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Emergency medical responder levels by U.S. state

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In the United States, the licensing of prehospital emergency medical providers (emergency medical technicians (EMTs)) 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] In the list, certification levels are provided from most basic to most advanced.

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 EMT-Basic and EMT-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.

Alabama

  • Emergency Care Provider (ECP)
  • Emergency Medical Responder (EMR)[4]
  • Emergency Medical Technician (EMT)[5]
  • Advanced Emergency Medical Technician (AEMT) [5]
  • Paramedic [5]

Alaska

  • ETT* (Emergency Trauma Technician)-
  • EMT-I* (One) (analogous to EMT-Basic)
  • EMT-II (Two) (analogous to EMT-Intermediate/85)(50 hours of additional education )
  • EMT-III (Three)-(50 hours of additional education.
  • AEMT-level established in 2015 (follows and is certified via the NREMT testing process)
  • Mobile Intensive Care Paramedic (MICP)[6][7]

Arizona

  • EMT-Basic*
  • EMT-Intermediate. Please note: Arizona is longer certifying new EMT-Is. However, existing certifications continue to be allowed to practice under this level of certification.
  • EMT-Paramedic*[8]

Arkansas

  • EMS First Responder (Phased out since 2012)
  • Emergency Medical Responder (Since 2012)
  • EMT-Basic
  • EMT-Ambulance* (analogous to EMT-Basic prior to 2000)
  • EMT-Intermediate/99
  • EMT-Paramedic*[9]

California

  • Emergency Medical Technician* (EMT)[10]
  • Advanced Emergency Medical Technician* (AEMT)[10]
  • Paramedic*[10]
  • Mobile Intensive Care Nurse (MICN)

Colorado

  • WFR (Wilderness First Responder)
  • EMT*
  • EMT-I
  • Advanced EMT* (AEMT)
  • Paramedic* [11][12]
  • Critical Care Endorsement for Paramedic level*

Connecticut

  • Emergency Medical Responder* (EMR)[13]
  • Emergency Medical Technician* (EMT)[13]
  • Advanced Emergency Medical Technician* (AEMT)[13]
  • Paramedic*[13] (Paramedics are Licensed professionals in Connecticut, whereas all other levels of EMS providers are certified and must participate in tri-annual recertification programs.)

Delaware

  • First Responder*
  • EMT-Basic*
  • EMT-Paramedic*[14]

Florida

  • Emergency Medical Technician[15]
  • Paramedic[15]

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)[16]

Hawaii

  • EMT* (analogue to Advanced EMT)
  • Paramedic* (also known as Mobile Intensive Care Technician)[17]

Idaho

  • Emergency Medical Responder (EMR-2011)[18]
  • 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
  • EMT-Paramedic* [19]
  • Pre-Hospital Registered Nurse (PHRN, analogous to EMT-Paramedic)

Indiana

  • Emergency Medical Responder
  • EMT
  • Advanced EMT
  • Paramedic*[20]

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)[21][22]
  • Critical Care Paramedic Endorsement for Paramedic Specialist Level*

Transition to new levels began January 2011, and finished in March 2015. [23]

  • Emergency Medical Responder* (EMR)
  • Emergency Medical Technician* (EMT)
  • Advanced Emergency Medical Technician* (AEMT)
  • Paramedic*
  • Critical Care Paramedic Endorsement for Paramedic Level*

Kansas

  • Emergency Medical Responder
  • Emergency Medical Technician* (EMT)
  • Advanced Emergency Medical Technician* (AEMT)
  • Paramedic* (EMT-P)[24]

Kentucky

  • First Responder[25]
  • Emergency Medical Technician* (EMT)[25]
  • Advanced Emergency Medical Technician* (AEMT)[25]
  • Paramedic*[25]
  • Critical Care Paramedic Endorsement[25]

Louisiana

  • Emergency Medical Responder
  • EMT-Basic*
  • EMT-Intermediate/85
  • EMT-Paramedic* [26]

Maine

  • 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

  • Emergency Medical Responder (EMR)
  • Emergency Medical Technician (EMT)
  • Cardiac Rescue Technician-Intermediate* (CRT-I) (analogous to EMT – Intermediate/99)
  • Paramedic [28]

Massachusetts

  • First Responder (Emergency Medical Responder)
  • EMT-Basic
  • EMT-Intermediate/85
  • EMT-Paramedic[29]

Michigan

  • EMR- Emergency Medical Responder (Also Medical First Responder)
  • EMT- Emergency Medical Technician (formerly EMT - Basic)
  • AEMT- Advanced Emergency Medical Technician (analogous to EMT-Intermediate/85)
  • Paramedic (formerly EMT-Paramedic*)[30]

Minnesota

  • Emergency Medical Responder*
  • EMT-Basic
  • AEMT
  • EMT-Paramedic*
  • Community Paramedic
  • Registered Nurse-EMT
  • Registered Physician Assistant-EMT[31][32]

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)
  • EMT-Paramedic*[33]

Missouri

  • First Responder
  • EMT-Basic*
  • EMT-Paramedic*[34]

Montana

(endorsements are listed below each level are optional and can be achieved in any order and combination)

  • EMT-First Responder
    • Immbolization
    • Monitoring
    • Ambulance
  • EMT-Basic*
    • Airway
    • Monitoring
    • IV and IO initiation
    • IV and IO maintenance
    • Endotracheal intubation
    • Medication
  • EMT-Intermediate
    • Needle decompression/surgical airway
    • Immunizations
    • Drips and pumps
    • 12 lead transmit
  • EMT-Paramedic*
    • 12 lead interpretation
    • Medications
    • Fibrinolytic with 12 lead interpretation
    • Critical Care Transport[35]

Nebraska

  • First Responder
  • EMT-Basic*
  • EMT-Intermediate
  • EMT-Paramedic*[36]

Nevada

  • First Responder
  • EMT
  • Advanced EMT
  • Paramedic

New Hampshire

  • First Responder
  • EMT
  • Advanced EMT
  • EMT-Paramedic*[37]

New Jersey

Current System

  • Emergency Medical Responder (EMR)
  • Emergency Medical Technician (EMT) [38]
  • Mobile Intensive Care Paramedic (MICP) [39][40]
  • Mobile Intensive Care Nurse (MICN)[39][40]

New Mexico

  • EMS First Responder
  • EMT-Basic
  • EMT-Intermediate
  • EMT-Paramedic*[41]

New York

  • Certified First Responder
  • EMT-Basic
  • AEMT-Intermediate (No new licenses granted, will now be replaced with AEMT)
  • AEMT-Critical Care
  • AEMT-Paramedic[42]

North Carolina

  • Medical Responder
  • EMT-Basic
  • EMT-Intermediate (The NC EMT-I scope of practice lies between the national I-85 and I-99 level)
  • EMT-Paramedic[43]
  • EMT-Advanced Practice Paramedic (currently a pilot program in Wake County; the emergency scope of APPs is similar to a paramedic, but they do additional work in community preventative care)

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*
  • EMT-Intermediate/85
  • EMT-Paramedic*[44]

Ohio

  • Emergency Medical Responder (EMR)
  • Emergency Medical Technician (EMT)
  • Advance EMT (AEMT)
  • Paramedic*[45]

Oklahoma

  • Emergency Medical Responder (EMR)[46]
  • EMT-Basic*[46]
  • EMT-Intermediate/85[46]
  • EMT-Paramedic*[46]

Oregon

  • Emergency Medical Responder (EMR)(National Curriculum)*
  • EMT (National Curriculum)*
  • Advanced EMT (National Curriculum)*
  • Paramedic (National Curriculum)* (requires a college degree)[47]

Pennsylvania

BLS

ALS

Puerto Rico

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

Rhode Island

  • EMT-Basic*
  • EMT-Cardiac (State Specific)
  • EMT-Paramedic*[49]

South Carolina

  • Emergency Medical Responder
  • EMT-Basic*
  • EMT-Intermediate/85
  • EMT-Paramedic*[50]

South Dakota

  • EMT-Responder (pending state recognition)
  • EMT
  • EMT-Intermediate/85
  • AEMT
  • EMT-Intermediate/99
  • Paramedic*[51]

Tennessee

  • Emergency Medical Responder (EMR)
  • EMT-Basic
  • EMT-IV (Phasing out)
  • EMT-Advanced (New)
  • Paramedic
  • Critical Care Paramedic* (now officially endorsed by the state)[52]

Texas

  • Emergency Medical Responder (Emergency Care Attendant License ECA)
  • EMT-Basic*
  • EMT-Intermediate
  • EMT-Paramedic*
  • Licensed Paramedic (paramedic with a college degree)[53]

Utah

  • Emergency Medical Responder* (EMR)[54]
  • Emergency Medical Technician* (EMT)[54]
  • Advanced Emergency Medical Technician* (AEMT)[54]
  • Paramedic*[54]

Now have been phased out of the state of Utah:

  • EMT-Intermediate (state specific, phased out by Sept. 30, 2013 )[54]
  • EMT-Intermediate Advanced (analogous to EMT-Intermediate/99, phased out by Sept. 30, 2013 )[54]

Vermont

  • Emergency Medical Responder (EMR)
  • Emergency Medical Technician (EMT)
  • Advanced Emergency Medical Technician(AEMT)
  • Paramedic[55]
  • Critical Care Paramedic (Service Specific)

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 (state-supported, will continue to use NREMT I-99 exam)
  • Paramedic[56]
  • Critical Care Paramedic

Washington

  • Emergency Medical Responder (EMR)
  • EMT
  • AEMT (advanced EMT)
  • Paramedic[57]

West Virginia

  • Emergency Medical Responder
  • EMT-Mining (specialty certification)
  • EMT-Basic
  • EMT-Paramedic
  • Mobile Critical Care Paramedic
  • Mobile Critical Care Nurse[58]

Wisconsin

  • Medical First Responder[59]
  • EMT-Basic
  • EMT-Intermediate Technician (analogous to EMT-Intermediate/85)
  • EMT-Intermediate/99
  • EMT-Paramedic
  • Critical Care Paramedic Endorsement[60]

Wyoming

  • EMR
  • EMT
  • AEMT
  • IEMT
  • 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.

[61]

References

Template:Research help

  1. ^ "National Standard Curriculum" (PDF). National Highway Transportation Safety Administration. Retrieved 2014-09-07.
  2. ^ "About NREMT Examinations". National Registry of Emergency Medical Technicians. Retrieved 2014-09-08.
  3. ^ "2011 Annual Report" (PDF). National Registry of Emergency Medical Technicians. p. 11. Retrieved 2012-11-11.
  4. ^ "Emergency Medical Responder (EMR)". Retrieved September 28, 2013.
  5. ^ a b c "EMS Rules and Protocols". EMS Rules 2011. Alabama Department of Public Health. Retrieved 9 November 2011.
  6. ^ "EMS Training Levels In Alaska". Alaska Health and Human Services. 2005-06-06. Retrieved 2008-03-27.
  7. ^ "Certification Search". Alaska Health and Human Services. Retrieved 2008-03-30. Certification search for ETT and Defib Technician returns zero results
  8. ^ "EMT Certification - FAQs: How do I gain certification in Arizona as an EMT-B, EMT-I, or EMT-P?". Arizona Department of Public Health Services. Retrieved 2008-03-27.
  9. ^ "Rules and Regulations for Emergency Medical Services" (PDF). Arkansas State Board of Health. pp. 25–27. Retrieved 2008-03-27.
  10. ^ a b c "EMS Statues, Regulations, and Legislation". California Code of Regulations, Title 22. California Emergency Medical Services Authority. Retrieved 5 December 2011.
  11. ^ "Rules Pertaining to EMS Practice and Medical Director Oversity" (PDF). Colorado Department of Public Health and Environment. Retrieved 2014-09-08.
  12. ^ "EMS Provider Certification Frequently Asked Questions" (PDF). Colorado Department of Public Health and Environment. Retrieved 2014-09-08.
  13. ^ a b c d "Emergency Medical Services - Licensure/Certification/Exams". Emergency Medical Services - Licensure/Certification/Exams. Connecticut Department of Public Health. Retrieved 5 December 2011. Cite error: The named reference "Emergency Medical Services - Licensure/Certification/Exams" was defined multiple times with different content (see the help page).
  14. ^ "Delaware Paramedic Education". Retrieved 11 November 2012.
  15. ^ a b "Emergency Medical Services Rules". Florida Administrative Code. Florida Department of State, Division of Library and Information Services. Retrieved 5 December 2011.
  16. ^ "Georgia Office of EMS Course Approval-Initial Education for Licensure" (PDF).
  17. ^ "Certifying Emergency Medical Service Personnel". State of Hawaii. Retrieved 2008-03-27.
  18. ^ "Idaho Emergency Medical Services Bureau". Idaho Department of Health and Welfare. Retrieved 8 September 2014.
  19. ^ "Emergency Medical System and Highway Safety". Illinois Department of Public Health. Retrieved 2008-03-27.
  20. ^ "Levels of EMS Personnel Certification" (PDF). Indiana Emergency Medical Services Commission. Retrieved 2008-03-27.
  21. ^ "Authorized Iowa EMS Training Programs" (PDF). Iowa Department of Public Health, Bureau of Emergency Medical Services. Retrieved 2008-03-27.
  22. ^ "Iowa EMT-Paramedic to Paramedic Specialist Transition Application" (PDF). Iowa Department of Public Health, Bureau of Emergency Medical Services. Retrieved 2008-03-27.
  23. ^ "IDPH - Bureau of EMS" (PDF). Iowa EMS Transition. Iowa Department of Public Health. Retrieved 10 November 2011.
  24. ^ "Frequently Asked Questions". Kansas Board of Emergency Medical Services. Archived from the original on 2008-02-19. Retrieved 2008-03-28.
  25. ^ a b c d e "Administrative Regulations". Kentucky EMS Administrative Regulations. Kentucky Board of Emergency Medical Services. Retrieved 5 December 2011.
  26. ^ "Certification Application" (PDF). State of Louisiana, Department of Health and Hospitals, Louisiana Bureau of Emergency Medical Systems. Retrieved 2012-11-11.
  27. ^ "Maine Emergency Medical System Rules" (PDF). p. 118. Retrieved 2014-09-16.
  28. ^ "MIEMSS Transition Timelines". Maryland Institute for Emergency Medical Services Systems. Retrieved 2011-11-01.
  29. ^ "Overview of Training Requirements". Massachusetts Office of Health and Human Services. Retrieved 2008-03-28.
  30. ^ "License Packet" (.PDF). Michigan Department of Community Health, Emergency Medical Services and Trauma System. p. 4. Retrieved 2008-03-28.
  31. ^ "Certification". Minnesota Emergency Medical Services Regulatory Board. Retrieved 2008-03-28.
  32. ^ . Minnesota State Legislature https://www.revisor.mn.gov/statutes/?id=144E.101&year=2014. Retrieved 2015-02-19. {{cite web}}: Missing or empty |title= (help)
  33. ^ "EMS Personnel Information Frequently Asked Questions (FAQ)". Mississippi State Department of Health, Emergency Medical Services. Retrieved 2008-03-28.
  34. ^ "Frequently Asked Questions: I am an EMT-Intermediate; can I work as an EMT-I in Missouri?". State of Missouri, Department of Health and Senior Services. Retrieved 2008-03-28.
  35. ^ "Montana State Board of Medical Examiners" (PDF). Department of Labor and Industry. p. 93. Retrieved 2008-03-28.
  36. ^ "Certification for Out-of-Hospital Providers". Nebraska Department of Health and Human Services. Archived from the original on 2008-05-17. Retrieved 2008-03-28.
  37. ^ "New Hampshire EMS Provider License Application" (PDF). Department of Safety. Retrieved 2008-03-28.
  38. ^ "Mobility Assistance Vehicle and Basic Life Support Ambulance Services" (PDF). New Jersey Administrative Code. State of New Jersey. NJAC 8:40. Retrieved 2010-01-04.
  39. ^ a b "Advanced Life Support Services; Mobile Intensive Care Programs, Specialty Care Transport Services and Air Medical Services" (PDF). New Jersey Administrative Code. State of New Jersey. NJAC 8:41. Retrieved 2010-01-04.
  40. ^ a b "Emergency Medical Technicians-Paramedic: Training and certification" (PDF). New Jersey Administrative Code. State of New Jersey. NJAC 8:41A. Retrieved 5 December 2011.
  41. ^ "Licensing Info". New Mexico Department of Health. Retrieved 11 November 2012.
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  43. ^ "http://www.ncdhhs.gov/dhsr/EMS/curricul.htm". North Carolina Office of Emergency Medical Services. Retrieved 2008-03-29. {{cite web}}: External link in |title= (help)
  44. ^ "Training, Testing and Certification Requirements". North Dakota, Department of Health, Emergency Medical Services. Retrieved 2008-03-29.
  45. ^ "Scope of Practice". Ohio Department of Public Safety, Ohio Emergency Medical Services. Retrieved 11 November 2012.
  46. ^ a b c d "Licensure". EMT Licensure and Registration. Oklahoma State Department of Health. Retrieved 5 December 2011.
  47. ^ "Welcome to EMT Educational Requirements". Oregon Department of Human Services, Emergency Medical Services and Trauma Systems. Retrieved 2008-03-29.
  48. ^ [1]
  49. ^ "Rules And Regulations Relating To Emergency Medical Services" (PDF). Rhode Island Department of Health. Retrieved 2011-10-06.
  50. ^ "South Carolina Certification Process" (PDF). South Carolina Emergency Medical Services. Archived from the original (PDF) on 2008-01-02. Retrieved 2008-03-29.
  51. ^ "South Dakota Emergency Medical Services". Retrieved 2013-06-21.
  52. ^ "Critical Care Paramedic Standardized Modules and Objectives" (PDF). State of Tennessee Department of Health. Retrieved 2008-04-10.
  53. ^ "Requirements for initial certification/licensure:". Texas Department of State Health Services. Retrieved 2008-03-27.
  54. ^ a b c d e f "EMT & Paramedic Certification". Utah EMT & Paramedic Certification. Utah Department of Health, Bureau of Emergency Medical Services. Retrieved 7 December 2011.
  55. ^ "Vermont Statewide Emergency Medical Services Protocols" (PDF). Vermont Department of Health, Office of Emergency Medical Services. Retrieved 2014-04-13.
  56. ^ "Transitioning to the new National EMS Scope of Practice and Education Standards". Virginia EMS Education Standards. Virginia Department of Health. Retrieved 10 November 2011.
  57. ^ "Initial Certification Process". Washington State Department of Health, Office of Emergency Medical Services and Trauma System. Retrieved 2008-03-29.
  58. ^ "EMS Education and Curriculum Materials". West Virginia Department of Health and Human Resources. Office of Emergency Medical Services. Retrieved 2014-04-13.
  59. ^ "First Responder Certification Process". Wisconsin Department of Health and Family Services, Emergency Medical Services. Retrieved 2012-11-11.
  60. ^ "Critical Care Paramedic Endorsement" (PDF). Wisconsin Department of Health and Family Services, Emergency Medical Services. Retrieved 2014-04-13.
  61. ^ "Certification Application" (pdf). Wyoming Department of Health, Office of Emergency Medical Services. Retrieved 2008-03-29.
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