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All US states and territories require that providers staffing EMS vehicles have successfully completed a program of initial training and passed an examination process. These providers are also required to complete continuing education in order to continue practice. EMS medical directors are responsible for the oversight of these education programs. Additionally, they should continually evaluate the actual clinical performance of their providers and, through their quality improvement process, implement an ongoing education program designed to continually improve provider practice. EMS education in the United States, although guided and supported by national guidelines and curricula, is regulated at the state level. As a result, the specific provider levels of training and the corresponding educational requirements vary from state to state. Fortunately, there are generalizations about provider education that can be made about the overall education and training processes and requirements.


  • Describe the national basis for the education of prehospital providers.

  • Describe the levels of prehospital providers and typical training requirements at each level.

  • Describe the types of educational organizations providing EMS education and the role of accreditation in preparing candidates for national EMS certification.

  • Detail the use of high-fidelity simulation.

  • Discuss the use of distance learning, including advanced self-study and Web-based education.

  • Detail the development of a field preceptor program and criteria for clearing a provider for independent practice.

  • Define remediation and discuss its use in educational programs and for providers identified during CQI as having additional education needs.

  • Contrast National Registry certification to state-specific EMS provider certification.

  • Discuss continuing education requirements and recertification pathways.

The most common levels of training include emergency medical technician (EMT) basic, EMT-intermediate, and paramedic. Many states also include some type of formal first responder training level. This training is provided by a wide variety of institutions ranging from formal degree programs in traditional educational institutions such as colleges and universities to system-based training programs. In all states, this training is, at least loosely, based on national standards, as is the standardized examinations administered either at the state level or by a national organization (new national standard levels: EMR, EMT, AEMT, paramedic).

Many EMS systems have advanced evaluation tools that medical directors can use to measure actual clinical performance. These tools are typically used by field training officers (FTOs)/preceptors to determine and institute “stretcher-side” training aimed at continuous teaching. Additionally, EMS educators and medical directors utilize a variety of mechanisms, including simulations and distance learning methodologies, to carry out their educational goals.

As with all of EMS, the medical director bears ultimate responsibility for ensuring that the education provided at both the initial and continuing levels is clinically and scientifically appropriate and up to date.


Authority for defining and regulating EMS provider education, certification, and licensure in the United States is held by each individual ...

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