There are four distinct levels of emergency medical response. Emergency medical responders, or EMRs, occupy the first and most fundamental tier. A step above are regular EMTs, who are below advanced EMTs.
At the very top of the expertise ladder are paramedics, who are the most advanced. All play critical roles in the field of quick-response treatment, and all require distinct forms of certifications before practice.
Below, we’ll be taking an in-depth look at each of these classifications, job descriptions, and required certification levels.
EMR - Emergency Medical Responders
EMRs are the most limited of the four certification levels, but they can still perform many life-saving care maneuvers, such as CPR and mouth-to-mouth resuscitation. Beyond this, they may have to wait for more qualified personnel to arrive.
EMR Certification Requirements
To become a certified EMR, one must pass through the following steps:
- Step 1: Enroll in an accredited EMR program
These tend to last up to four weeks and consist of 65 hours of teaching instructions.
- Step 2: Submit the Application for the EMR Exam
To do this, you must create an account with the National Registry of Emergency Medical Technicians and submit an approved application, payment, and approval from the Program Director.
- Step 3: Pass the EMR Cognitive Test
There are two aspects to the EMR exam - cognitive and psychomotor. The mental element consists of about 90 - 110 multiple choice questions covering cardiology & resuscitation, trauma, obstetrics & gynecology, EMS operations and airway, respiration & ventilation.
- Step 4: Pass the Psychomotor Exam
The NREMT does not conduct the psychomotor aspect of the EMR exam. Instead, the states in question are responsible. They either do so independently or delegate the responsibility to training institutions.
Regular EMT
Regular EMTs, or EMT Basics, do everything an EMR does and then some. Additional responsibilities taken on by regular EMTs include stabilizing and safely transporting patients from scenes of emergencies to the appropriate medical establishments.
They also help move patients from hospital to hospital, minimize secondary injury, comfort victims, and perform non-invasive interventions.
Regular EMT Certification Requirements:
- Step 1: Possess a current CPR-BLS for healthcare providers
- Step 2: Enroll and Complete a State-Approved Course
These tend to last up to two years and consist of 120 hours of teaching instructions.
- Step 3: Pass the EMT Cognitive Test
Like the EMR tests, there are two aspects to the EMT exam - cognitive and psychomotor. The mental element consists of about 70 - 120 multiple choice questions covering cardiology & resuscitation, trauma, obstetrics & gynecology, EMS operations and airway, respiration & ventilation. The maximum time allowed for completion is two hours.
- Step 4: Pass the Psychomotor Exam
The psychomotor aspect of the EMT exam is also not conducted by the NREMT. Instead, the states in question are responsible for its administration. They either do so independently or delegate the responsibility to training institutions.
Advanced EMT
Advanced EMTs do everything an EMT does and then some. In addition to non-invasive interventions, advanced EMTs can perform limited non-invasive interventions like administering fluids and medications.
They also use advanced medical equipment, which you don’t typically see EMT basics working with.
Advanced EMT Certification Requirements
- Step 1: Possess EMT certification/state license
- Step 2: Possess a current CPR-BLS for healthcare providers
- Step 3: Enroll and Complete a State-Approved AEMT Course
State-approved advanced EMT must be completed in up to two years. They require about 350 hours of learning and the time required for EMT certification.
- Step 4: Pass the AEMT Cognitive Test
The cognitive test for advanced EMTs is a computer-based exam administered by the National Registry of Emergency Medical Technicians. It consists of about 135 questions, 35 of which do not affect a candidate’s score. The maximum time allowed for completion is two hours.
Questions cover cardiology & resuscitation, trauma, obstetrics & gynecology, EMS operations and airway, respiration & ventilation.
- Step 5: Pass the Psychomotor Exam
The psychomotor aspect of the AEMT exam tests for proficiency in 10 skills. The test is administered by posing questions displaying possible scenarios. Candidates either get a “Pass” or a “Fail” with no additional information.
The skill categories include Patient Assessment (Trauma), Patient Assessment (Medical), IV and Medication Skills, Ventilatory Management, Random EMT skills, Pediatric Intraosseous Infusion, and Cardiac Arrest Management.
Paramedic
Paramedics are the most advanced of all emergency medical technicians. They have the most comprehensive duties, including doing everything an advanced EMT does and more invasive lifesaving maneuvers.
Because these procedures require much knowledge and expertise with a tiny margin for error, becoming a paramedic usually takes longer and is more challenging than the previous categories highlighted.
Below are the essential requirements to become a certified paramedic.
Paramedic Certification Requirements
- Step 1: Possess EMT certification/state license
- Step 2: Possess a current CPR-BLS for healthcare providers
- Step 3: Enroll and Complete a Paramedic Education Program Approved by CAAHEP
These programs last about two years and consist of up to 1800 hours of teaching instructions. They deal with more advanced aspects of emergency response, such as cardiology, anatomy, and pharmacology.
Completing these programs also requires completing an internship in a hospital or ambulance.
- Step 4: Pass the Paramedic Cognitive Test
Like the AEMT cognitive exam, the paramedic exam administered by the NREMT is computer-based. It consists of about 80 - 150 questions covering cardiology & resuscitation, trauma, obstetrics & gynecology, EMS operations and airway, respiration & ventilation.
The maximum time allowed for completion is two hours and thirty minutes.
- Step 5: Pass the Paramedic Psychomotor Exam
The categories tested in a paramedic psychomotor exam include Patient Assessment (Trauma), Static Cardiology, Dynamic Cardiology, Integrated Out-of-Hospital Scenario, Oral Station Case A and Oral Station Case B.
Final Thoughts
Emergency Medical Personnel may choose to begin as EMTs and work their way to becoming paramedics. Continuing education is also mandatory to keep their knowledge up-to-date and get acclimatized with new technologies.
License renewal every two or three years is also a common requirement in many states.
