Guide to EMT Certifications & State Licensure - EMR, AEMT, Paramedic

One of the most critical positions in quick-response healthcare and treatment is that of the EMT or emergency medical technician. The role of an EMR, an AEMT, and a paramedic—each of them a branch of EMT work—are similar in their domains of expertise but different in their respective levels of specialization. These medical professionals work outside the walls of hospitals, centers, and clinics, striving to give patients the very best care.

To become an EMR, EMT, AEMT, or paramedic, medical professionals must meet all prerequisites for eligibility and be admitted to an EMT or paramedic course of study. Candidates must first complete an emergency medical training program that is recognized by a state certification agency or the National Registry of Emergency Medical Technicians (NREMT).

After this, it’s necessary for prospective EMS personnel to take and pass either the NREMT EMR, EMT, AEMT, or paramedic exams. Upon passing with a satisfactory score, EMTs will be nationally registered as up-to-date on all training related to the sphere of the EMT. They must then apply for and gain certification at the state level to be eligible to work on an emergency medical team in that state. Each state requires its own certification.

In addition to national certification, an individual’s state of residence may have its own certification examinations, registration and/or licensing requirements. States may recognize components of the national exam for some of these purposes. However, they may have additional requirements for specializations or alternate emergency medical personnel.

Read on for an all-points guide to national EMT certification and registration.

EMR vs. EMT vs. AEMT vs. PARAMEDIC: What To Know

EMR (Emergency Medical Responder)

The emergency medical responder certification from NREMT is the initial certification for those seeking to be part of the EMS team. According to the National EMS Scope of Practice Model, emergency medical responders (EMRs) are professionals who “provide immediate lifesaving care to critical patients who access the emergency medical services system. EMRs have the knowledge and skills necessary to provide immediate lifesaving interventions while awaiting additional EMS resources to arrive.”

EMT (Emergency Medical Technician)

Emergency medical technicians (EMT) certified through NREMT can provide out-of-hospital emergency medical care services as well as transport patients in both emergent and nonemergent situations. The NEMSSPM defines EMTs as “a health professional whose primary focus is to respond to, assess and triage emergent, urgent, and non-urgent requests for medical care, apply basic knowledge and skills necessary to provide patient care and medical transportation to/from an emergency or health care facility.”

AEMT (Advanced Emergency Medical Technician)

NREMT provides the advanced emergency medical technician certification, which prepares EMTs for more specialized work in the field and at the scene. According to the NEMSSPM, AEMTs “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.”

Paramedics

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The paramedic is a senior member of the EMS team. Because they are often the most highly-trained and treatment-competent, paramedics are generally thought of as authority figures when on the scene. NREMT’s paramedic certification, according to the NEMSSPM, prepares a paramedic as “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.”

The EMT Certification Process and Eligibility

The NREMT certification process, in all respects, involves a number of steps and the meeting of specific medical criteria. They are:

  1. Successful completion of a state-approved EMR/EMT/AEMT/paramedic course that meets or exceeds the National Emergency Medical Services Education Standards for the Emergency Medical Responder.
  2. Current certification in CPR-BLS as “Healthcare Provider” or equivalent credential.
  3. Successful completion of the EMR/EMT/AEMT/paramedic cognitive exams and state-approved psychomotor exams.

There may be additional specific certification requirements, such as holding at least an EMT certification for AEMT and paramedic criteria. A psychomotor competency portfolio along with successful completion of a CAAHEP-accredited paramedic education program within the past two years is an additional requirement if applicants seek paramedic certification.

The standard level of training is NREMT’s EMT certification. The jobs mentioned above are subfields and/or advanced forms of emergency medical care. Such positions are defined by the National EMS Scope of Practice Model—a master government document that outlines expectations of emergency medical services staff.

Accredited coursework and programs in emergency medical technician training are available all across the country. Pursuing this path can mean anywhere from six months to two years of schooling, depending on the state and the institution.

To be admitted to such programs, applicants must possess a high school diploma or equivalent. Some schools may require a certain level of mathematics and science prerequisites, though this is less common. Student applicants must also be certified in CPR, pass a drug test and criminal background check, and be able to regularly lift up to or more than 100 pounds.

The kind of EMT basic training education chosen lays the groundwork for a rewarding career as one of many crucial EMS personnel. Detailed information about the NREMT’s application deadlines, types of exams, and eligibility and fees can be found on the organization’s website.

It should be noted that applicants to any EMT or EMS certification program must comply with both state and federal legislative regulations regarding emergency medical care and services. These regulations often work in tandem. For example, state programs require levels of education only provided by NREMT. However, NREMT certification alone does not automatically qualify someone to utilize EMS expertise. The legal ability to provide emergency medical services to patients in need must also be acquired through state certification.

National Certification Exams Overview – EMR, EMT, AEMT, Paramedic

The National Registry of Emergency Medical Technicians (NREMT) is the highest authority on emergency medical services in the United States. After the passing of exams, eligibility requirements, and the payment of various fees, NREMT includes emergency medical personnel in their national registry. This qualifies EMRs, EMTs, AEMTs, and paramedics to seek certification in their home state, which will make it legal for them to work in an emergency services capacity.

The qualification process for all four of these EMS specializations involves a cognitive competency exam, a psychomotor exam, and the certification eligibility process.

The Cognitive Exam

The cognitive portion of the exam comprises 90-110 questions (EMR exam), 70- 120 questions (EMT), 135 questions (AEMT exam), or 80-150 questions (paramedic exam). The EMR and paramedic exams are computer-adaptive tests, while the AEMT exam is a computer-based linear knowledge and competency exercise. The cost of the exams is:

  • $85 EMR
  • $98 EMT
  • $136 AEMT
  • $152 paramedic

The EMR exam has a time limit of one hour and forty-five minutes; the EMT exam has a limit of two hours; the AEMT exam a limit of two hours and fifteen minutes; and the paramedic exam a limit of two hours and thirty minutes.

The Psychomotor Exam

These tests verify the “hands-on” skill sets of EMS personnel. In effect, they test the level of on-the-job experience and the results of continuing EMS education.

  • EMR: Administered by state or local authorities. Sometimes an element of state certification. Foci include trauma assessment and management, oxygen administration, BVN ventilation, and cardiac arrest management.
  • EMT: Administered by state or local authorities. Often required for state certification. The primary focus is on patient assessment and management, ventilation of an apneic adult patient, oxygen administration, bleeding control, shock management, cardiac arrest management, and joint and long bone immobilization.
  • AEMT: Administered by state or local authorities. Also, sometimes an element of state certification. Emphasis is placed on ventilatory management, trauma assessment, medical assessment, AED/cardiac arrest management, IV and medication administration, random EMT skills, and pediatric intraosseous infusion competency.
  • Paramedic: Administered by both state and local authorities, occasionally as part of paramedic certification on the state level. Foci include patient assessment in trauma, dynamic cardiology, static cardiology, oral station case A, oral station case B, and an integrated out-of-hospital training scenario.

EMT & Paramedic Certification Renewals

There are two levels at which EMS personnel must be certified and recertified. The first is on the national level, through NREMT, and the second is on the state level, through various state health authorities.

The continuing education process comprises three areas: the national component, the local or state component, and the individual component. The Commission on Accreditation for Pre-Hospital Continuing Education (CAPCE) offers a number of continuing education materials that can count toward the local or state components of the NREMT recertification process.

For the EMR certification, renewal requires that applicants complete the proper amount of continuing education hours or retake the adaptive certification exam, which means filling out a Recertification by Exam application. Going with the continuing education option requires a total of 16 hours, made up of national, local, and individual components.

If applicants choose recertification by exam, they’ll take a modified, refresher-centric test in an adaptive format, just as in the initial certification process, after paying the $15 fee for the cognitive exam. EMRs will need to print the authorization to test (ATT) letter, which will provide details on where to take the recertification exam.

After successfully passing the exam, a cognitive competency form will be made available, which can be presented, along with all supporting documentation and required signatures, to the NREMT. This will complete the EMR recertification process.

EMTs who wish to renew their NREMT certification will have the option to either recertify by continuing education or by exam. To recertify with continuing education, candidates will need to earn a total of 40 hours of continuing education. Twenty hours must be for the national component and include one and half hours of airway and ventilation, six hours of cardiovascular, an hour and half of trauma, six hours of medical, and five hours of operations.

The ten local or state hours must meet state or local guidelines. In the absence of state or local requirements, these hours can be flexible but must be related to emergency medical care. The last 10 hours are considered individual and may be in any EMS-approved course. To recertify by exam, candidates must take the EMT cognitive competency exam.

After successfully passing the exam, a cognitive competency form will be made available, which can be presented, along with all supporting documentation and required signatures, to the NREMT. This will complete the EMT recertification process.

Renewing one’s AEMT certification means, unsurprisingly, that applicants retake the advanced certification exam or complete the proper amount of continuing education hours. Choosing the continuing education option means proving a combined total of 50 hours made up of national, local, and individual components. AEMT recertification by exam means logging into the NREMT system, applying to retake the certification exam, and paying the $20 fee for the cognitive exam. AEMT will need to print the authorization to test (ATT) letter, which will provide details on where to take the recertification exam.

After successfully passing the exam, a cognitive competency form will be made available, which can be presented, along with all supporting documentation and required signatures, to the NREMT. This will complete the AEMT recertification process.

Applicants interested in even more advanced work as a paramedic can rest easy about renewing their certifications. Paramedic certification renewal requires the same fee-paying and requirement-meeting as NREMT’s other specializations. Those seeking to renew their NREMT paramedic certification must complete the required 60 continuing education hours or choose the recertification by exam option. This option will cost $25 to retake the cognitive exam. To take the recertification exam, paramedics will need to print the authorization to test (ATT) letter, which will provide details on where to take the recertification exam.

After successfully passing the exam, a cognitive competency form will be made available, which can be presented, along with all supporting documentation and required signatures, to the NREMT. This will complete the paramedic recertification process.

State Certification for EMTs & Paramedics

Registration, licensing, and certification requirements for EMTs, EMRs, AEMTs, and paramedics vary from state to state. Check with the EMT board or certification authority in your state for more detailed information on how to become a properly certified emergency medical services technician. In combination with national certification from NREMT, state certification grants emergency medical technicians the right to legally perform their duties under specific state laws.

In the state of Oregon, for example, to work as a registered emergency medical technician, candidates must obtain EMS Provider Licensure from the Oregon Health Authority via the Oregon Department of Health.

To be eligible for emergency medical services certification in Oregon, students must have passed a certification exam from NREMT and be in possession of up-to-date certification. After providing evidence that the applicant has satisfied those state-level requirements (such as test scores, EMT program transcripts, and EMT or EMS program diploma), applicants must pay a fee to become certified in the state of Oregon. There are two phases of state licensing: initial and renewal. The following information contains instructions for both.

EMTs, EMRs, AEMTs, and paramedics must all be licensed as Oregon state EMS providers. Upon qualification for Oregon’s EMS Provider License exam, applicants must upload the following documents and proof of qualification during the online application process:

  • Current certification from the National Registry of Emergency Medical Technicians (NREMT)
  • Current CPR certification via AHA Healthcare or BLS Provider level (or equivalent). In Oregon, satisfactory courses must include skill performance and evaluation, as well as didactic exercises
  • Current government ID (driver’s license, military ID, or passport)
  • FBI background check via fingerprint

To ensure EMT professionals are up-to-date on their provider renewal, applicants seeking EMS Provider Licensure in Oregon must meet EMS Providers’ minimum continuing education requirements.

For most states, renewal periods cycle each year, opening in spring to those whose certifications are getting close to expiration. They typically close in June or July, meaning that applicants have a period of three to four months to submit renewal and recertification requirements.

Renewing the Oregon EMS eLicense means meeting continuing education requirements in technical and medical training, such as obstetric emergencies, pediatric emergencies, airway, breathing, cardiology, airway management, vascular access, splinting, mobilization, chest decompression, and cricothyroidotomy.

Consult local authorities to determine the specific requirements for EMS provider license renewal.

Kenneth Parker
Kenneth Parker Writer

Kenneth Parker is a feature writer, poet, and musician living in the Pacific Northwest. His writing on remote work, education, and technology has been published by BustedCubicle.com, MedicalTechnologySchools.com, and other websites. His poetry, short fiction, and album reviews have appeared in Scifaikuest, Nanoism, and No Clean Singing. His background includes time spent as an associate editor, proofreader, private grammar instructor, freelance content editor, medical claims agent, and SEO consultant. He is a graduate of the University of Oregon, where he studied literature and worked as a composition tutor.