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The History of the National Registry and EMS in the United States

More than five decades ago, President Lyndon Johnson’s Committee on Highway Traffic Safety recommended creating a national certification agency to set uniform standards for training and examining emergency ambulance personnel. In 1966, the National Academy of Sciences’ report Accidental Death and Disability highlighted the epidemic of accidental injury, which led to the National Registry of Emergency Medical Technicians' establishment in 1970. 

Since then, pre-hospital emergency medical care has evolved significantly. Today, EMS professionals are recognized as integral members of the healthcare team, with advanced training programs, national standards, and accredited paramedic programs in place. The National Registry has consistently upheld its mission to provide a uniform process for assessing the knowledge and skills required for competent practice and maintaining certification records. 

The organization has set and maintained uniform certification and recertification requirements, actively participated in national projects, and contributed to improving EMS standards by engaging in major committees. 

Click on the decades below to explore key milestones in the history of Emergency Medical Services and the National Registry of EMTs. 

Timeline

Pre-1970:

Pre-1970: Key Milestones 

  • Early EMS Era: Before the 1970s, there were no consistent standards for the training and testing of Emergency Medical Service (EMS) professionals. Patients did not know the quality of care they would receive, and many suffered as a result of insufficiently trained first responders. Emergency medical education varied significantly across different regions and providers. 

  • 1969: President Lyndon Johnson's Committee on Highway Traffic Safety recommended the establishment of a national certification agency to ensure uniform standards in EMS training and examination. In response, the American Medical Association's Commission on EMS appointed a Task Force to study the feasibility of creating a National Registry for EMTs. The Task Force was led by Oscar P. Hampton, Jr., MD, known for his pioneering efforts with the American College of Surgeons' Committee on Trauma, laying the groundwork for what would later become the National Registry of Emergency Medical Technicians. 
     

1970s 

  • 1970: First Meeting of the Task Force: Representatives from various organizations involved in EMS convened to discuss the establishment of a national certification agency. The Task Force met three times to draft bylaws and address funding and organizational concerns. 
  • Formation of the National Registry of EMTs: The Task Force was dissolved and reconvened as the Board of Directors of the National Registry, with Roddy A. Brandes elected as the first Chairman. 
  • 1971: Executive Director Appointment: Rocco V. Morando is appointed as the founding Executive Director of the National Registry. 
  • First NREMT-Ambulance Exam: The first examination is administered to 1,520 ambulance personnel at 51 test sites, marking the beginning of national certification for EMTs. 
  • 1972: Recognition of EMS Professionals: EMS providers gained respect within the medical community, and the systematic response to emergencies began to evolve from earlier practices. 
  • 1973: First Recertification: The first recertification of a Nationally Registered EMT is processed. 
  • 1974: Development of EMT-Paramedic Curriculum: The National Registry convenes national leaders to establish guidelines for the EMT-Paramedic curriculum. 
  • 1975: Continuing Education Requirements: Continuing education requirements are established for EMT-Ambulance and EMT-Non Ambulance personnel. 
    • Formation of the National Association of Emergency Medical Technicians: The National Registry plays a key role in forming this association. 
    • AMA Approval: The AMA accepts a brief from the National Registry, adding EMT-Paramedic to the list of approved health occupations. 
  • 1976-1977: Examination Development: The National Registry partners with the University of Kansas to develop and pilot written and practical examinations for the EMT-Paramedic. 
  • National Curriculum Development: A national curriculum for paramedic training is created in collaboration with leading EMS agencies. 
  • 1978: First NREMT-Paramedic Examination: The first NREMT-Paramedic examination is administered in Minneapolis, MN. The National Registry joins the National Commission for Health Certifying Agencies. 
  • 1979: Continuing Education for EMT-Paramedics: Continuing education requirements for EMT-Paramedics are established. 
    • Accreditation Guidelines: The National Registry contributes to developing guidelines for accrediting EMT-Paramedic educational training sites. 
 

1980s 

  • 1980: Funding Challenges: The federal deficit affects EMS funding, leading to state and local jurisdictions accepting funding responsibilities. The quest for standardization becomes difficult, and national direction diminishes as local needs take precedence. 

  • Development of EMT-Intermediate Guidelines: Guidelines and examinations for the EMT-Intermediate level are created. The first National Registry-Intermediate examination is held in Jackson, Mississippi. 

  • 1981: New Headquarters Dedication: On June 23, the National Registry's new headquarters is dedicated in Columbus, OH, where it remains located today. 

  • 1982: Introduction of Two Examination Versions: For the first time, two versions of the EMT-Ambulance examination are introduced to reduce the risk of examination compromise. 

  • 1983: EMT-Intermediate Examinations: Free-standing written and practical examinations for EMT-Intermediate are developed and implemented. 

  • 1984: National Registry Examinations Adoption: The National Registry examinations are used by 24 states and territories as the sole certification basis, while 15 additional states accept them in place of state examinations. 

  • Research Participation: The National Registry participates in a research project with the National Council of State EMS Training Coordinators to establish standards for the EMT-Defibrillator level of care. 

  • 1986: Incorporation of AHA Standards: The National Registry integrates all new standards from the American Heart Association into examinations at all certification levels. 

  • DoD Directive on EMS Personnel: The U.S. Department of Defense issues Directive No. 6000.10, mandating current certification in Basic Life Support for EMS personnel, with EMT-A certification required for technicians. 

  • 1987: Examination Blueprint Changes: The National Registry updates its examination blueprints to align with the newly released National Standard EMT-Intermediate and EMT-Paramedic Curricula from the U.S. Department of Transportation. 

  • Criminal Conviction Questions: Questions regarding criminal convictions are added to all certification applications. 

  • 1988: Retirement of Executive Director: Rocco V. Morando retires as Executive Director but continues as an Executive Consultant. The National Registry headquarters is renamed the Rocco V. Morando Building.  

  • 300,000 EMT-Ambulance Applications Accepted: The organization accepts its 300,000th EMT-Ambulance application. 

  • 1989: New Executive Director: William E. Brown, Jr. becomes the second Executive Director. 

  • Military Compliance with DoD Directive: All branches of the U.S. military begin to comply with the DoD Directive requiring National Registration for EMTs. 

  • Creation of EMT-Basic Category: A new EMT-Basic category is established, combining EMT-Ambulance and EMT-Non-Ambulance roles. 

  • Board Changes: The National Association of State Emergency Medical Services Directors replaces the International Association of Chiefs of Police on the Board of Directors. 


1990s 

  • 1990: Formation of the EMS Alliance: The federal approach to health care management leads to the formation of the EMS Alliance for national cooperation among organizations.  

  • Creation of the EMS Agenda for the Future: NHTSA contracts with NASEMSO and NAEMSP to create the "EMS Agenda for the Future," setting goals for EMS development. 

  • 1991: Curriculum Revisions: The National Registry participates in revising the U.S. Department of Transportation’s EMT-Basic curriculum. 

  • 1992: Inclusivity Initiatives: A policy accommodating candidates with learning disabilities is implemented, in line with the Americans with Disabilities Act.  

  • Funding for National EMT Training Blueprint: The National EMT Training Blueprint project receives funding. 

  • 1993: Endorsement of Education Standards: The National Registry endorses the EMS Education and Practice Blueprint and supports the Commission on Accreditation of Allied Health Education Programs for accreditation. 

  • 1995: Practice Analysis Study: A practice analysis study is conducted to update all examinations based on key practice areas identified. 

  • 1996: Technology Enhancements: A new computer system is installed to enhance communication with State EMS Offices, and registration for first responders begins.  

  • Curriculum Revisions with the Center for Emergency Medicine: Collaboration occurs with the Center for Emergency Medicine on curriculum revisions. 

  • 1998: Launch of LEADS: The National Registry Board approves the Longitudinal EMT Attribute Demographic Study (LEADS) project to investigate critical issues facing EMS personnel. 

  • 1999: Adoption of the National Registry of EMTs Mission Statement: The National Registry’s first Mission Statement is adopted: "To certify and register Emergency Medical Services Professionals throughout their careers by a valid and uniform process to assess the knowledge and skills for competent practice."  

  • Introduction of EMT-Intermediate/99 Level: The EMT-Intermediate/99 level is introduced while retaining the EMT-Intermediate/85 certification until curriculum updates are completed. 


2000s  

  • 2000: Strategic Direction Established: The National Registry Board adopts a Strategic Plan to guide the organization's direction. The LEADS committee completes its second survey on EMS work life. 

  • 2001: Widespread Certification Use: The National Registry examinations are used by 43 states and territories for certification. The LEADS committee completes a survey on EMS compensation. 

  • 2002: Fee Adjustments: The National Registry raises fees for the first time since 1973. The LEADS committee completes a survey on EMS driving safety and health risks. 

  • 2003: Research and Accreditation Milestones: A Research Program is established to improve National Registry programs. All five examination levels receive accreditation from the National Commission for Certifying Agencies. The LEADS committee completes a post-9/11 survey. 

  • 2004: Focus on Ambulance Safety: The LEADS committee completes a survey focused on ambulance safety. 

  • 2005: Transition to Computer-Based Testing Begins: The National Registry examinations are used by 46 states and territories. Plans are initiated to transition from pencil-and-paper to computer-based testing (CBT) by January 2007. 

  • 2006: Regional Meetings on Testing Advancements: The National Registry hosts regional meetings with State EMS Officials about the benefits of computer adaptive testing (CAT). Item writing and pilot tests are conducted to prepare for the transition to CBT. 

  • 2007: Launch of Computer-Based Testing: Computer-based testing is successfully launched, allowing next-day results and testing at over 300 locations. The National EMS Education Standards are developed. A motion is passed to require Paramedic program graduates to enroll in accredited programs by 2013. 

  • 2008: Strategic Planning for the Future: A long-range strategic planning session develops plans from 2009 to 2015. Item writing begins for the National EMS Scope of Practice Model. 

  • 2009: Implementation of Online Recertification: An online recertification system is implemented. A third practice analysis study changes the test structure to five areas of focus. Development of a psychomotor competency portfolio project begins. 

  • 2010: Record Participation in National Registry Examinations: A record 140,686 applicants take National Registry examinations. NASEMSO declares the National Registry as the National EMS Certification. 

  • 2011: Psychomotor Examination Revisions: Revised psychomotor examinations for EMR, EMT, and AEMT levels are released. The first Advanced-EMT National EMS Certification is issued. 

  • 2012: Recognition of Leadership: Executive Director William E. Brown, Jr. receives a JEMS Lifetime Achievement Award.  

  • The National Registry begins testing at the new EMR and EMT levels, retiring the EMT-Paramedic examination as an initial entry level. 

  • 2013: Leadership Transition: William E. Brown, Jr. retires, and Severo Rodriguez is appointed as the third executive director. Initial entry certifications for EMT-Intermediate-85 and EMT-Intermediate-99 are retired. 

  • 2014: Introduction of eCards: Electronic versions of registrants' National Registry cards (eCards) become available. The National Continued Competency Program is implemented in Alabama. The National Registry Board of Directors approved a re-entry pathway for Emergency Medical Technicians (EMT). 

  • 2016: Enhancements to Recertification Processes: "Rolling Recert" capabilities are added for recertification. 

  • 2017: Expansion of the EMS Compact: Georgia becomes the 10th state to join the EMS Compact, activating the Interstate Commission for EMS Personnel Practice. 

  • 2018: Launch of National Registry of EMTs Mobile App: The National Registry app is released, becoming the top medical app in the App Store. Several states add National Registry certification requirements for various levels. 

  • New Leadership for the Future: Bill Seifarth is appointed as the fifth executive director of the National Registry. 

  • Reaching 400,000 Certified Professionals: The number of EMS professionals holding National Registry certification surpassed 400,000, highlighting the increasing reliance on National Registry certification for national standards. 


2019-Present

  • 2019: Modernizing Testing Infrastructure: The National Registry began strategic advancements to modernize its testing infrastructure and improve accessibility for EMS professionals. This included the introduction of updated examination formats and processes. 

  • 2020: The National Registry celebrates 50 years of protecting the public: The National Registry celebrated 50 years of supporting EMS clinicians and advancing emergency medical services nationwide. 

  • National Registry Launches the National EMS-ID: The National Registry of Emergency Medical Technicians launched the National EMS-ID number system. 

  • COVID-19 Response and Temporary Provisions: In response to the COVID-19 pandemic, the National Registry implemented temporary provisions such as provisional certifications and extended recertification deadlines, recognizing the strain on EMS professionals during the public health crisis. 

  • 2021: National Registry Launches New Website: The National Registry unveiled its redesigned website, enhancing user experience and improving access to timely information for the EMS community.  

  • 2023: Surpassing 500,000 Certifications: The National Registry reached over 500,000 certified EMS professionals, marking a significant milestone in the value and recognition of standardized certification within the EMS community. 

  • National Registry Adopts Scaled Score Reporting for Examinations: The National Registry launched a new scaled score report on June 1, 2023, to help unsuccessful candidates understand their performance and better prepare for future examinations. 

  • Discontinuation of ALS Psychomotor Examination Announced: The National Registry announced the discontinuation of the ALS psychomotor examination, focusing more on cognitive assessments for AEMTs and Paramedics. 

  • New Purpose, Vision, and Mission Statements Introduced: The National Registry adopted new purpose, vision, and mission statements to better align with current and future plans. 

  • 2024: Updated Examinations: The National Registry launched updated AEMT and Paramedic certification examinations, removing the ALS psychomotor testing requirement to streamline certification.  

  • All Fifty States Recognize the National Registry: New York joined as the 50th state to recognize National Registry of EMTs certification, creating a fully nationwide pathway for EMS professionals.