# National Registry of Emergency Medical Technicians

The National Registry of Emergency Medical Technicians (NREMT) is a US based, non-profit certification organization for pre-hospital emergency medical providers that exists to ensure that every Emergency Medical Technician has the knowledge and skills required for competent practice.
EMTs are not trained to provide definitive medical care, but instead focus on rapid in-field treatment and transport to higher medical providers. EMTs work in conjunction with other medical providers such as paramedics, nurses, and physicians, as well as with other EMTs. When operating in the prehospital environment, their actions are governed by protocols and procedures set by their system's physician medical director.

## History

The NREMT was established in 1970 in response to a recommendation from President Lyndon Johnson's Committee on Highway Traffic Safety that recommended that a national certifying agency for Emergency Medical Technicians be created in order to establish and standardize training requirements.
National Standard Curriculum as defined by the Department of Transportation - National Highway Traffic Safety Administration (NHTSA)

## Scope of practice

The scope of medical practice for EMTs is regulated by state law, and can vary significantly both among states as well as inside states. In general, EMTs provide what is considered basic life support (BLS) and are limited to essentially non-invasive procedures. Besides employing basic medical assessment skills, typical procedures provided by EMTs include CPR, automated external defibrillation, mechanical ventilation using a bag valve mask, placement of air way adjuncts such as oropharyngeal and nasopharyngeal airways, pulse oximetry, glucose testing using a glucometer, splinting (including spinal immobilization and traction splints), and suctioning. In addition, EMT-Bs are trained to assist patients with administration of certain prescribed medications, including nitroglycerin, metered-dose inhaler such as albuterol, and epinephrine auto injectors such as the EpiPen. EMT-Bs can typically also administer certain non-preprescribed drugs including oxygen, oral glucose, and activated charcoal (usually upon medical direction). In response to the opioid overdose epidemic, states are rapidly changing protocols to permit EMT-Bs to administer naloxone as well.
Individually, each state is free to add or subtract to their EMTs scope of practice. For example, EMTs working in California may not administer activated charcoal, an NHTSA approved intervention, under a standard certification. Local EMS systems (i.e. counties in California) can apply to the state to implement an extended scope of practice for EMTs that includes activated charcoal as well as other pharmaceutical interventions not normally allowed to be administered by EMTs.

## Standards

Most states use or require NREMT testing for some level of state certification. NREMT recognizes four levels of EMS: EMR, EMT, Advanced EMT, and Paramedic (some states may have additional certifications). NREMT certification at an EMT Intermediate level may or may not be sufficient for some state EMT-I requirements. While NREMT certification may be mandatory for new state certification, it is not necessarily required for renewals. These procedures and requirements vary from state to state. In 1986, military emergency rooms were required to certify all medical technicians through NREMT.

## Education and training

EMT training is regulated at both the state and federal level. At the federal level, the National Highway Traffic Safety Administration (NHTSA) has developed a minimum content and hour curriculum, but it is not binding on the states. This is known as the National Standard Curriculum. Under the NHTSA curriculum, students receive 110 hours of lecture and lab time covering anatomy, physiology, legal aspects of medical care, assessment, and treatment of medical, trauma, behavioral, and obstetric emergencies. In addition to class time, the NHTSA recommends clinical rotations on board ambulances and in emergency departments.
Using NHTSA guidelines, the National Registry of Emergency Medical Technicians have developed and implemented certification tests for the NHTSA EMT levels, including the EMT level. As of 2006, 39 US states utilize the NREMT EMT exam as part of the state licensing and/or certification procedure.
Once certified, EMTs are required to obtain continuing education hours to recertify. Recertification requirements vary from state to state. Continuing education courses can cover a variety of topics, provided that they cover relevant material, including college courses covering anatomy, physiology, or psychology, to more applied courses that are either standardized, such as a Prehospital Trauma Life Support (PHTLS), or tailored to the needs of an individual EMS system or region.
Some states allow for an already certified EMT from another state to apply for reciprocity in their state. The states that participate in this can be found by contacting the certification boards of each state or on their websites.

### Levels of certification

* Nationally Registered Emergency Medical Responder (NREMR): This is the entry level into emergency medical services (EMS). They are trained in CPR, advanced first aid, automated external defibrillator usage, and patient assessment. Most police and fire services require their employees to be emergency medical responders at a minimum. This course is usually 40–60 hours in length.
* Nationally Registered Emergency Medical Technician (NREMT): This level of certification provides basic life support.
* Nationally Registered Advanced Emergency Medical Technician (NRAEMT)
* Nationally Registered Paramedic (NRP)

## EMS-ID

The NREMT launched the EMS-ID system on January 23, 2020, modeled after the National Provider Identifier (NPI). The idea was that one identifier could be issued to a verified individual upon creation of an NREMT account, which could then reference all certifications for that person. The number would remain constant, even if the individual changed their name, national certification level, etc. Similar to the NPI number issued by the Centers for Medicare and Medicaid Services (CMS), the number is a 12-position, intelligence-free numeric identifier (12-digit number). The EMS-ID is not intended to replace the individual registry number.

## Controversy

In 2010, accusations ultimately determined to be false were made against NREMT claiming failure to prevent cheating during some of their certification exams (administered by Pearson VUE). The Washington, D.C. Fire Department was investigated for cheating on the NREMT certification exam; however, an extensive investigation by the NREMT and Pearson VUE, with assistance from the DC Fire and EMS department as well as the DC police, revealed no evidence of cheating at Pearson VUE's LaPlata, MD testing center. Per the report, “… that all scores reported on DCFEMS members were valid.”
The NREMT works with the EMS community to implement the National EMS System including the EMS Agenda for the Future, EMS Education Agenda: A Systems Approach, and National Scope of Practice Model.