EMT or paramedic: course, NREMT exam and state license
An EMT course takes less than a year; paramedic programs come after EMT work and take up to 2 years. All states require EMTs and paramedics to be licensed, usually after the NREMT exam.
For: People who stay calm in emergencies, are physically fit and are ready for nights, weekends and stressful calls.
Route 1: EMT Under 1 year
Program applicants usually need a high school diploma and CPR / basic life support certification; some high schools offer EMT training.
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Start here
High school diploma + CPR
BLS
EMTs and Paramedics — How to Become OneU.S. Bureau of Labor Statistics (OOH)- Checked
- 20 Oct 2026
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Under 1 year
State-approved EMT program
Patient assessment, handling emergencies and field equipment, partly in a hospital or ambulance.
BLS
EMTs and Paramedics — How to Become OneU.S. Bureau of Labor Statistics (OOH)- Checked
- 20 Oct 2026
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Exam gate
NREMT EMT exam, or the state exam
New York, for example, gives its own state written exam.
EMT examsNREMT EMT
EMT certificationNational Registry of Emergency Medical Technicians (NREMT)- Checked
- 20 Oct 2026
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License
State EMT license or certification
States may also set a minimum age and a background check.
EMT license stepsBLS
EMTs and Paramedics — How to Become OneU.S. Bureau of Labor Statistics (OOH)- Checked
- 20 Oct 2026
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Goal
EMT
Employers typically ask for a driver's license.
BLS
EMTs and Paramedics — How to Become OneU.S. Bureau of Labor Statistics (OOH)- Checked
- 20 Oct 2026
Route 2: EMT → paramedic Up to 2 years more
Paramedic programs require EMT-Intermediate certification, and paramedics typically need EMT work experience first.
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Start here
EMT certification and work experience
BLS
EMTs and Paramedics — How to Become OneU.S. Bureau of Labor Statistics (OOH)- Checked
- 20 Oct 2026
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Program
Paramedic program
A nondegree award or associate's degree at community colleges, or a bachelor's at universities; anatomy and physiology, EKG interpretation and supervised field experience.
BLS
EMTs and Paramedics — How to Become OneU.S. Bureau of Labor Statistics (OOH)- Checked
- 20 Oct 2026
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Exam gate
NREMT Paramedic exam
Paramedic examNREMT Paramedic
Paramedic certificationNational Registry of Emergency Medical Technicians (NREMT)- Checked
- 20 Oct 2026
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License
State paramedic license or certification
Paramedic license stepsBLS
EMTs and Paramedics — How to Become OneU.S. Bureau of Labor Statistics (OOH)- Checked
- 20 Oct 2026
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Goal
Paramedic
Paramedic-to-RN programs offer an accelerated path to registered nursing.
BLS
EMTs and Paramedics — How to Become OneU.S. Bureau of Labor Statistics (OOH)- Checked
- 20 Oct 2026
State licensing matrix
State EMS offices license EMTs and paramedics; many call it certification. What three state EMS offices publish: NREMT
View source
| State or city | What you need |
|---|---|
| Texas Department of State Health Services (DSHS) |
At least 18, high school diploma or GED, a DSHS-approved EMS course, the state application and fee, the National Registry exam and fingerprints. Paramedics: EMT-Paramedic certification after a paramedic course, or Paramedic Licensure with a two-year EMS degree or a four-year degree in any field. Texas DSHSEMS initial certification and licensureTexas Department of State Health Services (DSHS)
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| New York Department of Health, Bureau of EMS and Trauma Systems |
After an approved course, students take the New York State written certification exam by computer through PSI (EMT students may use live remote proctoring). Reciprocity is possible with a current certification from another state, the military or the NREMT. NYS DOHNYS EMS examination informationNew York State Department of Health, Bureau of EMS and Trauma Systems
NYS DOHEMS reciprocity informationNew York State Department of Health, Bureau of EMS and Trauma Systems
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| Florida Department of Health, Division of Medical Quality Assurance |
Uses the NREMT exam. Florida-trained applicants must pass within 2 years of finishing the course or retake the course. Paramedic students must graduate from a CAAHEP-accredited program (or one with a CoAEMSP letter of review). Florida DOHEmergency medical technicians and paramedicsFlorida Department of Health, Division of Medical Quality Assurance
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Where to go next
Every career page in this cluster: entry, license, BLS pay and outlook.
What the job is, BLS pay and job outlook, and how to become one.