NREMT EMS Certification Levels

There are four different certification levels administered by the NREMT.  The NREMT maintains multiple EMS certification levels that represent a ladder of increasing knowledge skills and abilities for an EMS professional.  There used to be 5 certifications - First responder, EMT-Basic, EMT-Intermediate 1985, EMT Intermediate 1999, and EMT-Paramedic. In 2014, new levels were introduced that replaced the old levels/certifications.

NREMT EMS certifications

The new NREMT EMS certification levels consist of emergency medical responder (replacing first responder), emergency medical technician (replacing EMT-Basic), advanced emergency medical technician (replacing EMT-Intermediate 1985), and paramedic (replacing EMT-Intermediate 1999 and EMT-Paramedic). The different NREMT certification levels are summarized below:

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Emergency Medical Responder

Entry level NREMT EMS certification. Provides immediate lifesaving care to critical patients. The primary role of an Emergency Medical Responder is to take care of the situation while waiting for additional EMS personnel to arrive on the scene. Almost all police and fire agencies require their employees to be first responders. A first reponder must have the basic skills and knowledge to perform lifesaving procedures while awaiting additional support from higher level personnel.  Emergency Medical Responders provide a key role in the overall EMS system by performing basic interventions (with minimal equipment) under medical oversight.

Emergency Medical Technician

This is the second level of the NREMT EMS certification. Provides out of hospital emergency and transportation care. Emergency Medical Technicians are able to use the basic equipment found on an ambulance to assist patients. Emergency Medical Technicians play a critical role between the emergency scene and the health care system.  

advanced emergency medical technician

This is the third level of the NREMT EMS certification. An Advanced Emergency Medical Technician also provides out of hospital emergency and transportation care. An Advanced Emergency Medical Technician is able to provide limited advanced medical care. This would be the next step for an Emergency Medical Technician that would like to make some more money or become a paramedic. 

Paramedic

This is the final level of the NREMT EMS certification. A Paramedic has the main goal of providing advanced emergency medical care to patients. A Paramedic has the knowledge and skills to provide patient care and transport that patient. Paramedics can administer a wide range of medication, provide advanced life support, and perform advanced surgical and electrical therapies.

Certification Process 

EMERGENCY MEDICAL RESPONDER

In order to apply for the Emergency Medical Responder certificate, applicants must meet the following requirements: 

  • Complete a state-approved Emergency Medical Responder course 
    • Please note that this course must have been completed within the past two years
    • The program director for the course must also verify that you have successfully completed the course on the National Registry website
  • Applicants must have a valid CPR-BLS for "Healthcare Provider"
  • Completion and passing of the Emergency Medical Responder cognitive exam along with completion of the state approved psychomotor examination
    • The psychomotor exam is administered by either the state or the state approved course
    • After passing each exam, they will remain valid for 24 months

 EMERGENCY MEDICAL TECHNICIAN

In order to apply for the Emergency Medical Technician certificate, applicants must meet the following requirements: 

  • Applicants must be 18 years of age or older
  • Complete a state-approved Emergency Medical Technician course 
    • Please note that this course must have been completed within the past two years
    • The program director for the course must also verify that you have successfully completed the course on the National Registry website 
  • Applicants must have a valid CPR-BLS for "Healthcare Provider"
  • Completion and passing of the Emergency Medical Technician cognitive exam along with completion of the state approved psychomotor examination
    • The psychomotor exam is administered by either the state or the state approved course
    • After passing each exam, they will remain valid for 24 months

ADVANCED EMERGENCY MEDICAL TECHNICIAN

In order to apply for the Advanced Emergency Medical Technician certificate, applicants must meet the following requirements: 

  • Applicants must be 18 years of age or older
  • Must have an NREMT or state license at the EMT level (or higher)
  • Complete a state-approved Advanced Emergency Medical Technician course 
    • Please note that this course must have been completed within the past two years
  • Applicants must have a valid CPR-BLS for "Healthcare Provider"
  • Completion and passing of the Advanced Emergency Medical Technician cognitive exam along with completion of the state approved psychomotor examination
    • The psychomotor exam is administered by either the state or the state approved course
    • After passing each exam, they will remain valid for 24 months

PARAMEDIC

In order to apply for the Paramedic certificate, applicants must meet the following requirements: 

  • Applicants must be 18 years of age or older
  • Must have an NREMT or state license at the EMT level (or higher)
  • Complete a CAAHEP-accredited Paramedic program 
    • Please note that this course must have been completed within the past two years
    • The program director for the course must also verify that you have successfully completed the course on the National Registry website
  • Complete a psychomotor competency portfolio
  • Applicants must have a valid CPR-BLS for "Healthcare Provider."
  • Completion and passing of the Paramedic cognitive exam along with completion of the state approved psychomotor examination
    • The psychomotor exam is administered by either the state or the state approved course
    • After passing each exam, they will remain valid for 24 months

Cognitive Exam

EMERGENCY MEDICAL RESPONDER

An applicant can expect to see 90 to 110 items. Of the 90 to 110 items, 60 to 80 of them will be counted towards the final score, while the other 30 "pilot" questions will not be counted towards an applicants final score. Applicants will have a maximum time of 1 hour and 45 minutes to complete the test. The test is a computer adaptive test (CAT). 

The Emergency Medical Responder cognitive exam includes information on the following topics: 

EMR Cognitive Exam

Source: National Registry of Emergency Medical Technicians

 EMERGENCY MEDICAL TECHNICIAN

An applicant can expect to see 70 to 120 items. Of the 70 to 120 items, 60 to 110 of them will be counted towards the final score, while the other 10 "pilot" questions will not be counted towards an applicants final score. Applicants will have a maximum time of 2 hours to complete the test. The test is a computer adaptive test (CAT). 

The Emergency Medical Technician cognitive exam includes information on the following topics: 

EMT Cognitive Exam

Source: National Registry of Emergency Medical Technicians

ADVANCED EMERGENCY MEDICAL TECHNICIAN

An applicant can expect to see 135 items. Of the 135 items, 100 of them will be counted towards the final score, while the other 35 "pilot" questions will not be counted towards an applicants final score. Applicants will have a maximum time of 2 hours and 15 minutes to complete the test. The test is a linear computer based test (CBT). 

The Advanced Emergency Medical Technician cognitive exam includes information on the following topics: 

AEMT Cognitive Exam

Source: National Registry of Emergency Medical Technicians

PARAMEDIC

An applicant can expect to see 80 to 150 items. Of the 80 to 150 items, 60 to 130 of them will be counted towards the final score, while the other 20 "pilot" questions will not be counted towards an applicants final score. Applicants will have a maximum time of 2 hours and 30 minutes to complete the test. The test is a computer adaptive test (CAT). 

The Paramedic cognitive exam includes information on the following topics: 

Paramedic Cognitive Exam

Source: National Registry of Emergency Medical Technicians

takeaways

EMTs and Paramedics provide a vital service as they often are responsible for the urgent care and transport of the sick and injured to a medical facility. EMTs have different duties and responsibilities based on their training and certification.  Typically, most EMTs are certified to one of four levels that are administered by NREMT, the National Registry of Emergency Medical Technicians. There are also state by state levels and licensure requirements that may differ from the NREMT’s certifications.

Training for Emergency Medical Technicians is available at virtually all community colleges as well as various state colleges, hospitals and private schools.  The training is typically a three month course, often taken as part of other curriculum at a college.  After your courses, you must take and pass a computer administered national certification exam, known as the National Registry Exam.  After successfully completing your NREMT exam, you must obtain a license to work in your specific county.  To work as an EMT you must be a U.S. citizen, at least 18 years old and agree to a background check.

To attain your EMT Certification from the NREMT, it is important that you pass your EMT test. Try our free EMT practice tests as a study guide for your NREMT tests.

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