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.
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.)
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.
Emergency Medical Responder (Not recognized by the Arkansas Department of Health, certification issued by local EMS Authorities and/or the Arkansas Fire Training Academy)[5]
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.)
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]
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)
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)[55]
EMT-Intermediate Advanced (analogous to EMT-Intermediate/99, phased out by Sept. 30, 2013 )[55]
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.)
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]
^ ab"Emergency Medical Services Rules". Florida Administrative Code. Florida Department of State, Division of Library and Information Services. Retrieved 5 December 2011.
^"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.
^"Frequently Asked Questions". State of Louisiana, Department of Health and Hospitals, Louisiana Bureau of Emergency Medical Systems. Retrieved 2018-05-22.
^"Scope of Practice". Ohio Department of Public Safety, Ohio Emergency Medical Services. Archived from the original on 26 October 2012. Retrieved 11 November 2012.
^ abcd"Licensure". EMT Licensure and Registration. Oklahoma State Department of Health. Archived from the original on 7 December 2011. Retrieved 5 December 2011.
^ abcdef"EMT & Paramedic Certification". Utah EMT & Paramedic Certification. Utah Department of Health, Bureau of Emergency Medical Services. Retrieved 7 December 2011.
^"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.
^"Certification Application". Wyoming Department of Health, Office of Emergency Medical Services. Archived from the original(pdf) on 2011-07-21. Retrieved 2008-03-29.