorsement for Paramedic Level* (It is offered in and recognized in some counties in California.)

Colorado

*Emergency Medical Responder (EMR) *Emergency Medical Technician (EMT) *EMT- IV (Intravenous Therapy certification) *EMT-I *Advanced EMT (AEMT) *Paramedic *Critical Care Endorsement to Paramedic level certificatio
Colorado EMS Scope of Practice and Education Standard Comparison

Connecticut

*Emergency Medical Responder (EMR) *Emergency Medical Technician (EMT) *Advanced Emergency Medical Technician (AEMT) *Paramedic (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

*First Responder *EMT-Basic *EMT-Paramedic

Florida

*Emergency Medical Technician *Paramedic

Georgia

*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) not

Hawaii

*EMT (analogue to Advanced EMT) *Paramedi (also known as Mobile Intensive Care Technician or MICT)

Idaho

*Emergency Medical Responder (EMR-2011) *Emergency Medical Technician (EMT-2011) *Advanced Emergency Medical Technician-85 (AEMT-85) (No new licenses granted) *Advanced Emergency Medical Technician-2011 *Paramedic-2011

Illinois

*FRD-First Responder Defibrillator *EMT-Basic *EMT-Intermediate/99 *PHRN *EMT-Paramedic

Indiana

*Emergency Medical Responder (EMR) *EMT (Emergency Medical Technician) *Advanced EMT *Paramedic*

Iowa

*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) *Critical Care Paramedic Endorsement for Paramedic Transition to new levels began January 2011, and finished in March 2015. *Emergency Medical Responder (EMR) *Emergency Medical Technician (EMT) *Advanced Emergency Medical Technician (AEMT) *Paramedic *Critical Care Paramedic Endorsement for Paramedic level certification

Kansas

*Emergency Medical Responder (EMR) - Formerly known as First Responder *Emergency Medical Technician (EMT) *Advanced Emergency Medical Technician (AEMT) *Paramedic (EMT-P)

Kentucky

*CPR Drivers *Emergency Medical Responder (EMR) *Emergency Medical Technician (EMT) *Advanced Emergency Medical Technician (AEMT) *Paramedic *Critical Care Paramedic Endorsement

Louisiana

*EMR-Emergency Medical Responder *EMT-Emergency Medical Technician *AEMT-Advanced EMT *Paramedic (formerly EMT-P)

Maine

*Emergency Medical Responder *Ambulance Attendant (no ''new'' licenses granted since 1996) *EMT *Advanced AEMT *EMT-Critical Care (no ''new'' licenses after 1998) *Paramedic

Maryland

*Emergency Medical Responder (EMR) *Emergency Medical Technician-Basic (EMT-B) *Cardiac Rescue Technician-Intermediate* (CRT-I) (analogous to EMT – Intermediate/99) *Paramedic

Massachusetts

*EMS First Responder (EFR) *EMT-Basic *EMT-Advanced *EMT-Paramedic

Michigan

*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)

Minnesota

*Emergency Medical Responder *Emergency Medical Technician *Paramedic *Community Paramedic *Registered Physician Assistant-EMT

Mississippi

*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

Missouri

*EMT-Basic *Advanced EMT (AEMT) *EMT-Paramedic

Montana

(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

*Emergency Medical Responder *EMT-Basic *AEMT *EMT-Paramedic

Nevada

*First Responder *EMT *Advanced EMT *Paramedic

New Hampshire

*First Responder *EMT *Advanced EMT *EMT-Paramedic

New Jersey

*Emergency Medical Technician (EMT)* *Mobile Intensive Care Paramedic (MICP) *Mobile Intensive Care Nurse (MICN)

New Mexico

*EMS First Responder *EMT-Basic *EMT-Intermediate *EMT-Paramedic

New York

*Certified First Responder *EMT-Basic *AEMT *AEMT-Intermediate (No new certifications granted, will now be replaced with AEMT) * AEMT-Critical Care (No new certifications granted) *AEMT-Paramedic

North Carolina

*Emergency Medical Responder (EMR) *EMT *AEMT (Advanced EMT) *Paramedic

North Dakota

*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

Ohio

*Emergency Medical Responder (EMR) *Emergency Medical Technician (EMT) *Advanced EMT (AEMT) *Paramedic

Oklahoma

*Emergency Medical Responder (EMR) *EMT-Basic *EMT-Intermediate/85 *EMT-Paramedic

Oregon

*Emergency Medical Responder (EMR)(National Curriculum) *EMT (National Curriculum) *Advanced EMT (National Curriculum) *EMT Intermediate (State Curriculum) *Paramedic (National Curriculum) (requires a college degree)

Pennsylvania

*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

*EMT-Provisional License (Student) *EMT-Basic *EMT-Paramedic

Rhode Island

*Emergency Medical Responder (EMR) *Emergency Medical Technician (EMT) *Advanced Emergency Medical Technician (AEMT) *Advanced Emergency Medical Technician Cardiac (AEMT-C) (State Specific) *Paramedic

South Carolina

*Emergency Medical Responder *EMT-Basic *EMT-Advanced *EMT-Paramedic

South Dakota

*Emergency Medical Responder (EMR) *Emergency Medical Technician (EMT) *Emergency Medical Technician - Intermediate/85 *Advanced Emergency Medical Technician (AEMT) *Emergency Medical Technician - Intermediate/99 *Emergency Medical Technician - Paramedic

Tennessee

*Emergency Medical Responder (EMR) *Emergency Medical Technician (EMT) *Advanced Emergency Medical Technician (AEMT) *Paramedic *Critical Care Paramedic (now officially endorsed by the state)

Texas

*Emergency Care Attendant *EMT *AEMT (formerly EMT-I) *Certified Paramedic *Licensed Paramedic (*Degree Requirement* Requires either an Associates Degree in EMS -OR- a Bachelors Degree in any field.)

Utah

*Emergency Medical Responder (EMR) *Emergency Medical Technician (EMT) *Advanced Emergency Medical Technician (AEMT) *Paramedic 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 never did have to switch to advanced) *EMT-Intermediate Advanced (analogous to EMT-Intermediate/99, phased out by Sept. 30, 2013 )

Vermont

*Emergency Medical Responder (EMR) *Emergency Medical Technician (EMT) *Advanced Emergency Medical Technician (AEMT) *Paramedic *Advanced Paramedic (replaces state sponsored Critical Care Paramedic endorsement)

Virginia

*Emergency Medical Responder (EMR) *Emergency Medical Technician (EMT) *Emergency Medical Technician Enhanced (EMT-E) (Transition from EMT-E to AEMT begins 2013 providers have up to 3 recertification cycles to transition to AEMT) *Advanced Emergency Medical Technician (AEMT) *EMT-Intermediate (As of January 1, 2020 no new certifications will be issued. Providers certified before 2020 may still practice under current EMT-I (I/99) certification level, and renew it indefinitely with completion of CME hours each cycle.) *Paramedic

Washington

*Emergency Medical Responder (EMR) *EMT *AEMT (Advanced EMT) *Paramedic

West Virginia

*Emergency Medical Responder *EMT-Mining (specialty certification) *EMT-Basic *Advanced Care Technician *EMT-Paramedic *Mobile Critical Care Paramedic

Wisconsin

*EMR (Emergency Medical Responder) *EMT (Emergency Medical Technician) *AEMT (Advanced Emergency Medical Technician) *EMT-Intermediate (Emergency Medical Technical Intermediate) *Paramedic *Critical Care Paramedic Endorsement *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.

References

{{DEFAULTSORT:Emergency Medical Responder Levels By U.S. State Emergency medical services in the United States Medical lists