The National Registry of EMTs is the Nations EMS Certification. Certification by its very meaning implies the certified individual has obtained and maintained competency. Many outside reports
have stressed upon Certification Agencies the need to have processes in place that maintain competency throughout the certificant’s career.
In EMS there are three elements of credentialing, all designed to protect the public. The first element is obtaining and maintaining National EMS Certification. The NREMT has entry
requirements that must be met by all applicants. These include successful completion of an approved EMS education course, criminal background considerations, CPR validation, and passing an approved
psychomotor (practical) and cognitive (computer-based) examinations. Once all of these requirements have been met the applicant is issued National EMS Certification by the National Registry
of EMTs. Many states (44 as of December 2007) require applicants for licensure to possess a National EMS Certification from the NREMT prior to making application. Some states execute their own
certification and licensure, regardless of how valid their initial entry level process is established. Some states have levels of EMS care that do not match the national levels as outlined in the
National EMS Education and Practice Blueprint. This document was established via a consensus process and is used by the Department of Transportation to establish federal recognition of the various
professions of EMS care.
Licensure, the second element, has the highest level of public protection. Many states use National Certification as part of their licensure process, but possession of National EMS Certification
does not imply licensure will be granted. National EMS Certification is not a right to practice. All NREMTs must also possess a state licensure unless that EMT works exclusively on federal
land or is in the military. In many instances states have additional requirements, beyond those of the NREMT, for licensure. For example, some states have stricter rules regarding licensure of persons
with criminal backgrounds and many require government documents to validate that no criminal record exists. Some states require affiliation with a licensed EMS agency to obtain a state license. The
NREMT is unaware of any state that requires fitness requirements, mental health requirements or any other qualifications for licensure. Because a state is the final authority for public protection,
states can remove (revoke) a state licensure via a disciplinary process. Revocation typically surrounds inappropriate actions taken by the EMS provider.
Credentialing, the third element of public protection, is accomplished at the local level. Many EMS providers must pass local requirements to maintain employment or obtain protocols to practice
in a local EMS system. Most employers require successful completion of an orientation period before permitting a new employee to provide care alone in the patient compartment of an ambulance. This
orientation program is similar to a local credentialing process.
Because certification should not be granted as a life-long credential and because knowledge, skills and abilities necessary to treat patients change over time, the NREMT requires re-certification
(re-registration). The NREMT requires this process to be accomplished every two years. Emergency Medical Services has a high degree of public risk and EMS providers must maintain a high degree
of proficiency. EMS does not require a tremendous amount of initial education, even for Paramedics who deliver very advanced level resuscitation care. Standards and guidelines are always under
review and changing. At times Scopes of Practice may change, adding new knowledge, skills and abilities to a level of EMS care. Therefore, over the years the NREMT has developed a re-certification
process structured to help maintain competency throughout an EMS provider’s career. Additionally, the NREMT has mandated a two year period for re-certification because a majority of state licensure periods
are two years in length.
One study conducted at the Paramedic level indicates registered Paramedics are twice as likely to pass the NREMT cognitive examination if they maintain National certification (registration). The
Research Department of the NREMT has adopted as its highest priority research centered on competency and continued competency. In only four short years, the Research Department had 13 manuscripts
published or accepted for publication and 36 abstracts of other studies accepted as both oral and poster presentations at a variety of scientific assemblies. It is the commitment of the NREMT Board
of Directors to continue this research and to update or revise our re-certification requirements for the purpose of maintenance of continued competency based on this research. The Board will be
implementing a new research agenda in the future, to increase the amount of research activity and to develop re-certification requirements that increase validity around continued competency of EMS
professionals.
Currently there are two options to demonstrate maintenance of competency: (1) Refresher, Continuing Education, cardiac resuscitation updates (CPR/AL) and field skill validation or (2) successful
completion of the cognitive (computer-based) examination, cardiac resuscitation updates and field skill validation. Successful completion of the examination is considered to be satisfactory evidence
of maintenance of continued cognitive competency. Registrants who use option #2 are permitted to take the exam once. If the registrant does not pass the exam on the first attempt the registrant
must complete all refresher and continuing education requirements prior to the expiration date of their registration.
We hope the importance of demonstrating continued competency is clear to your future patients, state EMS licensing agencies, EMS medical directors, employers and fellow peers. This can only be
accomplished through your own work, education and a caring attitude. Maintenance of National EMS Certification is important to the public!
The current NREMT re-certification (re-registration) requirements are provided on the NREMT website at
Re-registration Brochures
