'At the Region' is an ongoing feature that discusses the state-by-state training, certification and employment requirements of first responder departments across the nation. This section looks at the history and development of first responder standards, and spotlights the way that small departments integrate local specialties into national regulations. In this issue, At the Region begins with an updated look (July 2017) at EMS requirements in the northwestern United States, including Alaska, Washington, Oregon, and Idaho.



FEMA Region X – EMS

Emergency Medical Technician certification levels result from a combination of national requirements and state by state regulations. All EMT training must meet minimum standards provided by the National Highway Traffic Safety Administration (NHTSA); this includes fundamentals in areas such as anatomy, medicine, and trauma, but states determine the final designations and requirements. An independent organization, the National Registry of Emergency Medical Technicians, also provides guidelines, and, although these are not mandatory, NREMT exams are used as the basis for certification at one or more levels in 45 states. Because of the variation in training, the NREMT national certification as an EMT does not equate to a license to practice, and transferring local certification depends on state by state reciprocity agreements.

Alaska- updated July 2017 to include requirements for licensure as a Mobile Intensive Paramedic.

EMT Certification Requirements

EMTs applying for certification have two options for completing EMT-I requirements, which must include a minimum of 120 hours of course instruction and CPR certification. EMT-I certification is considered equivalent to "the National Standard EMT-Basic, as described in the United States Department of Transportation (USDOT) curriculum, revised in 1994, excluding the use of advanced airway devices." The first option is the completion of a standard EMT-I course. These courses are offered at institutions such as:

    • The University of Alaska Southeast – This institution offers both EMS-I and ETT programs. Also required is the additional course HS S102, or current CPR certification.
    • The University of Alaska Anchorage – Programs offered include ETT (3 credits), EMS-I (6 credits), EMS-II (3 credits), and EMS-III (3 credits).

The second option is the ETT to EMT bridge program. The ETT, or Emergency Trauma Technician designation, is based on a 40-hour training course originally developed for logging camps, which has evolved into a state-wide program that may be modified to suit local needs. Bridge courses are a minimum of 80 hours in length, and meet EMT-I regulations for content.

After completing the EMT-I examination, applicants must submit a completed, signed, and notarized application for certification, in addition to a copy of CPR credential, and non-refundable $25 fee. If using the ETT to EMT bridge option, an ETT credential or signed verification must be included as well.

Initial Qualifications for License as Mobile Intensive Paramedic:

Applicants for licensure must:
    • Be 19 years of age or older
    • Be a high school graduate
    • Provide a letter from the applicant's physician sponsor verifying that the applicant will, always, be under the supervision of a physician sponsor approved by the board, as required by 12 AAC 40.315
    • Submit a certified copy of the applicant's paramedic education program certificate or an original letter, signed by the education program director and sent directly to the division from the program director, verifying completion of a training program that meets the requirements of 12 AAC 40.320
After successfully completing board approved classroom and clinical studies, applicants must:
    • Have satisfactorily completed a 480-hour internship that meets the requirements of 12 AAC 40.325;
    • Pass the written and practical examination for emergency medical technician-paramedic administered by the National Registry of Emergency Medical Technicians
    • Submit verification of licensure from the appropriate licensing authority in each state, territory, or province where the applicant holds or has ever held a license as a paramedic or other health care professional
    • Submit the applicable fees established in 12 AAC 02.250

Reciprocity

EMT-I
Alaska accepts NREMT national certification for EMT-I, as well as certification or licensing and the equivalent from states or territories whose training includes DOT, National Standard Curriculum for the "Emergency Medical Technician: Basic, 1994 objectives". If an EMT's local certification does not include these objectives, a temporary EMT-I license will be issued that is valid until December 31st of the year of application, after which an approved refresher course must be completed, and an application for recertification is required.

To be issued a state certification, applicants must provide:
    • A non-refundable application fee of $25
    • A copy of the valid state, territory, or National Registry certification
    • Evidence of valid CPR credential
    • Other proof of qualifications that the department, in its discretion, requires.

After completing the EMT-I examination, applicants must submit a completed, signed, and notarized application for certification, in addition to a copy of CPR credential, and non-refundable $25 fee. If using the ETT to EMT bridge option, an ETT credential or signed verification must be included as well.

EMT-II and EMT-III
Alaska accepts EMT-II and EMT-III or equivalent certification from other states or territories, as well as NREMT national certification; however, applicants must also obtain sponsorship from a state-approved medical director. All other documentation as listed above is also required, in addition to proof of completion of the state written and practical examination at the level of certification requested.

Mobile Intensive Paramedic
Applicants for licensure as a mobile intensive care paramedic who are currently licensed in another state must fulfill the following requirements:

    • Be 19 years of age or older
    • Be a high school graduate
    • Provide a letter from the applicant's physician sponsor verifying that the applicant will, always, be under the supervision of a physician sponsor approved by the board, as required by 12 AAC 40.315
    • Submit a certified copy of the applicant's paramedic education program certificate or an original letter, signed by the education program director and sent directly to the division from the program director, verifying completion of a training program that meets the requirements of 12 AAC 40.320
    • Pass the written and practical examination for emergency medical technician-paramedic administered by the National Registry of Emergency Medical Technicians
    • Submit verification of licensure from the appropriate licensing authority in each state, territory, or province where the applicant holds or has ever held a license as a paramedic or other health care professional
    • Submit the applicable fees established in 12 AAC 02.250
    • Not be currently under suspension or revocation as a mobile intensive care paramedic, or emergency medical technician- paramedic, or the equivalent, and may not be the subject of an unresolved investigation, complaint review procedure, or disciplinary proceeding undertaken by a certifying or licensing agency in another state
    • Must submit written verification from the applicant's previous physician sponsor, on a form approved by the department, attesting that the applicant can perform the activities listed in 12 AAC 40.370 plus any other specific emergency procedures authorized by the physician sponsor.
    • The board will, in its discretion, require an applicant to provide additional documentation necessary to verify the applicant's education or experience.



Idaho

EMT Licensure
Idaho has a new system; IGEMS https://www.idahoemslicense.net/public/idaho/, that EMS professionals use to manage their licenses. There are several steps in completing the Idaho EMT licensing requirements that must be finished before submitting the application packet. The first is the successful completion of an EMS Course; several accredited institutions offer this, including but not limited to:
    • The College of Western Idaho – EMT Basic classes are a total of 140 hours, broken down into 35 sessions for a cost of $950. Prerequisites include a minimum age of 18, a high school diploma, AHA Healthcare Provider CPR completed by midterm (also offered at the college as a single day course for a $50 fee), a drug test/background check, and vaccinations. Additional costs of $162 for books (estimated), and a $130 charge for fees and testing also apply.
    • The College of Southern Idaho – EMT Basic classes are a total of 144 hours plus clinicals, provided over two semesters for a cost of $2640 for Technical Certificates, and an additional semester plus $880 for Postsecondary Technical Certificates. Prerequisites include a minimum age of 17, application to CSI, academic transcripts, recommendations, a resume and cover letter, AHA Healthcare Provider certification, a physical exam, drug/background check, and vaccinations.

For a complete list of Idaho approved Education Institutions click here

Following the successful completion of an EMT course, applicants must pass NREMT's written and practical examination. This requires registration on the NREMT website, and completion of the exam at one of the Pearson VUE Authorized Test Centers, located in Boise, Coeur d'Alene, Idaho Falls, Lewiston, Pocatello, Twin Falls, and Spokane, Washington. Applicants must also pass a Criminal History Check by the Department of Health and Welfare, using Employer ID #1350. Applicants must secure affiliation with an Idaho-licensed EMS agency. Finally, applicants must complete and submit an Initial Provider Application. To download the application click here.

A photo ID (driver's license, state identification card or military identification card must be included with the application.

License Renewal

Applicants who need to renew their licenses must meet Idaho's continuing education requirements. To view the requirements for renewal, click here.

Reciprocity

Idaho accepts EMT certifications equivalent to NREMT-B, NREMT-I, and NREMT-P, and requires verification that an applicant's training was based on national standards. If the applicant's original certification was not based on these standards, a Transition Course is required; courses vary by county. Applicants not required to take a Transition Course must still complete Idaho Extraction Awareness and Landing Zone Officer courses available at the TRAIN Idaho website. Reciprocity instructions can be found here.

When applying for licensure, you must:
    • Complete and submit the Idaho EMS Reciprocity Application; downloadable after creating an IGEMS account, including a photocopy of an approved photo ID (driver's license, state identification, card, or military ID)
    • Send an Idaho EMS License Verification Request to all states where you have held or applied for an EMS license
    • Pass the NREMT assessment exam for your license level
    • Complete a Department of Health and Welfare Criminal History Unit background check using EIN 1350
    • Secure affiliation with a licensed Idaho EMS agency
    • For Advanced EMTs and Paramedics – pay a $35 application fee.



Oregon

EMT Certification
Oregon's EMT certification process is based on NREMT standards and begins with the completion of an approved EMT course. These courses are available at institutions including, but not limited to:

    • The National College of Technical Instruction – EMT Basic courses include 144 hours of classes and skills lab training, 12 hours of field time, and 12 hours of clinical observation, for a cost of $1045. Additional costs including testing, books, and fingerprinting are estimated at $352.50. Students must be at least 18 years of age, possess a GED or high school diploma, and provide two letters of recommendation, proof of health insurance, a valid driver's license, and proof of vaccination.
    • Portland Community College - EMT Basic is offered as a six-month course with a total projected cost of $1650.05, including all tuition, exam, and additional fees. Prerequisites include a completed application, placement tests, proof of age (18 minimum) and high school diploma or GED, and documentation of vaccinations.

Following the successful completion of the EMT course, all applicants submit their application packet and examination fee to their course director, who will forward documents to the Oregon Health Authority, EMS Section, for processing. Students then must pass the NREMT certification examination for the desired level; this is consistent for EMT, AEMT, and paramedic testing. As of early 2016, the examination is administered under the 2011 NREMT Psychomotor Examination User Guide. The practical examination process is coordinated through individual educational programs. Even candidates for re-examination can typically rely on the course director for scheduling. Information about the 2017 practical examinations can be found here After successfully completing this exam, applicants receive both National Registry certification and Oregon licensure. Applicants must take and pass both the written and practical examinations within 24 months of course completion. To learn about renewing licensure go to

Reciprocity

EMT Level
Oregon will grant licensure at the applicants National Registry certification level. Applicants who are not licensed in another state but are still registered in the National Registry, will not be granted a license. They can, however apply for initial Oregon licensure. Applicants must use Oregon's online license management system, eLicense and create an account. This is a new system. Another change is that Oregon does not accept National Registry Intermediate-85 or Intermediate-99 certifications as the basis for reciprocal licensure.

Applicants for reciprocity must submit verification for every state license they currently hold. The form for doing so is here Applicants complete only the top part of the form. They then return the document in a sealed envelope to:



Also, paramedics applying for reciprocity must provide proof of an associate's degree or higher, or proof of active employment as a paramedic for three of the past five years. A background check is also required for all whom apply for reciprocity. Some applicants (those whom have lived in another state for more than 60 days in the past five years) will also be fingerprinted. Active Duty military or individuals who were discharged in the last 180 days and who are requesting reciprocity in the State of Oregon may waive the fingerprint-based background check by submitting active orders or a DD214.

Contact Information:



Washington

EMT Certification
The first step in EMT certification is to complete a Washington State approved EMS training course. These courses are provided by institutions included, but not limited to:

    • Tacoma Community College – EMT-B classes are offered in 12 to 13 week, and 8 to 9 week options, and cost approximately $1144.57, including tuition, books, lab fees, and state examination fees. Prerequisites include proof of high school diploma or GED, sealed official transcripts from other colleges, or photocopy of Accuplacer assessment exam scores, a photocopy of a current driver's license, a copy of a current Healthcare Provider CPR Card (American Heart Association) or Professional Rescuer CPR Card (American Red Cross), and documentation of vaccinations.
    • North Seattle Community College – The 12 credit EMT course costs approximately $1185, and a first aid entrance exam is required prior to the start of the class. Prerequisites include a minimum age of 18, attendance at the orientation session, a valid driver's license, a high school diploma or GED, completion of AHE191 ($146) or having a Healthcare Provider CPR certification, and physical strength to lift and carry patients of up to 200 pounds with the aid of a partner.
Following the completion of the course, applicants must pass a Department of Health approved certification examination for the applicable level of certification. The final step is the completion of the Initial EMS Certification Application, found here to be provided to the Department of Health, EMS Credentialing P.O. Box 47877 Olympia, WA 98504-7877. Along with the form, applicants should include the EMS Supervisor/Medical Program Director Signature Form, and Certificate of Course Completion.

Reciprocity

Washington accepts reciprocal and "challenge" certification for EMTs, Advanced EMTs and Paramedics, provided several conditions are met. All applicants must complete an infectious disease prevention training, even if completed in a different state. Acceptable classes include the "Infectious Disease Prevention For EMS Providers" generally given in initial EMR and EMT courses, or the seven-hour HIV/AIDS prevention training program, available here in person or online. Applicants must also meet the Reciprocity or Challenge requirements found in the Application Packet.

Reciprocity is defined as "applying for Washington State EMS Provider certification based on current EMS provider certification from another state or with the National Registry of Emergency Medical Technicians." Applicants must:
    • Provide proof of valid EMS certification from another state or national certifying agency approved by the department. Send the EMS Verification Form, found here to all states you have or have previously held a healthcare credential in.
    • Provide proof of a passing score on the National Registry of Emergency Medical Technicians (NREMT) examination. Examination results are valid for 12 months from the date of the examination.
    • Pass a Department of Health approved certification exam for the level of certification requested, valid for 12 months from the date of examination. Following 12 months, a department-approved certification exam is required.
Challenge application is defined as "applying for certification based on possession of a current health care provider credential and proof of education equivalent to the knowledge and skills for the level of certification." Applicants must:
    • Provide "course completion document showing education equivalent to the knowledge and skills at the EMR, EMT, or AEMT training level." Following review, applicants will be notified of the examination required for certification.
    • Provide valid health care provider credentials
    • Meet paramedic guidelines equivalent to reciprocal requirements (if applicable)
    • Pass a Department of Health certification examination.

Reciprocity applicants must also meet skill maintenance requirements following initial certification.
Military personnel, spouses, or registered domestic partners of military personnel have additional opportunities in maintaining and obtaining a license in Washington. Visit the Washington State Military Resource page for more information.