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). 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 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. Some states have certifications allowing other healthcare providers, such as Registered Nurses and Physician Assistants, to practice in the prehospital setting. Others require all EMS responders to obtain EMT or paramedic qualifications regardless of other licensure. 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 Advanced EMT 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. 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 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) Advanced EMT (AEMT) EMT-Intermediate (EMT-I) Paramedic 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 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
District of Columbia 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 Emergency Medical Technician Paramedic
Georgia Emergency Medical Technician-Responder (EMT-R) (similar to NREMT EMR) Emergency Medical Technician (EMT) Emergency Medical Technician-Intermediate (EMT-I) (no new licenses granted) Advanced Emergency Medical Technician (AEMT) Cardiac Technician (no new licenses granted since 1998, similar to the NREMT-I/99) Paramedic (at least 504 classroom hours plus 320 clinical hours)
Hawaii EMT (analogue to Advanced EMT) Paramedic (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 Emergency Medical Responder (EMR) EMT-Basic Advanced EMT Paramedic Pre-hospital Registered Nurse (PHRN)
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 Emergency Medical Responder (EMR) Emergency Medical Technician (EMT) Advanced Emergency Medical Technician (AEMT) Paramedic Advanced Practice Paramedic Community Paramedic Wilderness Paramedic Critical Care Paramedic Flight Paramedic Tactical Paramedic
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)* Cardiac Rescue Technician-Intermediate* (CRT-I) (analogous to EMT – Intermediate/99)(MIEMMS is only recertifying current EMT-Cardiacs) 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 Community Intigrated Healthcare Paramedic
Nebraska Emergency Medical Responder EMT-Basic AEMT EMT-Paramedic
Nevada First Responder EMT Advanced EMT Paramedic CCT-Paramedic EMS RN
New Hampshire First Responder EMT Advanced EMT EMT-Paramedic
New Jersey Emergency Medical Responder (EMR) 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 Advanced EMT AEMT-Critical Care (discontinued) 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 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 associate degree in EMS -OR- a bachelor's 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 by the next recert cycle had to switch to AEMT) EMT-Intermediate Advanced (analogous to EMT-Intermediate/99, phased out by Sept. 30, 2013 )
Vermont Vermont Emergency First Responder (VEFR) Emergency Medical Responder (EMR) Emergency Medical Technician (EMT) Advanced Emergency Medical Technician (AEMT) Paramedic Critical Care Paramedic (Requires IBSC CCP-C or FP-C certification or UBMC CCEMT-P course)
Virginia 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
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 Source:
EMR (Emergency Medical Responder) EMT (Emergency Medical Technician) AEMT (Advanced Emergency Medical Technician) EMT-Intermediate (Emergency Medical Technician Intermediate) No new EMT-Intermediates certified. Paramedic Community 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.
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