EMT and Paramedic Licenses Across State Lines

Paramedic opening ambulance
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EMS in the United States is pieced together from various state and local regulations, sometimes differing between neighboring municipalities, which makes reciprocity complicated. In this disorganized system, can an EMT from New Jersey work in another state?

Definitely maybe.


Emergency medical technician (EMT) licensing (or certifying) is handled by the states. There is no federal authority (other than the District of Columbia) that grants licenses or certifications to EMS personnel.

Each state determines how it will recognize emergency medical technicians. Every state has at least two levels of EMT license: EMT and Paramedic (many areas of the country have other names, but they all have EMT. Some states use paramedic as a standalone, while others call them EMT-Paramedics). Many states have additional levels that may include EMT-Intermediate, Advanced Paramedic or Critical Care Paramedic.

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 standards, including an exam, before being certified by NREMT. Many states use the NREMT certification to license EMTs, which makes it very easy to grant reciprocity from one state to another. As long as you are NREMT certified, you can easily move to another NREMT state.

States that don't rely on NREMT for certification usually create their own tests and standards.

It may be much harder to be granted reciprocity from (or to) one of those states.

Even if the state where an EMT is first licensed doesn't use NREMT, he or she can still apply and become NREMT certified in order to move to a state that accepts it.

But wait, it gets even more confusing...

In most cases, licenses are good statewide, but some states are more complicated.

California grants statewide certification to EMTs, but local EMS agencies hand out the cards and handle applications for certification.

EMT-Paramedics in California are licensed by the state EMS Authority, but an EMT-Paramedic can't practice in a local county or region unless he or she is accredited by the local EMS agency. Each county or region creates its own standing orders and may have expanded scopes of practice.

The only way to know for sure if an EMT from one state can easily be licensed and employed in another state is to ask. Contact the EMS agency for the state you plan to move to and tell them where you are certified. They'll be able to guide you on the steps to becoming licensed in your new home.