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Most states use or require NREMT testing for some level of state certification. [2] [7] [8] NREMT recognizes four levels of EMS: EMR, EMT, Advanced EMT, and Paramedic (some states may have additional certifications). [7] NREMT certification at an EMT Intermediate level may or may not be sufficient for some state EMT-I requirements. [9]
As of 2011, 38 states use the NREMT examination for EMT certification and 45 states use the NREMT examination for Paramedic certification. [3] These levels are denoted below using an asterisk (*). At present time, use of the NREMT examination for EMT-Intermediate 85 and 99 have not been included in this list.
The training, knowledge base, and skill sets of both paramedics and emergency medical technicians (both competed for the job title, and 'EMT-Paramedic' was a common compromise) were typically determined by what local medical directors were comfortable with, what it was felt that the community needed, and what could actually be afforded.
[25] [26] Currently, NREMT exams are used by 46 states as the sole basis for certification at one or more EMT certification levels. [27] A NREMT exam consists of skills and patient assessments as well as a written portion. On June 12, 2019, the NREMT changed the rules regarding age limits for EMTs, AEMTs, and paramedics.
EMT-Intermediates can establish IVs in addition to the EMT-basic skills. An Iowa paramedic is a NREMT-intermediate/99 and is not the highest level of care in Iowa. This allows them to insert ET tubes and perform needle decompressions, manual defibrillations and medication administrations. The Iowa paramedic specialist is the NREMT-paramedic.
Paramedic Practitioners also undertake examinations modelled upon the MRCGP (a combination of applied knowledge exams, clinical skills and work place based assessment) in order to use the title "specialist". There are also now a growing number of these advanced paramedics who are independent and supplementary prescribers.