The lowest level of responder, the EMR possesses simple skills to provide immediate life-saving care for critical patients. The EMR can render on-scene interventions while awaiting additional resources and may serve as part of a transport crew, but generally will not be the primary caregiver. State licensure as an EMR requires completion of a state-accredited training program.

The EMT conducts basic, noninvasive interventions to reduce the morbidity and mortality of acute out-of-hospital emergencies. They have all the EMR's capabilities, plus additional skills associated with patient transport. In many places EMTs provide the majority of out-of-hospital care, and in some places the highest level. State licensure as an EMT requires completion of a state-accredited program.

The AEMT has all the skills of the EMR and EMT, and can also conduct limited advanced and pharmacological interventions. This level allows provision of high-benefit, lower-risk advanced skills by systems that can't support Paramedic-level care. In some jurisdictions, AEMTs may represent the highest level of out-of-hospital care. State licensure requires completion of a state-accredited program.

The Paramedic is an allied health professional who can conduct invasive and pharmacological interventions. Possessing all the skills of the lower-level providers, Paramedics can also conduct a broader range of interventions based on skills that are harder to maintain and pose greater risk to patients if done incorrectly. Paramedic care is based on advanced assessment and formulating a field impression. State licensure requires successful completion of a CAAHEP-accredited Paramedic program at the certificate or associate's degree level.

Beyond providing care in the field, many EMS practitioners seek positions in management. EMS systems are diverse in structure and scope, and may have unique positions and designations. A title such as Field Training Officer can mean different things in different organizations. Whatever positions are called, as systems grow, they are likely to develop increased vertical promotional opportunities. The National EMS Management Association has developed a framework to standardize EMS officer levels (supervising, managing and executive) and competencies, which it hopes will be nationally accepted.

The Board for Critical Care Transport Certification (BCCTPC) is a non-profit organization responsible for the development and administration of the Flight Paramedic Certification (FP-C®), Critical Care Paramedic Certification (CCP-C®), and the Tactical Paramedic Certification (TP-C®) exams. 

The mission of the BCCTPC is to improve the critical care transport community. This is accomplished by providing a certification exam that is an objective, fair, and honest validation of critical care paramedic knowledge. For additional information about their certification programs, contact help@bcctpc.org.

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