Certification/Special Training for EMTs

To obtain a job as an emergency medical technician (EMT), there are certain training, licensing, and certification requirements that must be met. EMT training is provided at the local or state level, with licensing provided by the state upon successful completion of all requirements. Additionally, most states also require an EMT to be certified at the national level before he or she can apply for a license to practice in the state. National EMT certification is granted by the National Registry of Emergency Medical Technicians (NREMT).

While NREMT certification is one of the first requirements for the state license application, some states may have even stricter requirements for an individual to obtain their state license. Specifically, the state may require official government documentation as proof that the applicant has no criminal record. States can also revoke an EMT’s license if they determine the EMT has taken an inappropriate action. States take all of these steps to ensure the public is fully protected against individuals who are not authorized, legally or otherwise, to work as an EMT.

NREMT certification ensures the EMT has achieved and met all appropriate standards of training, practice, and testing. This certification means the EMT is highly proficient at performing his or her job. The NREMT provides three levels of certification: EMT, Advanced EMT and Paramedic. (There is also a separate certification for first responders, called EMR.) In order to obtain any of these certifications the EMT must comply with several requirements. In addition to completing an approved emergency medical services (EMS) training course, the individual must also have Cardiopulmonary Resuscitation (CPR) validation, pass a criminal background check, and satisfy the NREMT’s testing obligations.

EMTs provide care and treatment that may mean the difference between life and death for their patient. For this reason, certifications and licensures, as well as biennial recertifications and relicensures, are a necessary and mandatory part of the EMT profession.

NREMT Certification Programs


The National Registry of Emergency Medical Technicians (NREMT) was founded in 1970 as a result of a recommendation made by President Lyndon Johnson’s Committee on Highway Traffic Safety to create an organization that would establish uniform standards for the training and examination of individuals involved in delivering emergency ambulance services. Further, the NREMT serves to ensure continuing education and EMT competency levels are met and re-verified every two years through its EMT certification process. Since its inception, the NREMT has certified over one million emergency medical services (EMS) providers. Today 46 states use the NREMT to certify/recertify EMTs at one or more levels.

In order to work as an emergency medical technician (EMT), an individual must have both a state license/certification to work and also be certified to work as an EMT by the NREMT. Upon successful completion of all required coursework and field and clinical training, an aspiring EMT must take and pass a state-level examination in order to receive a license to provide EMT services in a given state. The state’s emergency medical services system or another similar licensing agency is responsible for authorizing an individual’s EMT state license.

In order for the individual to be certified at the national level, that is by the NREMT, the individual has to have successfully completed the NREMT’s own coursework requirements and demonstrated his or her EMT knowledge and skills in the NREMT examinations. The NREMT is separate and distinct from any state licensing procedures in that it exists solely to identify NREMT-certified EMTs for employers, state licensing agencies, and the general public. The NREMT also tracks whether an EMT’s state license has been revoked or if the EMT has had a criminal conviction, both events which negatively impact that EMT’s ability to obtain an EMT license in another state.

An EMT can obtain national certification at three levels: EMT, Advanced EMT and Paramedic. To obtain NREMT certification at the EMT level, the applicant must have completed a state-approved EMT course within the past two years, with the program director confirming his or her successful completion on the NREMT website. Advanced EMT certification requires an EMT certification as a prerequisite, and the Paramedic level requires both EMT and Advanced EMT certifications to qualify.

It takes approximately one year for an EMT to be sufficiently developed to take the NREMT certification test, which includes both cognitive and psychomotor examinations. The cognitive examination asks a series of questions on a range of emergency medical services care and treatment. The EMT may have two hours or more to complete the test, depending on the level for which they are testing. The psychomotor examination is a hands-on practical test in which the individual must demonstrate competence in EMT skills. For example, the psychomotor examination for EMT-Basic will test the individual on how well he or she assesses and manages a trauma patient or how well he or she handles a patient who has gone into cardiac arrest.

Thanks to the consistent EMT training and examination standards, a patient can expect to receive the same level of medical treatment and competency from all emergency medical services personnel, whether they volunteer for the local fire department or work for a city ambulance service.

Continuing Education

Certification is required for an individual to become an emergency medical technician (EMT) at any of the five levels that exist from First Responder to EMT-Basic to EMT-Intermediate (85 or 99) to Paramedic. EMT licensure is awarded first at the state level and then full EMT certification is received at the national level from the National Registry of Emergency Medical Technicians (NREMT). An EMT’s formal training does not end there, however. In order to be able to continue practicing as an EMT, the individual must demonstrate his or her continued job competency on a regular basis throughout their entire professional emergency medical services (EMS) career.

The NREMT does not believe that EMT certifications should last an EMT’s entire career; rather, because standards of treatment and medical guidelines change and advance over time, EMTs must be regularly recertified to demonstrate they still possess the knowledge and skills required to perform their job in a competent, proficient manner. The rationale behind this is to, above all, protect the public. The EMT licensure period in most states is two years. The NREMT has aligned its requirements with those of the states, mandating its own EMT recertification timeline of every two years. In addition to the requirements listed below, an approved cardiopulmonary resuscitation (CPR) credential is required at every level in order for the EMT to qualify for recertification.

EMT recertification requirements include 72 hours of EMS education. This training includes 24 hours of refresher training which can be completed by taking either a traditional DOT National Standard Basic refresher course or through continuing education at a state or local EMS facility. In addition, the EMT must complete 48 hours of additional EMS-related continuing education, for example college courses in anatomy or chemistry, or credit hours from a course in emergency driving.

Advanced EMT recertifications require 72 hours of EMS education. The EMT will take the courses specific to their level as Advanced EMT. Thirty-six hours can be completed by taking the traditional DOT National Standard Intermediate 85 refresher course or through continuing education at a state or local EMS facility. These hours of training include both mandatory and flexible content. The other 36 hours of training can come from EMS-related college courses or other miscellaneous training courses.

Lastly, EMTs at the level of Paramedic must complete 72 hours of EMS education. This training includes 48 hours of refresher training which can be completed by taking either a traditional DOT National Standard Paramedic refresher course or through continuing education at a state or local EMS facility. Paramedics must also complete 24 hours of continuing education from college courses or other miscellaneous training courses. An approved Advanced Cardiac Life Support (ACLS) credential must also be provided.

The miscellaneous continuing education and training available for an EMT’s recertification must be approved through the state EMS agency or through the Continuing Education Coordinating Board of Emergency Medical Services (CECBEMS). Continuing education training can take many forms for example, classroom instruction, workshops or seminars, practical exercises, or online videos. The EMT profession involves a high level of public risk; for that reason, recertification through continuing education courses maintains an EMT’s high level of job proficiency and protects the public.