Sean Z. Barnette, NRP, AAS

August 1, 2022

EMS Certification Levels and Skill Sets

Yesterday marked the beginning of the 46th Annual Emergency Medical Services week instated by President Gerald Ford in 1976.  Because we commonly interact with and have the potential to be treated by an EMS practitioner, I thought it would be an interesting Medical Monday to outline the different certification levels as well as the skill sets practiced by EMS professionals.  

The National Registry of Emergency Medical Technicians is the national level certifying body of EMS certification applicants.  The NREMT, or “National Registry” as it is commonly referred to offers four separate certification levels.  Two important points to mention.  In addition to having an NREMT certification, you must also have a license from your state’s department of health as well as a medical director to practice under before performing any type of medical procedures outside of what would fall under good Samaritan laws.  

In the class that I developed for SCT, I mention that it is GENERALLY ok to put something ON somebody, and it is GENERALLY NOT ok to put something IN somebody.  The second point is that in order to perform advanced medical procedures, I must be in an on-duty status.  The instant that I am not on duty, I do not fall under the license of my medical director.  To give a quick example:  If I witness a vehicle accident on my day off and I stop to assist, if the person needed to be intubated, I could NOT perform that skill.  If I did so, even if it meant that it would save that person’s life, I would be at risk for losing my paramedic license as well as my certification.  With that being said, keep in mind that laws, regulations, and medical protocols will vary from state to state, and agency to agency.  Without going too much further down that rabbit hole, here are the levels of EMS certification:

Emergency Medical Responder:  This is the entry level certification.  Professionals that are certified to this level are considered trained to perform immediate lifesaving care with basic treatments and with little equipment.  Most fire service organizations around the country require their firefighters to be certified to at least this level.  The EMR equivalent in the law enforcement world would be an police recruit.  

Emergency Medical Technician – Basic:  This is the minimum level of certification that you must have to work on an ambulance in a paid status in most states.  EMTs are trained in basic trauma care and other basic lifesaving and first aid interventions.  At the college that I instruct for, an EMT-Basic course takes place over one semester.  The semester encompasses both classroom hours and clinical hours on an ambulance putting into practice what they have learned.  The EMT-B equivalent in the law enforcement world would be a first-year rookie officer.  

Emergency Medical Technician – Advanced:  In addition to all of the previous skills mentioned, this practitioner is also able to begin utilizing some of the more advanced equipment on the ambulance such as limited use of the cardiac monitor as well as limited administration of medications outside of Aspirin, Glucose, and Nitroglycerin.  The EMT-A candidate is allowed to test after successful completion of the first two semesters of paramedic school in the paramedic program that I am involved with.  In addition to the classroom hours and ambulance clinicals, these candidates must also participate in hospital based clinicals.  While performing hospital clinicals, the candidates intubate patients in the operating room as well as perform a wide array of other emergency skills in the emergency room under the guidance of a physician.  The EMT-A equivalent in the law enforcement world would be a field training officer.  

Paramedic:  At this level, the paramedic is certified to do a myriad of advanced medical procedures such as intubation, cricothyroidotomy, and needle chest decompression.  When it comes to the heart, we do interpretation of 3 lead, 4 lead, 12 lead, and 15 lead ECGs (the squiggly lines on the paper that comes out of a machine).  From our interpretation of those rhythms we can perform cardiac pacing, synchronized cardioversion, unsynchronized cardioversion, (Edison medicine as we call it) or treat the rhythm with a medication.  Speaking of medications, the paramedic is also trained on when, where, who, and how to administer multiple different medications.  In addition to four semesters (two years) of classroom instruction, the paramedic candidate in our program must complete 560 clinical hours.  These hours include time on an ambulance to include a paramedic internship, time in a behavioral health center, time in an operating room, clinical hours in an emergency department of a hospital, and a physician internship.  At the conclusion these educational programs for all levels of certification you must take and pass a difficult written examination.  You must also pass multiple skill stations in a psychomotor examination.  The paramedic level equivalent in the law enforcement world would be a detective or investigator.      

I have held each of these certifications over the course of my career for the exception of Emergency Medical Responder.  In my experience, the biggest difference between any of the previous certification levels and being a paramedic is the level of critical thinking and ultimate responsibility involved.  (Just like law enforcement)

After gaining some experience as a paramedic, there are a myriad of options to continue to grow professionally.  Paramedics can gain additional certifications as critical care paramedics, community medicine paramedics, flight paramedics, and of course the most awesome, tactical paramedics!  From our program, you can either obtain your Certificate of Mastery, or you have the option of completing a few more classes to earn an Associate Degree in Emergency Medical Sciences.  The latter was the option that I selected.   

I am incredibly thankful for the opportunities that I have been presented in becoming an instructor for our college’s Emergency Medical Sciences Program as well as becoming an instructor for SCT.  Just as in law enforcement, EMS is certainly a career where the learning never stops.  Serving as an instructor not only allows me to help others grow in their careers, but I also get to learn or refresh on topics and skills that I may not have used in a while.  There is no better reward than knowing that something that I have taught to a student of mine has saved a life.  

I will wrap this Medical Monday up with a shout out to my fellow medics in the Street Cop Training community.  HAPPY EMS WEEK!  Thank you to those who have added something to the Medical Monday posts, and to those who have reached out via private message.  If anyone has any questions or comments about this or any other Medical Monday, please comment below.  

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