The History of the NREMT and EMS in the United States
It has been five decades since President Lyndon Johnson's Committee on Highway Traffic Safety recommended the creation of a national certification agency to establish uniform standards for training and examination of personnel active in the delivery of emergency ambulance service. In 1966, the National Academy of Sciences released "Accidental Death and Disability" drawing attention to the neglected epidemic of accidential injury. the result of this recommendation was the inception of the national registry of emergency medical technicians (nremt) in 1970.
Since that time, pre-hospital emergency medical care has continually evolved and improved. Today, Emergency Medical Services professionals are acknowledged as bonafide members of the health care team. Excellent training programs have been developed and a vital focus has been placed on continuing education. National standards have been established. Ambulance equipment essentials have been set. National accreditation of paramedic programs has been achieved, and professional EMS associations have been organized.
Through every change, the NREMT has remained steadfast in upholding its mission to provide a valid, uniform process to assess the knowledge and skills required for competent practice required by professionals throughout their careers and by maintaining a registry of certification status.
The organization has done what was necessary to establish, implement and maintain uniform requirements for the certification and recertification of emergency medical technicians. The NREMT has also been involved in numerous national projects and its staff participates on major national committees, playing an active part in the ever-continuing process of improving standards of emergency medical services.
Click on the decades below to read about key milestones in the history of Emergency Medical Services and the National Registry of EMTs.
There was a time when there were no consistent standards for training and testing for Emergency Medical Service (EMS) professionals. When patients were injured or ill, they didn’t know what level of medical attention they would receive. The education and ability of those providing emergency care or first aid varied. As a result, many patients may have been permanently disabled due to poorly trained personnel.
President Lyndon Johnson's Committee on Highway Traffic Safety recommends the creation of a national certification agency to establish uniform standards for training and examination of personnel active in the delivery of emergency ambulance service. This resulted in the appointment of a Task Force by the American Medical Association's Commission on EMS to study the feasibility of a National Registry for EMTs. The Task Force was headed by Oscar P. Hampton, Jr., M.D., a physician recognized for his pioneering work with the American College of Surgeons’ Committee on Trauma.
During the 1970's, improved care of the sick and injured in the pre-hospital phase became a crusade led by concerned physicians, nurses, ambulance service providers, health care administrators, elected officials, and private citizens. The movement was supported by statistics reflecting an abysmal state of affairs. In 1972, a representative for the Ambulance Association of America stated, "Possibly as many as 25,000 persons a year may be permanently disabled due to mishandling by poorly trained ambulance personnel." The patient was being twice victimized: once by the injury or illness and once by failing to receive competent emergency medical care.
Representatives of organizations actively involved in emergency medical service attend the first meeting of the Task Force on January 21, 1970. Organizations invited to participate were:
- Ambulance Association of America
- International Association of Fire Chiefs
- International Rescue and First Aid Association
- National Ambulance and Medical Services Association
- National Forest Service
- National Funeral Directors Association
- National Park Service
- National Safety Council
- National Ski Patrol
- American Heart Association
- International Association of Chiefs of Police
The Task Force met only three times to draft bylaws, determine the composition of the Board, discuss funding, and tackle a myriad of other concerns inherent in the birth of the new certifying agency.
On June 4, 1970, the Task Force was dissolved and was immediately reconvened as the first meeting of the Board of Directors of the National Registry of Emergency Medical Technicians. Roddy A. Brandes of the Ambulance Association of America was elected the Board's first Chairman.
Rocco V. Morando is selected as NREMT's founding Executive Director.
The first basic NREMT-Ambulance exam is administered simultaneously to 1,520 ambulance personnel at 51 test sites throughout the U.S. This event marked the beginning of National Board Certification for the nation's Emergency Medical Technicians.
The fiction of TV's "Emergency" paled before the action of real-life EMS professionals as they lived the spontaneous script of the streets. With every run made, EMS professionals added to their reputation as respected members of the medical community. Death and disability statistics felt the impact, and the gratitude of those served by quality care was boundless. The genesis of Emergency Medical Services evolved from the "You call, we haul" or "Snatch'em and patch 'em" approach to today's systematic response.
The first recertification of a Nationally Registered EMT is processed.
The NREMT calls a meeting of national EMT-Paramedic leaders and educators to develop initial guidelines for the national EMT-Paramedic curriculum.
Continuing education requirements for recertification are established for EMT-Ambulance and EMT-Non Ambulance personnel.
The NREMT is instrumental in the formation of the National Association of Emergency Medical Technicians.
A brief prepared by the NREMT is reviewed and accepted by the American Medical Association's Committee on Health Manpower, resulting in the addition of EMT-Paramedic to the list of approved health occupations and the subsequent Council of Allied Health Education and Accreditation (C.A.H.E.A.) procedure.
The NREMT contracts with the University of Kansas to develop and pilot test written and practical examinations for the EMT-Paramedic.
National curriculum for paramedic training is developed in conjunction with leading EMS agencies and the University of Pittsburgh. A multi-media, audiovisual teaching package is produced by the NREMT to train examiners in the administration of an objective practical performance examination for the EMT-Ambulance.
The First NREMT-Paramedic exam is given in Minneapolis, MN. The Registry becomes a member of the National Commission for Health Certifying Agencies.
Continuing education requirements for recertification are established for EMT-Paramedics. As a member of the C.A.H.E.A. Joint Review Committee, the Registry helps to develop essentials and guidelines for the accreditation of educational training sites for the EMT-Paramedic.
As EMS evolved into the 1980's, the huge federal deficit began to take its toll on EMS funding. State and local jurisdictions began to accept some funding responsibilities and ultimately so did the consumers: the patients. "National" direction began to diminish and state by state needs sprang up with local jurisdictions demanding more from the new funder-- the State. Standardization became difficult to attain; universal agreement on issues were only resolved when the lowest common denominator could be agreed upon by every entity. The final product often looked like Swiss cheese with no one accepting the final standard even though all took part in its development. The consensus process for national standards failed to achieve its goals. All of this evolved while the public, via the next EMS television event, "Rescue 911", became more aware of the possible success of EMS when all goes well.
Guidelines and examination for the EMT-Intermediate are developed. The NREMT breaks ground on a new headquarters at 6610 Busch Boulevard in Columbus, Ohio, to house the growing organization. The first NREMT-Intermediate exam is given in Jackson, Mississippi
The NREMT’s new headquarters were dedicated on June 23.
For the first time, two versions of the EMT-Ambulance exam are introduced, reducing the possibility of exam compromise.
Free-standing EMT-Intermediate written and practical examinations are developed and implemented.
The NREMT exams are now used by 24 states and territories as the sole basis for certification at one or more levels. An additional 15 states and territories accept NREMT exams in lieu of their state examinations, at one or more levels.
The NREMT becomes an active participant in a research project conducted by the National Council of State EMS Training Coordinators to collect data and determine the need for standards and guidelines for the EMT-Defibrillator level of care.
The NREMT incorporates all new standards of the American Heart Association into the examinations at all three levels of certification.
The U.S. Department of Defense develops and disseminates Directive No. 6000.10 on Emergency Medical Services which states, "All EMS health care personnel working in an emergency care area shall have current certification in Basic Life Support. Technicians or hospital corpsman working in EMS and/or assigned to ambulance duty shall have a minimum of EMT-A certification from the National Registry of EMTs."
The NREMT adopts examination blueprint changes to meet the newly released National Standard EMT-Intermediate and EMT-Paramedic Curricula as developed and promulgated by the U.S. Department of Transportation.
The NREMT begins to include appropriate questions related to criminal convictions on all applications for initial certification and recertification. New examinations are written and used at the EMT-Intermediate level according to the U.S. Department of Transportation’s EMT-Intermediate curriculum.
NREMT Executive Director Rocco V. Morando retires but continues his service as Executive Consultant to the Board of Directors. The NREMT headquarter building is renamed the Rocco V. Morando Building. The NREMT accepts its 300,000th EMT-Ambulance application.
William E. Brown, Jr., RN, MS, CEN, NREMT-P assumes the position of Executive Director.
All branches of the U.S. military begin to comply with the Department of Defense Directive requiring National Registration for EMTs in the military. A new category, EMT-Basic, is established, combining EMT-Ambulance and EMT-Non-Ambulance.
The National Association of State Emergency Medical Services Directors replaces the International Association of Chiefs of Police on the Board of Directors.
The 90's started off with a new federal approach to managing the health care industry. Suddenly words like "managed-care", "capitation," consolidation of services, ambulance buy-outs, and a national health plan began to be discussed predicated upon the need to control the cost of health care. The EMS Alliance was founded (the pre-cursor for today's EMS Advocates) and more cooperation of organizations nationally based upon the perceived need for information sharing and a "unified EMS voice." These developments caused the National Highway Traffic Safety Administration (NHTSA) to contract with the National Association of State EMS Officials (NASEMSO) and the National Association of EMS Physicians (NAEMSP) to develop a comprehensive review of EMS and to prioritize what came to officially be known as the “EMS Agenda for the Future.” The "Agenda" serves as a cornerstone for development of ideas, legislation, goals and objectives for organizations well into the next millennium.
By the mid-90’s EMS continued to be influenced by television. “ER” became one of the highest rated TV shows. Along with “Paramedics”, “Third Watch”, “Trauma” and other shows, EMS enjoyed a highly positive public image. New curricula for EMT-Basics, Intermediates and Paramedics were developed. The debate over the definition of licensure and certification of EMS providers continued. The NREMT analyzed the practice of EMTs in 1994 and repeated the study in 1999. NHTSA convened a group of experts to review the process for future curricula projects which evolved into a document entitled the “EMS Education Agenda for the Future”, which continues to serve as the standard for development of EMS educational curriculum. After 30 years of evolving EMS, the NREMT committed to study the EMS profession and commissioned a Longitudinal EMT Attribute Demographic Study (LEADS) project.
The NREMT participate in the revision of the U.S. Department of Transportation’s EMT-Basic curriculum.
The NREMT implements a scientifically developed policy to accommodate candidates with learning disabilities in accordance with the Americans with Disabilities Act.
The Board of Directors approves funding for a National EMT Training Blueprint project and study design for a knowledge and skills retention study.
The NREMT endorsed the EMS Education and Practice Blueprint.
The NREMT votes to support the Commission on Accreditation of Allied Health Education Programs, which replaced the American Medical Associations Committee on Allied Health Accreditation as the sponsoring body for accreditation.
The NREMT conducts a practice analysis study to determine key areas required for practice. All exams are updated based on the data obtained from this study.
The NREMT installs a new computer system which improves communications with State EMS Offices. The NREMT begins registration of First Responders.
The NREMT works with the Center for Emergency Medicine of Western Pennsylvania on revision of the EMT-Intermediate and EMT-Paramedic curricula.
The NREMT Board approves formation of the Longitudinal EMT Attribute Demographic Study (LEADS) project committee to learn more about the important issues facing EMS personnel and to help identify the critical issues affecting the profession.
The NREMT 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.""
The NREMT adopts the EMT-Intermediate/99 level and retains Registry certification of the EMT-Intermediate/85 until completion of the EMS Education Agenda for the Future process has been completed. The LEADS committee completes first survey and snapshot on EMS education.
The NREMT exams are now used by 43 states and territories as the sole basis for certification at one or more levels. The LEADS committee completes third survey and snapshot on EMS compensation.
The NREMT increases fees for the first time since 1973. The LEADS committee completes fourth survey and snapshot on EMS driving safety and health risk.
The NREMT implements a Research Program for the betterment of NREMT programs and to contribute to the EMS community.
The NREMT receives accreditation of all five levels of exams from the National Commission for Certifying Agencies, a certification accrediting agency sponsored by the National Organization for Competency Assurance.
The LEADS committee completes fifth survey and a post 9/11 survey.
The LEADS committee completes sixth survey and snapshot on ambulance safety.
The NREMT exams are now used by 46 states and territories as the sole basis for certification at one or more levels. The NREMT begins the process to transition from pencil-and-paper based exams to computer based testing in January 2007.
The NREMT hosts regional meetings with State EMS Officials to explain benefits of computer adaptive testing (CAT) and its delivery via computer based testing (CBT).
Many item writing meetings and pilot tests are conducted to prepare for CAT. Computers are programmed to allow online applications via the NREMT website.
An Education Network is developed to allow EMS Education Program Directors to validate course completion for candidates applying for National EMS Certification.
The NREMT successfully launches computer based testing via a contract with Pearson VUE. CBT allows next day delivery of results to candidates across the United States, enhances examination security, allows next day delivery of results to state licensing agencies and permits testing when the candidate is ready at over 300+ locations across the country.
The NREMT begins electronic delivery of communiques to State EMS Officials and Educators.
The NREMT Staff participates in development of the National EMS Education Standards.
The NREMT Board passes a motion to require all Paramedic Education Program graduates to be enrolled in nationally accredited programs in 2013 in order to obtain National EMS Certification at the Paramedic level.
The NREMT Board, based upon a motion by Mark King, State EMS Director in West Virginia, passes a plan to re-instate former NREMTs into the NREMT if states require continued maintenance of NREMT certification.
The NREMT Board of Director holds a long range Strategic Planning session to develop concepts for plans from 2009 to 2015.
The NREMT begins item writing for implementation of the National EMS Scope of Practice Model in accordance with the National EMS Education Agenda for the Future: A Systems Approach and in conjunction with State EMS Offices.
The NREMT implements an online system to recertify NREMTs via the website.
The NREMT hosts 11 item writing meetings in order to meet the pilot test item demands to continue computer adaptive testing.
The NREMT completes a third study “Practice Analysis,” which forms the basis for the test plan until 2014. The outcome changes the test to five areas, Airway/Oxygenation/Ventilation, Cardiology, Trauma, Medicine and Operations with 15% of all items covering Pediatrics throughout the test.
The NREMT begins work with EMS educators, CoA representatives and NASEMSO members on development of a psychomotor competency portfolio project.
The NREMT begins development of a LEADS ten year report. LEADS is a Longitudinal EMT Attribute Demographic Study project which NREMT has led since 1999. The LEADS studied the EMS workforce and had over 15,000 EMS providers in the study.
The NREMT completes a survey of Paramedic Program Directors regarding Paramedic Accreditation opportunities, barriers and knowledge. The survey has an 89% response rate and confirms Paramedic Program Directors favor the accreditation requirement.
The NREMT hosts a meeting of State EMS Officials, Fire Chiefs, IAFF representatives, AAA members, NAEMSP representatives and State Medical Directors to begin a process to re-design NREMT recertification requirements.
The NREMT has a record year of applications for National EMS Certification. 140,686 applicants take NREMT examinations.
The National Association of State EMS Officials (NASEMSO) proclaims by resolution that the NREMT is the National EMS Certification as outlined in the EMS Education Agenda for the Future: A Systems Approach.
The NREMT hosts a “summit” of 8 Paramedic programs that pilot tested the Psychomotor Competency Portfolio project during the past year. Results indicate greater success of students on NREMTs cognitive and psychomotor examination. The NREMT replaces computer system hardware to virtual servers.
The NREMT releases revised psychomotor examinations for EMR, EMT and AEMT levels of certification.
Alabama and Vermont become the first states to implement the Mark King Initiative, a process whereby former NREMTs can be re-instated into the NREMT after the state mandates continued National EMS Certification by the NREMT.
The NREMT issues the first Advanced-EMT National EMS Certification (NRAEMT).
The NREMT hosts along with Educators and State EMS Directors and Medical Directors a course for physician EMS fellows on Education, Measurement and the State Regulatory Process.
The NREMT signs a contract extension with Pearson VUE for another five year term ending in 2016 which allows delivery of CBT without an increase in fees for the duration of the contract.
Executive Director William E. Brown, Jr. is awarded a JEMS Lifetime Achievement Award and the Ronald D. Stewart Award for his contributions and dedication to the EMS community.
NREMT begins testing and issuing certifications at the new Emergency Medical Responder (EMR) and Emergency Medical Technician (EMT) levels.
The EMT-Paramedic exam is retired as an initial entry certification level on December 31.
- William E. Brown, Jr. retires after 28 years of service.
- Severo Rodriguez is hired and appointed to be the new Executive Director.
- EMT-Intermediate-85 (I85) is retired as an initial entry certification level on March 31.
- EMT-Intermediate-99 (I99) is retired as an initial entry certification level on December 31.
- NREMT begins testing and issuing certifications at the new Paramedic (NRP) level.
- Beginning January 1, 2013, Paramedic applicants must have successfully completed state-approved and CAAHEP-accredited (or one that has a Letter of Review) Paramedic (NRP) program.
- Massachusetts becomes the latest state to implement the Mark King Initiative.
- Printing electronic versions of registrant's current NREMT card (eCard) is now available through the individual's account on the website.
- In June, the NREMT Board of Directors approved a re-entry pathway for Emergency Medical Technicians (EMT).
- Alabama implemented the National Continued Competency Program on October 1, 2014.
- EMT-Intermediate-99 (I99) is retired as an initial entry certification level on December 31.
- Development to the electronic recertification process generated shortened turn around time for application processing from 23.4 hours to 11.7 hours.
- The NREMT completes a fourth study of "practice analysis" which forms the basis for the test plan until 2019.
- Department of Homeland Security implemented the Mark King Initiative.
- 1,000,000th NREMT CBT Exam Administered December 6, 2014.