History of the NREMT in the United States

Emergency response and medical treatment is a sophisticated process that requires rigorous training. Qualified emergency medicine is a relatively recent phenomenon thanks, in part, to the National Registry of EMTs.  


By Rikki Roehrich, EMS1 Contributor 

Prior to 1970s, there were no standards for paramedic or EMT training, and the quality of care found in the pre-hospital setting varied greatly depending upon the ability of the responders. Patients were uncertain what quality of medical treatment they would receive.

The establishment of the NREMT and EMS testing alleviated some of these concerns.

‘The White Paper’ for EMS

NREMT has raised the bar for emergency medical services (Photo/Flickr)
NREMT has raised the bar for emergency medical services (Photo/Flickr)

In the late 1960s, a report called Accidental Death and Disability: The Neglected Disease of Modern Society (more commonly called ‘the White Paper’) was published. Among other facts, the report cited that accidental injuries were the leading cause of death in the first half of someone’s lifespan. The paper also drew the conclusion that in the year of 1965 alone, there were more Americans killed in auto accidents than in the Korean War and that one was more likely to survive injury in a combat zone than on the average city street.

By identifying the lack of regulations, operating standards and EMS provider training, the report brought attention to the deficiencies in the industry. Eventually, President Lyndon Johnson became involved. These events led the recommendation and development of standardized curriculum for emergency medical technician-ambulance (EMT-A) which was finalized in 1969. 

President Johnson also appointed a task force to study the feasibility of creating a national registry of EMTs that consisted of many different, disjointed emergency response organizations such as the Ambulance Association of America, the National Ambulance and Medical Services Association, and the International Rescue and First Aid Association, among others. This task force developed a certifying agency which ultimately became the National Registry of Emergency Medical Technicians. The NREMT held its first official meeting on June 4, 1970.

The first NREMT tests

In 1971, the first NREMT-Ambulance exam was administered to over 1,500 personnel at 51 test sites nationally, marking the beginning of the official certification of EMTs. In 1972, there was a further advancement in emergency treatment as residency programs began to appear. These programs specifically trained physicians to practice emergency medicine. 

NREMT began to work with paramedic leaders and educators to develop the EMT-Paramedic (EMT-P) curriculum. The first EMT-Paramedic exam was administered in 1978. The following year, NREMT adopted continuing education requirements NREMT recertification. 

The rise of NREMT in the community

Throughout the 1980’s, NREMT continued to gain traction throughout the nation, with more states accepting or requiring the organization’s certification.  NREMT introduced another curriculum, the EMT-Intermediate, and implemented corresponding practical and written examinations. 

In 1986, the U.S. Department of Defense began to require certification in Basic Life Support for all EMS providers and EMT-A certification from NREMT for anyone working directly in EMS or on an ambulance. This requirement allowed EMT-Ambulance and EMT-Non-Ambulance curricula to combine and became the EMT-Basic. 

During the 1990’s the shift towards digital technology began and the organization started to look for valuable data on trends affecting the EMS industry. The largest of which was the formation of the Longitudinal EMT Attribute Demographic Study (LEADS), which completed its first survey on EMS education in 1999. 

The current scope of NREMT

By 2001, NREMT exams were used in 43 states and territories as the sole basis for certification on one level at least and the LEADS survey continued to gauge other aspects of the EMS profession, including compensation, driving safety, health risk, and work life. 

By 2009, the LEADS committee began to develop a 10-year report based on the responses of over 15,000 EMS providers that participated in the study. During this time, NREMT continued to refine its testing and certification policies. 

Today, we see the accumulation of training requirements, certification, and education that were spearheaded by NREMT actualize to show a much more sophisticated, structured, and complex program. 

Historically, the level of care that is displayed in the pre-hospital period is much higher than it was without NREMT requirements, and their certification allows for states and individuals to complete the certification process much easier than they would without the standardization. This level of education and training is integral to producing high-quality EMS personnel.
  
 

About the author

EMS 101 articles are intended to educate a non-emergency medical services audience about the emergency medical services profession. These articles are written by EMS1 staff members and EMS1 contributors, and cover a wide range of topics from EMS protocols all paramedics & EMTs should follow to an overview of the necessary requirements for becoming a paramedic.

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