EMS professionals in front of an ambulance

The 3 Levels of EMT Certification

A Guide to the Various Levels of EMT Certification, Including Education, Training, and Testing Requirements

EMS professionals in front of an ambulance

It might seem natural to assume that everyone working inside an ambulance is a paramedic. But in fact, there are four different levels of Emergency Medical Services (EMS) professionals working in and out of ambulances, each with a diverse scope of services and training.

The 4 EMT Certification Levels

In order of increasing responsibility, the four levels of EMT certification and training are:

  1. Emergency Medical Responder (EMR): EMRs administer life-saving techniques such as CPR and mouth-to-mouth resuscitation while waiting for more qualified medical professionals to arrive. EMRs are also responsible for assisting other medical professionals at the scene of the emergency or during transport. EMRs perform basic interventions with minimal equipment.
  2. Emergency Medical Technician (EMT): EMTs have acquired the knowledge and skills to stabilize and safely transport patients for all emergency calls, from routine transports to life-threatening emergencies. They provide crucial treatment onsite and during the ambulance ride to the hospital, including controlling bleeding, stabilizing breaks, and addressing shock. EMTs perform their vital services using the basic equipment typically found in an ambulance.
  3. Advanced Emergency Medical Technicians (AEMT): AEMTs provide the same services as EMTs. However, in addition, they can administer fluids and some medications. They are also trained to use the advanced medical equipment carried in the ambulance.
  4. Paramedic: Paramedics provide advanced medical care for critical patients. This includes triage with sophisticated medical equipment and administering approximately 30 different types of drugs.

[SOURCE: National EMS Scope of Practice Model]

No matter the level of training or the job title, no two days in an ambulance are the same. If you’re curious about what typically constitutes a day in an ambulance, here’s a unique look.

Wikipedia also provides a guide to the various levels of emergency responders, along with state-by-state links to understanding the differences.

Below is a review of all four types of EMT certification, including the requirements to obtain certification and the job duties and career opportunities of each certification level.

1. EMR Certification

What Can an EMR Do?

Certified EMRs can administer life-saving techniques such as CPR and mouth-to-mouth resuscitation while waiting for more qualified medical professionals to arrive. EMRs can also assist other medical professionals in an emergency or during transport.

An EMR’s scope of practice includes simple, non-invasive interventions. Emergency care is based on assessment findings. EMRs also provide care to minimize the chances of secondary injury and comfort the patient and family while awaiting additional EMS resources.

How to Become EMR Certified

To become certified as an EMR, you must complete the following steps:

  1. Enroll in an EMR education program. Different states have different requirements, but an EMR program typically requires 2–4 weeks to complete about 55–65 hours of instruction.
  2. Register for the EMR exam. Once enrolled in an EMR education program, create your account with the National Registry of Emergency Medical Technicians. To be authorized to take the cognitive EMR exam, you must submit your approved application, payment, and your Program Director’s approval.
  3. Pass the EMR cognitive exam. You must take the cognitive exam on a computer at an authorized testing center. The exam consists of between 90 and 110 multiple-choice questions.
    1. The EMR cognitive exam covers the following areas:
      • Airway, Respiration & Ventilation (18%–22%)
      • Cardiology & Resuscitation (20%–24%)
      • Trauma (15%–19%)
      • Medical; Obstetrics & Gynecology (27%–31%)
      • EMS Operations (11%–15%)
    2. Among the questions related to patient care, 85% focus on adult and geriatric patients, and 15% pertain to pediatric patients.
    3. If you do not pass the cognitive exam, the National Registry will provide feedback on your results, and you may apply to retest 15 days after the last examination.
  4. Pass the EMR psychomotor exam. The National Registry does not administer EMR psychomotor examinations. All EMR psychomotor exams are administered by either the State EMS Office or at the training institution (with approval of the State EMS Office). Your EMR course instructor should provide you with information about this examination. The following performance checklists (from the National Registry) are a guide for verifying required skills. The State EMS Office or training institution may use different forms.
    1. Patient Assessment / Management – Trauma
    2. Patient Assessment / Management – Medical
    3. BVM Ventilation of an Apneic Adult Patient
    4. Oxygen Administration by Non-Rebreather Mask
    5. Cardiac Arrest Management / AED

Smiling paramedic beside an ambulance

2. EMT Certification

What Can an EMT Do?

In addition to all the responsibilities of an EMR, certified EMTs can stabilize and safely transport patients for all calls ranging from routine transports to life-threatening emergencies.

An EMT’s scope of practice includes basic, non-invasive interventions based on assessment findings. EMTs can also provide care to help minimize secondary injury and comfort the patient and family while transporting the patient to an emergency care facility.

EMT is the minimum licensure level for personnel transporting patients in ambulances. The scope of practice is limited to basic skills that can be performed safely in an out-of-hospital setting, with medical oversight and limited training. No use of advanced equipment or drug administration is within their scope.

How to Become EMT Certified

To become certified as an EMT, you must complete the following steps:

  1. Complete a state-approved EMT course. An EMT program typically requires about 120 hours of instruction. Candidates must have completed the course within two years to get certified.
  2. Hold a current CPR-BLS for “Healthcare Provider” or equivalent credential.
  3. Pass the EMT cognitive exam. You will need to take the National Registry Medical Technician (EMT) cognitive exam on a computer at an authorized testing center. The exam consists of between 70 and 120 questions with a maximum time to complete the exam of 2 hours.
    1. The EMT cognitive exam covers the entire spectrum of EMS care including:
      • Airway, Respiration & Ventilation (18%–22%)
      • Cardiology & Resuscitation (20%–24%)
      • Trauma (14%–18%)
      • Medical; Obstetrics & Gynecology (27%–31%)
      • EMS Operations (10%–14%)
    2. Among the questions related to patient care, 85% focus on adult and geriatric patients, and 15% pertain to pediatric patients.
    3. If you do not pass the cognitive exam, the National Registry will provide feedback on your test so you’ll know your weaknesses, and you may apply to retest 15 days after the last examination.
  4. Pass the psychomotor exam. The National Registry does not administer the EMT psychomotor exams. All EMT psychomotor exams are administered by either the State EMS Office or at the training institution (with approval and oversight by the State EMS Office). Your EMT course instructor should provide you with information about this examination.

To learn more about becoming an EMT or passing the EMT exam, visit the Unitek EMT website.

3. AEMT Certification

What Can an AEMT Do?

Advanced Emergency Medical Technicians (AEMTs) can provide the same services as an EMT. They also can administer fluids and some medications and use the advanced medical equipment carried in the ambulance.

An AEMT’s scope of practice will overlap with some of the duties of EMTs and EMRs.

The major difference between an Advanced Emergency Medical Technician and an Emergency Medical Technician is the ability to perform certain advanced procedures and provide pharmacological interventions to emergency patients.

AEMT is the minimum licensure level to provide limited advanced care to patients at the scene or during transportation. The scope of practice for AEMTs is to lower risk. Their advanced skills can be performed safely in an out-of-hospital setting.

Young paramedic sitting in an ambulance

How to Become AEMT Certified

To become certified as an AEMT, you must complete the following:

  1. Hold current certification or state license at the EMT level or higher.
  2. Complete a state-approved Advanced EMT course. An AEMT program typically requires the EMT program PLUS an additional 350 hours of instruction. Candidates must have completed the course within two years to become certified.
  3. Hold a current CPR-BLS for “Healthcare Provider” or equivalent credential.
  4. Pass the cognitive exam. You will need to take the National Registry Medical Technician (AEMT) cognitive exam on a computer at an authorized testing center. Your exam will consist of 135 questions. 35 questions will not affect your score, and the maximum time to complete the exam is 2 hours and 15 minutes.
    • The AEMT cognitive exam covers the entire spectrum of EMS care including:
      • Airway, Respiration & Ventilation (18%–22%)
      • Cardiology & Resuscitation (21%–25%)
      • Trauma (14%–18%)
      • Medical; Obstetrics & Gynecology (26%–30%)
      • EMS Operations (11%–15%)
    • Among the questions related to patient care, 85% focus on adult and geriatric patients, and 15% pertain to pediatric patients.
    • If you do not pass the cognitive exam, don’t panic, the National Registry will provide feedback on your test so you’ll know your weaknesses, and you may apply to retest 15 days after the last examination.
  5. Pass the psychomotor exam. The AEMT psychomotor examination consists of 10 skills presented in a scenario-type format. The psychomotor exam is used to verify the candidate’s hands-on knowledge and skills. Apart from Pass or Fail, candidates will receive no feedback on their performance.

Advanced EMTs must demonstrate proficiency in the following areas:

  • Patient Assessment – Trauma
  • Patient Assessment – Medical
  • Ventilatory Management
  • Cardiac Arrest Management/AED
  • IV and Medication Skills
  • Pediatric Intraosseous Infusion
  • Random EMT Skills
  • Advanced EMT candidates are allowed two attempts to pass the psychomotor examination.

4. Paramedic Certification

What Can a Paramedic Do?

Paramedics provide advanced medical care for critical and emergent. Paramedics have the most extensive job duties, including EMTs’ responsibilities, reading labs, EKGs, X-rays, and manual defibrillation.

A paramedic’s scope of practice can include invasive and pharmacological interventions. Emergency care is based on an advanced assessment and the formulation of a field impression.

A paramedic has all the knowledge, skills, and responsibility associated with EMRs, EMTs, and AEMTs. The biggest difference between the paramedic and the advanced emergency medical technician is their ability to perform a broader range of advanced duties. These procedures carry greater risk for the patient if improperly performed, are more challenging, and require significant background knowledge in basic and applied sciences.

Paramedic is the minimum licensure level for patients requiring the full range of advanced out-of-hospital care. The scope of practice includes advanced skills that can be performed safely in an out-of-hospital setting.

Female healthcare worker with glasses

How to Become Paramedic Certified

To become certified as a paramedic, you must complete the following:

  1. Hold current National Registry Certification or state license at the EMT level or higher.
  2. Complete a CAAHEP-accredited paramedic education program. A paramedic program typically requires about two years or 1,200 to 1,800 hours of instruction. Paramedic certification courses focus on the more advanced practice of emergency medicine, including pharmacology, cardiology, and anatomy. To graduate from paramedic school, you must complete an internship working in a hospital or ambulance. Candidates must have completed the program within the past two years.
  3. Hold a current CPR-BLS for “Healthcare Provider” or equivalent credential.
  4. Pass the cognitive exam. You will need to take the National Registry Paramedic (NRP) cognitive exam on a computer at an authorized testing center. Your exam will consist of between 80 questions to 150 questions. Each exam will have between 60 to 130 “live” items that count toward the final score, and the maximum time to complete the exam is 2 hours and 30 minutes.
    • The Paramedic cognitive exam covers the entire spectrum of EMS care including:
      • Airway, Respiration & Ventilation (18%–22%)
      • Cardiology & Resuscitation (22%–26%)
      • Trauma (13%–17%)
      • Medical; Obstetrics & Gynecology (25%–29%)
      • EMS Operations (10%–14%)
    • Among the questions related to patient care, 85% focus on adult and geriatric patients, and 15% pertain to pediatric patients.
    • If you do not pass the cognitive exam, don’t panic, the National Registry will provide feedback on your test so you can understand your weaknesses, and you may apply to retest 15 days after the last examination.
  5. Pass the psychomotor exam. The Paramedic psychomotor exam tests candidates on these skills:
    • Patient Assessment – Trauma
    • Dynamic Cardiology
    • Static Cardiology
    • Oral Station Case A
    • Oral Station Case B
    • Integrated Out-of-Hospital Scenario

To learn more about becoming a paramedic, visit the Unitek EMT career guide.

EMT Continuing Education

EMS professionals must periodically complete additional training courses to keep their knowledge up-to-date and learn about new technologies and techniques. Depending on the state where you’re EMT certified, licenses must be renewed every two to three years.

However, license renewal isn’t the only reason for continuing education. The best EMTs use continuing education to develop their skills further to become better and more effective at their jobs.

Unitek EMT offers a short yet intensive 3-Day EMT Refresher course that provides the 24 hours of continuing education required for EMT state recertification by NREMT guidelines. We also offer a BLS to ALS course as a 1-day workshop, which prepares EMTs to assist paramedics and hospital staff with skills including 12-lead electrocardiograms, nebulized medication, IV and IO administration and monitoring, CPCP, endotracheal tube insertion, and more. EMTs who go above and beyond their basic job duties are invaluable to their coworkers and patients.

The Difference Between Certification and Licensure

All EMS professionals (EMRs, EMTs, AEMTs, and paramedics) are required to be certified. The National Registry of Emergency Technicians provides certification at the national level. Some states may only require certification at the state level, but the NREMT certification is the most common.

Once your certification process is complete, you’ll also need to apply for an EMR, EMT, AEMT, or paramedic license in your state. Certification shows that you have the skills to provide the necessary medical care, while the state license grants you the actual permission to provide that care.

Laptop draped with a stethoscope

About the National Registry

Created in 1970, the National Registry is a government agency establishing uniform standards for the training and testing of EMS personnel. Since its founding, the National Registry has certified nearly 2 million EMS providers. Today, more than 400,000 EMS professionals are Nationally Certified as Emergency Medical Responders (EMR), Emergency Medical Technicians (EMT), Advanced-EMT (AEMT), or Paramedics.

About Unitek EMT

Unitek EMT is recognized as one of the premier EMT schools in Arizona. Our mission is simple: to train the next wave of highly qualified EMT professionals. We offer various training options to fit varied needs, including an accelerated EMT “Boot Camp” program to get you mission-ready and certified fast. We also offer EMS Continuing Education courses to keep you updated on your expertise and enhance your career. Unitek EMT instructors are experienced, proven leaders in their fields, and our real-world training scenarios have proven ideal for aspiring EMT professionals.