States require that Emergency Medical Technicians are at least eighteen years of age and possess a high school diploma.  A certain level of fitness is also necessary as lifting patients is part of the job.

Many states ask that an ambulance service or hospital has sponsored the aspiring Emergency Medical Technician.  This is to ensure that the Emergency Medical Technician is serious about the job and has on-the-job training lined up.  To complete the first level, the aspiring First Responder takes a written test, much like the test taken by a teenager to get a driver learner’s permit.   The written test is completed first, and then the physical training begins.  Coursework often includes at least 110 hours of on-the-job training and five correct patient assessments.  Once this training is completed, a final exam is issued.   Scoring at least an 80% allows the state to issue certification.  Someone holding a First Responder certificate must be retested every two years.

An EMT-1 is tested on skills in trauma assessment, oxygen therapy, cardiac assessment, spine immobilization, CPR in adults, taking vital signs, immobilization of broken bones, bleeding control, shock management, and airway suction.  These components are included on the final testing.

The next level requires the Emergency Medical Technician possesses First Responder certification.  After the required proof is provided, the Emergency Medical Technician must complete over twenty hours of clinical study and over 60 hours of on-the-job training.  Additional coursework in childbirth, trauma response, and patient management are also provided.  Once the coursework and training are complete, a test is given to ensure the EMT-Intermediate is thoroughly aware of all aspects of his or her job. 

With the EMT-Intermediate, skills are tested on air passage clearing, CPR for infants, children and adults, preparing and administering medications, emergency childbirth, splinting bones, collecting blood samples, administering IVs, treating shock, and more.  The test includes three components in which the EMT-Intermediate demonstrates his or her capabilities in assessing a patient, managing the patient’s needs, providing intermediate airway clearing, preparing an IV, and administering medications. 

The final level, the EMT-Paramedic, include the courses administered for the EMT-Intermediate, but it also adds a number of other courses.  An EMT-Paramedic must also be trained in administering endotracheal tubes, chest decompressions, emergency airway puncturing, defibrillation, reading EKGs, and hooking up central IV lines.

An EMT-Paramedic requires months of training.  Due to the extensive training, all EMT-Paramedic hold paid positions.  Lower scale EMTs are often volunteer positions.