State Requirements for Paramedic Certification Exam

The table below identifies some of the minimum requirements necessary to become certified as an EMT-Paramedic in all 50 states and the District of Columbia. A complete listing of all state certifying agencies is also provided along with contact information.

Some minimum requirements are fairly standard and, therefore, not listed in the table. For example, one must be physically, mentally, and emotionally able to perform all the tasks of an EMT-Paramedic. It is also necessary to have a high school diploma or GED prior to attending training, as is a clean criminal record. Finally, successful completion of an approved EMT-Paramedic training program that meets the standards set forth by the U.S. Department of Transportation as well as current ACLS certification are required for sitting for state-certification and NREMT-certification exams.

The first column of the table, Time to Become Certified, means the amount of time one has between completion of an approved EMT-Paramedic training program and successfully meeting the certification requirements. If too much time passes between taking the course and passing the exam, one could end up taking the entire EMT-Paramedic training program again! In some states, the exam comes immediately following training. If this is the case, immediate is listed in this column.

States either use their own written and practical skills exams, exams from the NREMT, or a combination of both. The entry under exam will be state, meaning the state has its own exam, NREMT for National Registry, or an entry indicating a combination of both exams. Even when the state has its own exam, it will be similar to the National Registry exam and therefore to the exams in this book. The federal government mandates the curricula of the EMT-Paramedic courses nationwide, so exams are usually similar and based on the National Standard Curriculum for the EMT-Paramedic as well as the most current rules and regulations for ACLS.

Each state has its own rules and regulations surrounding certification. Some states have residency requirements for certification/reciprocity. Some states require NREMT certification for initial state certification/ licensure, but do not require the paramedic to maintain NREMT certification. Texas and Oregon require that paramedics possess a minimum of an A.A. degree in EMT/para-medicine prior to achieving licensure. If you are unaware of the requirements for your state, it is strongly recommended that you thoroughly research such requirements prior to completing your initial paramedic training. Some states have time limits from the completion of a paramedic training program to successfully passing the state/NREMT certification exams. Should you miss these time limits, it may be necessary to retake a paramedic course in its entirety. Better to know all the requirements upfront, as responsibility rests solely with the applicant—i.e., you.

While the information in the table is deemed correct at the time of publication, it is recommended that you contact the certifying agency in the state in which you intend to work, to determine if there has been a change to the certification process. Some states have been looking at moving away from NREMT certification as a requirement in favor of administering their own cognitive exam due to complaints over the new CAT system used by the NREMT. The percentage of candidates “showing competency” (i.e., pass rates) on the first attempt have been reduced significantly since the CAT system was introduced in 2007. NREMT insists, however, that the testing system is accurate and ensures a higher level of confidence that those individuals who pass the CAT examination are those who show minimum competencies to function as an EMT-Paramedic.

The next column in the table lists whether a state with its own certification exam also accepts the National Registry exam. Under Accepts National Registry, the possible entries are no, meaning the state requires successful completion of their own certification process; yes, meaning that you can be certified in the state if you are already certified by the National Registry; or with state, meaning that if you are certified by the NREMT, you can be certified in the state by taking the state’s written and practical skills exams. If the entry under exam in the previous column is NREMT, then that state accepts the National Registry exam.

The same idea follows under the Accepts Out-of- State Certification; the state will either not accept certification from another state (reciprocity), does accept it, or accepts it only if you successfully complete their certification exams as well. Some states require that you be certified through NREMT if you are transferring in from another state. For these state, the entry will be With NREMT. In most cases, a state that accepts out-of-state certification will insist that the training program and certification exams have met or exceeded its own standards, so whether or not a state accepts your credentials for reciprocity may be made on an individual basis.

Some states also have additional certification requirements for transferring paramedics, such as background investigations, state residency requirements, employment with an EMS agency in that state, or mandatory refresher training. If you are certified in another state, you will need to show proof of current certification when applying for reciprocity.

Some states have what is known as “legal recognition,” which means they will recognize and accept your training for a limited time period, often one year. This is similar to a temporary certification. During this period, you must apply for official certification and fulfill all necessary requirements. Once this process is complete, your certification will be good for the normal certification period. Check with the appropriate state EMS-certification agency office for further details.

The recertification column indicates the number of years a certification remains valid prior to the need for recertification. Recertification usually requires a given number of hours of continuing education, demonstration of continuing ability to perform necessary skills, or both. Again, check with the certifying agency in the state you will be employed for further information on recertification requirements.