EMT vs Paramedic

According to Emergency Medical Services' (EMS) textbooks, the modern concept of EMS was introduced during the mid-1960s through an academic narrative entitled "Accidental Death and Disability: The Neglected Disease of Modern Society." 

About a decade later, it became obvious that emergency medical services were an absolute necessity due to the increasing number of automobile accidents throughout the country. Thus began the need for the United States' Emergency Medical Technician (EMT) program. 

At its broadest perspective, Emergency Medical Technicians and Paramedics assist those who are injured or ill, and are situated somewhere other than a hospital or a medical facility. EMTs typically work for an ambulance service company, a governmental agency, and other medical facilities. EMTs are tasked with many responsibilities that include –

  • Assessing a patient's health 'on the scene' in countless situations.
  • Performing required medical procedures that include - 
    • Cardio Pulmonary Resuscitation (CPR).
    • Bleeding control. 
    • Automated External Defibrillator (AED) usage
    • Immobilization, where necessary.
    • The safe transportation of patients to hospitals, to name a few. 

More than 250,000 individuals were employed as EMTs or Paramedics, during 2019. 

Free Practice Tests - use Test-Guide.com's Free EMT Practice Tests to prepare for your EMT exam.

What's the Difference Between an EMT and a Paramedic?

As a general rule, most people mistakenly presume that an Emergency Medical Technician (EMT) and a Paramedic are one in the same job. And while the occupational tasks and responsibilities for each are similar, and often complement one another, they differ in fundamental ways. 

Both EMTs and paramedics are traditionally known as first responders. Other members of a first responder team include the law enforcement community as well as firefighters. EMT's and paramedics must be licensed and certified by the state in which they operate or, by the NREMT. 

A Paramedic is trained by scaling the more advanced EMT certification levels or by enrolling in a comprehensive program that exceeds 1,000 hours of training. Paramedics are authorized to begin an IV line, perform manual defibrillation or administer medicine – something an EMT cannot. Most paramedics are authorized to administer 25 – 40 different medications; depending upon the state.

If you are considering a career in EMS, be vigilant in your research regarding the requirements of a specific job, so you gather enough information to make an educated decision. 

EMT Certification Levels Lead to a Paramedic Certification

The National Registry of Emergency Medical Technicians (NREMT) awards several Emergency Medical Technician (EMT) certification levels. Each level represents more skillful requirements. 

The most advanced EMT level is known as a Paramedic.

EMT Education Requirements

An Emergency Medical Technician must be at least 18 years old and have a high school diploma or its equivalent. When taken part-time, most students finish in about one half of a year.

The state-approved EMT certification programs offer both traditional classroom lectures dispersed with hands-on training and lab work. 

Step #1 - Obtain your EMT Certification (Previously known as the EMT-B certification)

The Emergency Medical Technician (previously known as the EMT-B Certification) is the entry-level for all emergency medical training programs. It is noted that many EMTs volunteer their time to their local community.

An EMT's responsibilities are limited in scope and only include non-evasive procedures like –

  • Essential lifesaving care at the scene.
  • Administering basic medication like oral glucose.
  • Taking & Maintaining vital signs. 
  • Using a bag valve mask. 
  • Assisting more advanced personnel (EMTs & Paramedics), to name a few.

Recently, EMTs have received advanced training as first responders on the front line combatting the opioid crisis. The training allows for an EMT to administer the nasal spray naloxone, which can reverse the effects of an opioid overdose, if given in time. 

Test results for the EMT certification exam are typically accessible within 48 hours, although sometimes sooner, on the NREMT's website. If you need to retake the exam, you must wait at least fifteen days. 

When you complete the EMT training program, you must pass two tests that lead to certification. 

  • A State-Approved Psycho-Motor Certification test.
  • An NREMT Cognitive Certification test.

The EMT certification is entry-level training that provides the foundational knowledge used throughout your EMT/paramedic career. Training requirements vary by location, though at present, 46 states choose to follow the NREMT's suggested training guidelines. Therefore, it is imperative to confirm the certification requirements in the area you intend to work. Note, however that certification reciprocity is available between some states. 

Your EMT certification requires that you possess CPR certification and complete a state-approved formal training program. The pre-license program generally requires the completion of 125 – 200 hours of training. 

EMT tests are delivered using a computer-based system that adapts the test questions based on the test-taker's responses. The number of questions on the exam varies as the computer adapts to the test-taker's abilities. You can prepare for these tests by using our free EMT practice tests.

The Emergency Medical Technician certification exam covers five primary categories.

  • Airways & Breathing
  • Cardiology
  • Trauma
  • Medical
  • Operation

The EMT test questions are formatted as following –

NREMT Basic Exam Topics  Range of Questions
Airway and Breathing 12-21
Cardiology 12-21
Trauma 12-20
Medical 11-18
Obstetrics and Pediatrics 11-19
Operations 12-20
Total 70-120

One of the smartest ways to prepare for EMT exams is to practice regularly by using free online practice exams. This will allow you to gain an understanding as to the test's format and ‘feel.' 

Your first EMT practice score can act as a baseline that can be used to monitor how your knowledge is improving, by practice.

Step #2 – Become State Licensed & Gain work experience as a certified EMT professional. 

Step #3 - Obtain EMT Intermediate/85 Certification (EMT-1)

EMT Intermediate/85 is the next level of EMT certification training. A certified EMT-1 will have accumulated 225-425 hours of education, training, and experience, dependent upon the required EMT-1 requirements. The EMT-1 test is typically completed in 2.25 hours or less. The EMT-1 test follows this format –

NREMT Intermediate 85 Exam Topics  Range of Questions
Airway and Breathing 15-24
Cardiology 15-24
Trauma 14-23
Medical 13-21
Obstetrics and Pediatrics 14-22
Operations 14-22
Total 85-135

 The EMT Intermediate/85 prepares EMTs with the more advanced skills of -

  • Traction & Cervical Collar splinting. 
  • Insert IV lines.
  • Pulse Oximetry.
  • Airway obstruction, airway devices, CPAP, intubation.
  • Complex delivery of a child.
  • Administering medication that includes albuterol, epinephrine or glucose oral gel, to name just a few.

Certain locales modify an EMT-1's scope or responsibilities to meet the area's needs. Check with the regulatory agency overseeing the EMT program in your state. 

When the EMT Intermediate/99 training program is complete, you must pass the tests that lead to EMT Intermediate/85 certification. 

  • A State-Approved Psycho-Motor Certification test.
  • An NREMT Cognitive Certification test. 

Step #4 - Obtain EMT Intermediate Certification/99 (aka AEMT)

The EMT Intermediate/99 (EMT – 1) Advanced Emergency Medical Technician (AEMT) 

The advanced EMT Intermediate/99 is a training level that extends an EMT's education & capabilities, and is actually considered a part of an EMT Paramedic training curriculum. The Intermediate/99 test requires test-takers to meet the National Standard Curriculum set forth by the NHTSA (the National Highway Transportation Safety Administration). 

Some states certify an intermediate level position called an AEMT or EMT-Intermediate.

When the EMT Intermediate/99 training program is complete, you must sit for the tests that lead to EMT- 1 advanced certification. 

  • A State-Approved Four-Skill Psycho-Motor Certification test.
  • An NREMT Cognitive Certification

Step #5 - Paramedic Certification– (Previously known as an EMT-P)

Paramedic Certification Requirements

Paramedic Certification is representative of the most elevated level of patient care – the care one receives before reaching a medical facility or hospital. To be eligible to apply for the Paramedic Certification course, you must have held EMT and EMT Intermediate certifications. Paramedic training generally covers about two years of work/experience and a practicum internship in an ambulance or hospital setting. 

Paramedics are tasked with the widest range of job responsibilities. These include all the authorized actions pertaining to EMT and EMT Intermediate certifications plus –

  • Defibrillation manually.
  • The Reading of 
    • EKGs
    • X-rays
    • Lab Results, to name a few

The Paramedic Certification exam has a maximum time limit of 2 and ½ hours. The course format is as follows –

NREMT Paramedic Exam Topics  Range of Questions
Airway and Breathing 14-27
Cardiology 14-26
Trauma 13-25
Medical 12-23
Obstetrics and Pediatrics 13-24
Operations 14-25
Total 80-150

 Paramedic training programs typically require a student to complete 1,200 to 1,800 hours of coursework, which is generally done during a 1 to 2 year period. Most paramedic programs require an applicant to have earned some college credits in the areas of English and Biology, among other related courses. Some paramedic programs issue an associate's degree (a two-year degree) for the completion of the paramedic required training coursework. This depends upon the paramedic standards set forth by oversight professionals in the area you work. 

EMT vs Paramedic Pay

According to the federal Bureau of Labor Statistics (BLS), EMTs and Paramedics, for the calendar year 2018, earn a median yearly income of $34,320. Those earning in the top 90% (of all earners) earn approximately $58,640.

States that pay the highest average wages for EMTs and Paramedics –

  • Washington
  • Washington, DC
  • Hawaii
  • Maryland
  • Alaska

Of course, when comparing paramedic's salaries to those of EMTs, paramedics will tend to have greater earning power since they undergo more extensive training than their EMT counterparts. 

According to Payscale.com, the average hourly pay for an EMT is $12.51 while the average hourly pay for a Paramedic is $17.49 - an increase of 40%.  For more information, see our article on EMT salaries.

The good news is that the government's statisticians anticipate this industry to experience job growth of 15% through 2026, which is much faster than the average of all industries during this period - 8%. A stronger job growth translates to strong demand for your services, and in general, higher salaries. 


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