Healthcare Professionals Healthcare Compensation Training & Education Print Paramedic and EMT Licenses Across State Lines Written by facebook twitter linkedin Written by Rod Brouhard, EMT-P Rod Brouhard is an emergency medical technician paramedic (EMT-P), journalist, educator, and advocate for emergency medical service providers and patients. Learn about our editorial policy Rod Brouhard, EMT-P Updated on October 07, 2019 Granger Wootz / Getty Images More in Healthcare Professionals Healthcare Compensation Training & Education Career Choices Getting Hired Healthcare Trends Geriatric Care Office Management Medical Technology Medical Supplies Emergency medical services (EMS) in the United States is cobbled together from various state and local regulations, with variations occurring even between neighboring counties and municipalities. This can make reciprocity (the acceptance of medical credentials) difficult if moving from one state to another. Variations in Licensing Emergency medical technician (EMT) licensing or certification is handled by the individual states. There is no federal authority, other than the District of Columbia, that governs licensing or certification of EMS personnel. Similarly, each state determines how it will recognize EMTs. There will be at least two levels of licensure—one for an EMT and the other for a paramedic—although others will have more. In terms of hierarchy, EMTs are the entry-level providers, followed by EMT-Intermediates (in some states), and then paramedics. While certification requirements can vary by state, EMTs usually require less than 200 hours of training, while a paramedic course may take well over 1,500 hours. Other licenses are issued for advanced paramedics and critical care paramedics, both of which require additional training hours. Certifying Bodies The National Registry of Emergency Medical Technicians (NREMT) is a nongovernmental organization that maintains a database of certified EMTs. Each applicant must meet a set of requirements, including passing a final exam, before certification is obtained. Many states use NREMT certification to license EMTs, which makes it very easy to grant intrastate reciprocity. As long as you are NREMT certified, you can easily move to another NREMT state. However, not every state takes part in this centralized body. Some create their own tests and standards with a different code of practice for EMT personnel. What this means is that it may be much harder to be granted reciprocity from (or to) a non-NREMT state. If the state where an EMT was first licensed doesn't use NREMT, he or she would need to undergo NREMT certification to work in a state that does. The reverse also applies. It is usually not a difficult process, but it can be time-consuming, particularly if additional training is required. Non-Reciprocity Between States The NREMT offers different types of EMT certification known as EMT Basic (EMT-B), EMT Intermediate (EMT-I), and EMT Paramedic (EMT-P). Reciprocity can vary based on the type of certification granted. The number of states that don't accept NREMT is surprisingly large. All told, 12 states do not offer reciprocity for EMT-B, 19 do not offer reciprocity for EMT-I, and 13 do not offer reciprocity for EMT-P. Here is the list of states that do not recognize NREMT at the EMT-B level: DelawareGeorgiaIllinoisMarylandMassachusettsNew YorkOregonPennsylvaniaVermontVirginiaUtahWyoming Here are the states that do not recognize NREMT at the EMT-I level: ArizonaDelawareGeorgiaHawaiiIllinoisKansasKentuckyMarylandMassachusettsMissouriNew JerseyNew YorkOregonPennsylvaniaRhode IslandSouth CarolinaVirginiaWashingtonWyoming Here is the list of states that do not recognize NREMT at the EMT-P level: AlaskaDelawareGeorgiaIllinoisMarylandMassachusettsOregonPennsylvaniaSouth CarolinaSouth DakotaVirginiaUtahWyoming In order to be certified in a non-reciprocal state, you may be asked to do additional training, a refresher course, a practical exam, or a written exam. Some states like Alaska and Connecticut will even require you to have a sponsor for certain positions. Variations Within a State In most cases, licenses are good statewide, but some states are complicated. California is one such example. Though the state grants statewide certification to EMTs, local EMS agencies are the ones tasked with handling applications and issuing cards for certification. This creates an additional layer of bureaucracy that can be harder to navigate than some might imagine. For example, paramedics in California are licensed by the state EMS authority but cannot actually practice until he or she obtains separate accreditation from the county or regional EMS agency. To make matters worse, each county or region creates its own standing orders and oftentimes includes an expanded scope of practice. This is not to suggest the process is without its rationale or that EMS requirements cannot vary by the community involved. It simply means that any EMT moving to California (or any non-NREMT state) should not expect to walk in and get to work. Preparation will likely be needed. A Word From Verywell The only way to know for sure if an EMT from one state can be licensed and employed in another is to ask. Contact the EMS agency in the state you plan to move to and advise them of your current certification. They'll be able to guide you on the steps to obtaining licensure in your new state. You can also call the National Registry of EMTs at 1-614-888-4484. Health Careers in Emergency Medicine Was this page helpful? Thanks for your feedback! Get tips on how to better manage your health practice. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. National Registry of Emergency Medical Technicians. National Registry Data, Dashboard, and Maps. Columbus, Ohio; updated April 13, 2017. Continue Reading