Emergency medical responder levels by U.S. state

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). 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. 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-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)
 * Emergency Medical Technician (EMT)
 * Advanced Emergency Medical Technician (AEMT)
 * Paramedic

Alaska

 * ETT* (Emergency Trauma Technician)
 * EMT-I* (One) (analogous to EMT-Basic)
 * EMT-II (Two) (analogous to EMT-Intermediate/85)
 * EMT-III (Three)
 * Mobile Intensive Care Paramedic (MICP)

Arizona

 * EMT-Basic*
 * EMT-Intermediate/99
 * EMT-Paramedic*

Arkansas

 * EMS First Responder
 * EMT-Ambulance* (analogous to EMT-Basic)
 * EMT-Intermediate/99
 * EMT-Paramedic*

California

 * Emergency Medical Technician* (EMT)
 * Advanced Emergency Medical Technician* (AEMT)
 * Paramedic*
 * Mobile Intensive Care Nurse

Colorado

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

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 tri-annual recertification programs.)

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)

Hawaii

 * EMT* (analogue to Advanced EMT)
 * Paramedic* (also known as Mobile Intensive Care Technician)

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
 * EMT-Paramedic*
 * Pre-Hospital Registered Nurse (PHRN, analogous to EMT-Paramedic)

Indiana

 * Emergency Medical Responder
 * EMT
 * Advanced EMT
 * Paramedic*

Iowa

 * First Responder
 * EMT-Basic*
 * EMT-Intermediate (analogous to EMT-Intermediate/85)
 * EMT-Paramedic (analogous to EMT-Intermediate/99)
 * Paramedic Specialist* (analogous to EMT-Paramedic)
 * Critical Care Paramedic Endorsement for Paramedic Specialist Level*

Transition to new levels began January 2011, and will be completed March 2015.
 * Emergency Medical Responder* (EMR)
 * Emergency Medical Technician* (EMT)
 * Advanced Emergency Medical Technician* (AEMT)
 * Paramedic*
 * Critical Care Paramedic Endorsement for Paramedic Level*

Kansas

 * First Responder
 * EMT-Basic*
 * EMT-Defibrillator
 * EMT-Intermediate/85
 * EMT-Intermediate/Defibrillator
 * Mobile Intensive Care Technician* (analogous to EMT-Paramedic)

Kentucky

 * First Responder
 * Emergency Medical Technician* (EMT)
 * Advanced Emergency Medical Technician* (AEMT)
 * Paramedic*
 * Critical Care Paramedic Endorsement

Louisiana

 * Emergency Medical Responder
 * EMT-Basic*
 * EMT-Intermediate/85
 * EMT-Paramedic*

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 (EMT)
 * Cardiac Rescue Technician* (CRT) (analogous to EMT – Intermediate/99)
 * Paramedic*
 * Critical Care Paramedic (CCEMTP)

Massachusetts

 * First Responder
 * EMT-Basic
 * EMT-Intermediate/85
 * EMT-Paramedic

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*)

Minnesota

 * First Responder*
 * EMT-Basic*
 * EMT-Intermediate/85
 * EMT-Paramedic*

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*

Missouri

 * First Responder
 * EMT-Basic*
 * EMT-Paramedic*

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

Nebraska

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

Nevada

 * First Responder
 * EMT-Basic
 * EMT-Intermediate/85
 * EMT-Advanced (analogous to EMT-Paramedic)
 * Paramedic

New Hampshire

 * First Responder
 * EMT-Basic*
 * EMT-Intermediate/85
 * EMT-Paramedic*

New Jersey
Current System
 * 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-Intermediate (No new licenses granted, will now be replaced with AEMT)
 * AEMT-Critical Care
 * AEMT-Paramedic

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
 * 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*

Ohio

 * Emergency Medical Responder
 * EMT-Basic*
 * EMT-Intermediate (uses state approved intermediate course; not quite NREMT I-99 standard)
 * EMT-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)

BLS

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

ALS

 * Advanced EMT (AEMT)New in 2014.
 * Paramedic
 * Prehospital Registered Nurse (PHRN)
 * Prehospital Physician Extender (PHPE)
 * Prehospital Physician (PHP)

Puerto Rico

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

Rhode Island

 * EMT-Basic*
 * EMT-Cardiac (State Specific)
 * EMT-Paramedic*

South Carolina

 * EMT-Basic*
 * EMT-Intermediate/85
 * EMT-Paramedic*

South Dakota

 * EMT-Responder (pending state recognition)
 * EMT
 * EMT-Intermediate/85
 * AEMT
 * EMT-Intermediate/99
 * Paramedic*

Tennessee

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

Texas

 * Emergency Care Attendant
 * EMT-Basic*
 * EMT-Intermediate
 * EMT-Paramedic*
 * Licensed Paramedic (paramedic with a college degree)

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 )
 * 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
 * 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
 * Critical Care Paramedic

Washington

 * First Responder - Emergency Medical Responder (EMR)
 * EMT-Basic
 * EMT- Intravenous Therapy Technician
 * Paramedic

West Virginia

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

Wisconsin

 * Medical First Responder
 * EMT-Basic
 * EMT-Intermediate Technician (analogous to EMT-Intermediate/85)
 * EMT-Intermediate/99
 * EMT-Paramedic
 * Critical Care Paramedic Endorsement

Wyoming

 * EMR*
 * EMT-Basic*
 * EMT-Intermediate/85
 * EMT-Paramedic*