EMS professionals in front of an ambulance

The Difference Between EMT Certification Levels

Learn About Each Level of EMT Certification: Education, Training, and Testing Requirements

EMS professionals in front of an ambulance

Many people assume that everyone working inside an ambulance is a paramedic. But the fact is, there are four different levels of Emergency Medical Services (EMS) professionals who work in and out of ambulances, each with a different scope of services they have been trained to provide.

EMT Certification

The four levels of EMT certification, in order of increasing responsibility and training, are as follows:

  1. Emergency Medical Responder (EMR): EMRs administer life-saving techniques like CPR and mouth-to-mouth resuscitation while waiting for more qualified medical professionals to arrive. EMRs also provide assistance to 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 the knowledge and skills needed to stabilize and safely transport patients for all calls from routine transports to life-threatening emergencies. They provide treatment onsite and during the ambulance ride to the hospital, such as controlling bleeding, stabilizing breaks, and addressing shock. EMTs perform interventions with the basic equipment typically found on an ambulance.
  3. Advanced Emergency Medical Technicians (AEMT): AEMTs provide the same services as an EMT, plus administer fluids and some medications and use the advanced medical equipment carried in the ambulance.
  4. Paramedic: Paramedics provide advanced medical care for critical and emergent patients in the EMS system. This includes triage with sophisticated medical equipment and the administration of about 30 different types of drugs.

[SOURCE: National EMS Scope of Practice Model]

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

1. EMR Certification

What Can an EMR Do?

Certified EMRs are qualified and authorized to administer life-saving techniques like CPR and mouth-to-mouth resuscitation while waiting for more qualified medical professionals to arrive. EMRs can also provide assistance to other medical professionals at the scene of an emergency or during transport.

An EMR’s scope of practice includes simple, non-invasive interventions to reduce the morbidity and mortality associated with acute out-of-hospital medical and traumatic emergencies. Emergency care is based on assessment findings. EMRs also provide care designed to minimize the chances of secondary injury and comfort the patient and family while awaiting additional EMS resources.

EMS professionals speaking in an open ambulance

How to Become EMR Certified

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

  1. Enroll in an education program. To apply for EMR certification, you must be enrolled in an education program. Different states have different requirements, but an EMR program typically requires 2–4 weeks to complete with about 55–65 hours of instruction.
  2. Register for the EMR exam. Once you are enrolled in an EMR education program, create your account with the National Registry. About four weeks before you complete your education program, you should submit your application to the National Registry. To be authorized to take the cognitive EMR exam, you will need to submit your approved application, payment, and your Program Director’s approval.
  3. Pass the EMR cognitive exam. You will take the cognitive exam on a computer at an authorized testing center. Your exam will consist of between 90 and 110 multiple-choice questions. 30 of those questions will not affect your score.
    • 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%)
    • Among the questions related to patient care, 85% are focused on adult and geriatric patients, and 15% are about pediatric patients.
    • If you do not pass the cognitive exam, the National Registry will provide feedback on your test, 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 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.

To help you contact your state EMS office, the National Registry provides a contact list: https://www.nremt.org/resources/state-ems-offices.

2. EMT Certification

What Can an EMT Do?

Certified EMTs are qualified and authorized to stabilize and safely transport patients for all calls from routine transports to life-threatening emergencies.

An EMT’s scope of practice includes basic, non-invasive interventions to reduce the morbidity and mortality associated with acute out-of-hospital medical and traumatic emergencies. Emergency care is based on assessment findings. EMTs can also provide care to minimize secondary injury and provide comfort to 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 are effective and can be performed safely in an out-of-hospital setting with medical oversight and limited training.

How to Become EMT Certified

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

  1. Complete a state-approved EMT course. Different states have different requirements, but an EMT program typically requires 3–11 weeks or about 120 hours of instruction. Candidates must have completed the course within the past two years.
  2. Hold a current CPR-BLS for “Healthcare Provider” or equivalent credential.
  3. Pass the EMT cognitive exam. You will take the National Registry Medical Technician (EMT) cognitive exam on a computer at an authorized testing center. Your exam will consist of between 70 and 120 questions. 10 of those questions will not affect your score. The maximum time to complete the exam is 2 hours.
    • 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%)
    • Among the questions related to patient care, 85% are focused on adult and geriatric patients, and 15% are about pediatric patients.
    • If you do not pass the cognitive exam, the National Registry will provide feedback on your test, 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 information about this examination.

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

To help you contact your state EMS office, the National Registry provides a contact list: https://www.nremt.org/resources/state-ems-offices.

Female EMS worker opening an ambulance door

3. AEMT Certification

What Can an AEMT Do?

Advanced Emergency Medical Technicians (AEMTs) are qualified and authorized to provide the same services as an EMT and administer fluids and some medications, and use the advanced medical equipment carried in the ambulance.

An EMT’s scope of practice includes basic, limited advanced, and pharmacological interventions to reduce the morbidity and mortality associated with acute out-of-hospital medical and traumatic emergencies. Emergency care is based on assessment findings. AEMTs also provide care to minimize secondary injury and provide comfort to the patient and family while transporting the patient to an emergency care facility.

The major difference between the Advanced Emergency Medical Technician and the Emergency Medical Technician is the ability to perform limited advanced skills 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 model is limited to lower risk. These high-benefit advanced skills are effective and can be performed safely in an out-of-hospital setting with medical oversight and limited training.

How to Become AEMT Certified

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

  1. Hold current certification or state license at the EMT level or higher.
  2. Complete a state-approved Advanced EMT course. Different states have different requirements, but an AEMT program typically requires the EMT program PLUS an additional 350 hours of instruction. Candidates must have completed the course within the past two years.
  3. Hold a current CPR-BLS for “Healthcare Provider” or equivalent credential.
  4. Pass the cognitive exam. You will 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 of those questions will not affect your score. 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% are focused on adult and geriatric patients, and 15% are about pediatric patients.
    • If you do not pass the cognitive exam, the National Registry will provide feedback on your test, 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 a verification of the candidate’s hands-on knowledge and skills. Apart from Pass or Fail, candidates receive no feedback on their performance.
    • Advanced EMTs are required to 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 full attempts to pass the psychomotor examination (one “full attempt” is defined as completing all skills and two retesting opportunities if so entitled).

To help you contact your state EMS office, the National Registry provides a contact list: https://www.nremt.org/resources/state-ems-offices.

Masked paramedic retrieving supplies

4. Paramedic Certification

What Can a Paramedic Do?

Paramedics provide advanced medical care for critical and emergent patients in the EMS system. Paramedics have the largest range of job duties, including, but not limited to, all duties of lower-level EMTs, reading labs, EKGs, and X-rays, and manual defibrillation.

A paramedic’s scope of practice includes invasive and pharmacological interventions to reduce the morbidity and mortality associated with acute out-of-hospital medical and traumatic emergencies. Emergency care is based on an advanced assessment and the formulation of a field impression. The paramedic provides care designed to minimize secondary injury and provide comfort to the patient and family while transporting the patient to an appropriate health care facility.

A paramedic has the knowledge associated with the EMR, EMT, and AEMT. The major difference between the paramedic and the advanced emergency medical technician is the ability to perform a broader range of advanced skills. These skills carry greater risk for the patient if improperly or inappropriately performed, are more challenging to attain and maintain competency in, 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 is limited to advanced skills that are effective and can be performed safely in an out-of-hospital setting with medical oversight.

How to Become Paramedic Certified

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

  1. Hold current National Registry Certification or state license at the EMT level or higher.
  2. Complete a CAAHEP-accredited paramedic education program. Different states have different requirements, but 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 medicine, like 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 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. The maximum amount of 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% are focused on adult and geriatric patients, and 15% are about pediatric patients.
    • If you do not pass the cognitive exam, the National Registry will provide feedback on your test, 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 website.

To help you contact your state EMS office, the National Registry provides a contact list: https://www.nremt.org/resources/state-ems-offices.

EMT Continuing Education

EMS professionals must complete additional training courses to keep their knowledge up-to-date and learn new technologies and techniques at every level of certification. Keeping an EMT license requires that EMTs keep current with their training. Depending on the state where you’re EMT certified, licenses must be renewed every two to three years.

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

Unitek EMT offers a short yet intensive 3-Day EMT Refresher Program 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 in a variety of ways, 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 their patients.

Close up of a man writing on a piece of paper

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 attests that you have the necessary skills to provide medical care, while the state license grants you permission to provide that care.

About the National Registry

Created in 1970, the National Registry is a government agency that establishes uniform standards for training and examining EMS personnel. Before the National Registry, there was no standard. Since its founding, the National Registry has certified nearly 2 million EMS providers. Today, more than 400,000 EMS professionals are Nationally Certified as an Emergency Medical Responder (EMR), Emergency Medical Technician (EMT), Advanced-EMT (AEMT), or Paramedic.

About Unitek EMT

Unitek EMT is one of the premier EMT schools in Arizona. Our mission is simple: training the next wave of top-notch EMT professionals. We offer a variety of training options to fit your needs, including an accelerated EMT program, to get you mission-ready and certified fast. We also offer an EMS Continuing Education courses to update your expertise and enhance your career. Unitek EMT instructors are experienced leaders in their fields, and our real-world training scenarios are ideal for aspiring EMT professionals.

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