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ADVENTURE JOBS: Medic 101 – How to Become a Medic

A lot of people have asked me over the years; “Hey doc, how do I, an average Joe, become a high speed medic much like yourself?”  After I stop blushing, I tell them, “It’s really pretty easy, there are basically two ways. The first is the civilian route and the second is the military route.”

Let’s talk about the civilian route first. This is how I initially got involved with pre-hospital Para-medicine way back in 1986.  First off, a little background, there’s an organization called the (NREMT) National Registry of Emergency Medical Technicians ( that has, in conjunction with the Department of Transportation, set national standards for emergency medical responders.

The four levels of certification are; First Responder (FR), EMT-Basic (EMT-B, “basic”), EMT-Intermediate (EMT-I, “intermediate”) and EMT-Paramedic (AKA EMT-P, EMT-Advanced, paramedic, (“paramagic”, “medic”, etc).  These certifications are recognized by a majority of the United States (right now there are five states that do not recognize NREMT certification.  As of 31 Dec 2009 they are NY, MA, NC, IL, and WY.  When in doubt, check with your state health department to find out which certification is required.

Most states also have a concurrent certification process.  Some are easy to obtain by just submitting your NREMT certification and paying the state fee.  Or it can be as time consuming as having to sit for another set of tests along with the appropriate fees.

The first step to becoming certified is to find a school or organization that is offering a state-approved First Responder or EMT-B course that meets or exceeds the U.S. Department of Transportation First Responder National Standard Curriculum (

My honest opinion is that you should forego the First Responder and get directly into an EMT-B course.  For not much more time and money you’re going to learn a lot more, be able to help more people out in the “real world” and have a certification that is pretty much recognized throughout the country.

I recommend calling your local community college to see if they offer a course.  A couple of other options are to look for a volunteer fire department or rescue squad that offers the training or attend a private training program.

Last year, I took a Wilderness EMT course through a private outdoor leadership school.  The course allowed the students to sit for the NREMT-Basic testing, NREMT-B plus Wilderness EMT, and 30 days in the Rockies.  Sign me up!

EMT-Basic is the initial entry position that is required for later becoming an EMT Intermediate or Paramedic and is based on 110 hours of instruction.  Additionally, the EMT-B student will have to work several shifts on an ambulance, or in a hospital emergency department, sometimes both.

Generally a candidate must be 18 years old, have no felony convictions, have a current CPR card for the Professional Rescuer, be vaccinated against hepatitis B, DPT and MMR and have had a TB tine test within the past 6-12 months.  Most states also require some kind of formal background check that you’ll have to pay for.

After you have passed the didactic portion of the class, you will have to sit for the NREMT and/or state, written and practical tests to become certified.  On a side note, EMT’s are not “licensed” we are “certified”.  In the pre-hospital setting we work under the license of our Medical Director who is a physician.

The NREMT “written” test is actually a “computer adaptive test”.  This means the computer will give you harder and harder questions until you start to miss them.  Then it goes back to slightly easier questions to make sure you know what you’re talking about.

The practical test is an actual “hands-on”, psychomotor, scenario based skills test.  Some of the skills tested are; patient assessment, cardiac arrest management/Automated External Defibrillator, bag-valve-mask ventilation, spinal immobilization, long bone fractures, traction splinting, bleeding control/shock management, upper airway adjuncts and suction, and supplemental oxygen administration just to name a few.

I know it sounds like a lot, but a good program should devote at least 50% of class room time to skills practice.  Practice makes perfect!

In the next article; “Medic 201:  How to advance my training” we’ll discuss intermediate and paramedic levels of certification.


~Buck M.
Contributing Correspondent

Buck M. has been a medic for over twenty years in both the military and in the civilian sector.

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  1. Good post. I have a good friend that had no military or police background, but is now currently working as a medical officer for one of the PMC’s over in Afghanistan. The way he did it, was to get a paramedic certification, then work as an instructor with one of the recognized combat medical training schools. Also he gained experience working on ambulances. With the cert, training experience, and actual medic experience, he was able to qualify for and get work with the companies overseas. He was also persistent, which is another key factor in getting work overseas.

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  2. Spot on. I’m a Tactical Medic, EMTI, retired. Last work was as a contractor for BW. Prior, I was EMS Coordinator, working at the street level for a hospital Medical Director, responsible for six counties with medical oversight over 600 providers. I went the EMS/LE route into PSD work. I’ve said this before: if you wish employment as a contractor, having EMS creds at the Advance Life Support (ALS) level (EMTI or Paramedic), will sometimes make the difference. Not always, but they are a big boost.

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  3. Good article.
    I’m a bit surprise, what u wrote about practical test.
    I have finished a basic course of first aid in Poland, organised by Malta EMT (smth like paramedics), and we’ve got almost all of these things. At absolutely basic course. I thought, that professional EMT need to learn much more.
    Sorry 4 my english, I’m foreign and it’s late 😛

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  4. Great post! Looking forward to the next part!

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  5. Can’t wait for the next article man, this is what I want to do for a living

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  6. Great post!! The Emergency Care Attendant certification (aka Certified First Responder) is about 40 hours and can be done in a week or on two weekends (at least in Texas). You can then choose to take the National Registry once you take the class. IMHO, if you don’t have any plans on leaving your state, I wouldn’t bother with the NR and just maintain your state certification.

    However, to keep any certification you also must maintain Continuing Education (CE) hours every year. There’s a minimum for each classification but I can’t remember it off the top of my head.

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  7. Good article! I disagree with Brian, ALWAYS get the national certification it opens more doors if needed and is a pain to go get later. EMS is transient employment for a lot of people so national certification is a plus. Instructor certs are key as is a degree of some sort. I am 911 paramedic and TEMS medic and love this website.

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    • Good point, Ben. By all means, definitely get the NR if you’re planning on entering the EMS field. However, if you’re already employed with an agency (ie fire), they may not require you to maintain your NR. Many people fail the National Registry the first time they take it, but if you go through your curriculum book and take note of the learning objectives of each section *hint* *hint*, you’ll do fine. 😉

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  8. Very factual and informative article. I appreciate your help getting the word out on this. Many states (Like mine) need volunteer FIRE/EMS people desperately and a lot of the departments will pay your way through all levels if you will join up.

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  9. Nice article.
    Couple notes, for those coming in from the state level – Different states do things differently, so if you’re looking to get both the NR cert and be cert’d at the state level, be prepared for some differences.
    For example, here in New Mexico, each EMT is licensed by the state – Our certification is the ticket required to sit for the licensure exam. Also at the Basic level here in NM, we are not given clinicals (time working with a service, necessary for certification/license) until the Intermediate level. Thats for NM, and we do funny things… but other states do as well. When you start researching what you’ll be in for on this road, your state EMS Bureau should have all that information very easily available.

    I’m currently back in EMT school, after moving on and letting my Basic license go like an idiot, and enjoying it very much. Not sure why I ever went in another direction.

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  10. +1 for going the Wilderness EMT route. Really great training. I don’t know if this is true or not, but what I’ve heard is that folks who go the W-EMT route through Wilderness Medicine Institute have something like a 90% pass rate on the NREMT exam while people who go the normal, urban EMT-B route have something more like a 75% pass rate. Anyway, I’ve gone through all 3 levels of WMI’s training (Wilderness First Aid, Wilderness First Responder, and Wilderness EMT) and the training has always been top notch.

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    • They told us that during the WEMT course too. I was never actually shown any documentation to back up this claim, but the training was really good and I believe that WMI is probably correct in their assertions.

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  11. In addtion to your EMT several other classes are good to have, specific to combat. TCCC, PHTLS/ITLS Advanced and OEMS, (Operational Emergency Medical Skills) This is a particularily ggod course as its live tissue, which means you work on live pigs. The company that runs it is Deployment Medicine International, or at used to run it,
    Basically any extra classes that give you more knowledge and hands on training in the field of combat casuality care is good to have.

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