Basic Life Support (BLS) Levels

Prerequisites for BLS programs in Virginia:

1. Be proficient in reading, writing and speaking the English language.
2. The minimum age for enrollment is 16 years of age at the start of the training program. Students less than 18 years of age attending the course should provide the Instructor with documentation from an Officer of the agency, where applicable, and the signature of a parent or guardian verifying approval of the student attending the course.
3. Have no physical impairment which would render him or her unable to perform all practical skills required for that level of training.
4. Have never been convicted of a felony involving any sexual crime.
5. Not be convicted of any act which is a felony under the laws of this state or of the United States, except that such felon is eligible for certification if within five (5) years after the date of final release no additional felonies have been committed.
6. Shall hold current certification in an approved course in Cardio-Pulmonary Resuscitation (CPR) at the start date of the training program.

NOTE: These minimum requirements also apply for enrollment in all other programs administered by the Virginia Office of E.M.S.

First Responder (4 year certification)

The First Responder Program is a 40 hour (minimum) course intended to provide a basic understanding of human body systems and lifesaving emergency care procedures. This program is designed to be used by individuals such as fire service, industrial and law enforcement personnel who may be the first person to arrive at the scene of a medical emergency.

This course is not primarily intended for individuals whose main duty is the provision of ambulance services. It may however be used as a base level at which individuals are introduced to emergency medical care training.

Training in Cardio-Pulmonary Resuscitation (C.P.R.) for adults, children and infants is a requirement for certification at this and all higher levels in Virginia.

Emergency Medical Technician (4 year certification)

The Emergency Medical Technician (E.M.T.) Program is the basis for all higher levels of certification in Virginia. All providers must be certified at this level before they are eligible to advance to ALS certification. This program provides general instruction in all areas of human body systems and initial care for a wide range of medical conditions. This course requires a minimum of 110 hours of classroom and skills instruction plus 10 hours of clinical observation in a hospital or pre-hospital setting.

Virginia E.M.T. certification is the minimum requirement for provision of patient care as the Attendant-In-Charge on a basic life support ambulance in Virginia.

Advanced Life Support (ALS) Levels

Prerequisites for ALS programs in Virginia:

1. Be at least 18 years of age by the beginning of the training program.
2. Have a current and valid certificate evidencing Emergency Medical Technician certification pursuant to Section 6.0 of the Rules and Regulations Governing Emergency Medical Services.
3. Have a high school diploma or equivalent.
4. Meet any additional requirements set by local medical control.
5. Meet any additional requirements as set by the local regional E.M.S. council or respective E.M.S. agency.

EMT-Enhanced (3 year certification)

The Emergency Medical Technician-Enhanced: Virginia Standard Curriculum represents the minimum required information to be presented within a course that leads to a Virginia EMT-Enhanced certification eligibility. All skills and subjects contained in the curriculum for EMT-Enhanced are covered in a minimum of 80 hours of instruction plus a minimum of 48 hours devoted to extensive clinical rotations in specialty units and field internship. Clinical rotations of this type are not usually available for lower level providers to attend. These additional clinical rotations include time spent in OR/Recovery Units, Critical Care Units, Labor & Delivery Units, Pediatrics, Emergency Department, Family Practice, Mental Health Clinics, Dialysis Clinics, Neurovascular Rehabilitation Clinics, Detoxification Units, and Extended Care Facilities.

It is recognized that there is additional specific education that will be required of the EMT-Enhanced who practices in the field, i.e. ambulance driving, heavy and light rescue, basic extrication, special needs, for example. It is also recognized that this information might differ from locality to locality, and that each training program or system should identify and provide special instruction for these additional training requirements.

Shock trauma technician certifications are presently being phased to the EMT-Intermediate certification. In Virginia, EMT-E's provide a level of care and function within a scope of practice similar to shock trauma technicians.

EMT-Intermediate-99 (3 year certification)

The Emergency Medical Technician – Intermediate 99 Program is designed to certify technicians to a mid-level of pre-hospital advanced life support care in Virginia.  This program fulfills all the requirements of the National Standard Curriculum for the EMT-Intermediate 99.

All skills and subjects contained in the curriculum for Intermediate 99 are covered for a minimum of 272 hours of instruction with a minimum of 50 hours devoted to extensive clinical rotations in specialty units.  In addition to the above, the candidate must complete a minimum of 10 patient contact calls in which they act as the team leader on an ALS ambulance.  Clinical rotations of this type are not usually available for lower level providers.  These additional clinical rotations include time spent in OR/Recovery Units, Critical Care Units, Labor & Delivery Units, Pediatrics, Emergency Department, Family Practice, Mental Health Clinics, Dialysis Clinics, Neurovascular Rehabilitation Clinics, Detoxification Units, and Extended Care Facilities.

The Intermediate 99 Program is designed to educate the technician in the following areas of pre-hospital care:  preparatory skills, airway management and ventilation, patient assessment, trauma, medical, special considerations and assessment based management.

In Virginia, all initial Intermediate 99 Programs are required to satisfy the testing guidelines established by the National Registry of Emergency Medical Technicians.  Upon successful course completion and National Registry EMT – Intermediate 99 certification, the technician must apply for Virginia certification before being allowed to practice at this level.   After receiving Virginia credentials, the Intermediate 99 has the option to maintain National Registry Intermediate certification without affecting their Virginia certification.  However, Virginia certification must be maintained in order to provide patient care at this level in this state.

Cardiac technician certifications are presently being phased to the EMT-Intermediate certification. In Virginia, EMT-I's provide a level of care and function within a scope of practice similar to cardiac technicians.

Paramedic (3 year certification)

The EMT-Paramedic program is designed to certify the technician to the highest level of pre-hospital advanced life support care patient available in Virginia. All of the requirements of the National Standard Curriculum for the EMT-Paramedic are fulfilled by this program.

All skills and subjects contained in the shock trauma technician and the cardiac technician programs are expanded upon in this course for a minimum total of 444 hours of instruction. Of this amount, a minimum of 232 hours are devoted to extensive clinical rotations in specialty critical care units. Clinical rotations of this type are usually not available for lower level providers to attend. These additional clinical rotations include time spent observing and/or assisting in surgery, surgical recovery, burn care center, pediatrics, labor and delivery, and psychiatric treatment.

The paramedic program is designed to educate the technician in all areas of pre-hospital patient care. These courses include instruction in: The prehospital environment, preparatory skills, trauma care, medical illness management, obstetrical/gynecological conditions, pediatrics, neonatal care, psychiatric and behavioral emergencies.

In Virginia, all initial paramedic programs are required to satisfy the testing guidelines established by the National Registry of Emergency Medical Technicians. Upon successful course completion and National Registry EMT-Paramedic certification, the technician must apply for Virginia certification before being allowed to practice at this level. After receiving Virginia credentials, the paramedic has the option to maintain NREMT-P certification without affecting their Virginia certification. However, Virginia certification must be maintained by the Paramedic in order to provide patient care in this state.

Paramedic programs are most often taught at a college or university which is affiliated with a large regional hospital complex. Some courses are available which include paramedic certification as a part of a formal two to four year college program leading to an Associate of Applied Science (A.A.S.) or Bachelor of Science (B.S.) degree. A few of these college based programs also include intermediate level certification(s) before progressing to the Paramedic level.

In contrast, almost all of the non-degree paramedic Programs require current EMT-CT certification as a prerequisite for enrollment. Paramedic programs are primarily conducted in Virginia's urban areas due to greater availability of the many resources and support structures required to maintain continuous course offerings of this type.

Certification at the paramedic level is the prevailing national standard for advanced life support training. Virginia paramedic certification is generally transferrable to other states, although maintaining NREMT-P certification is usually beneficial if you plan to relocate.

EMT-Instructor

Prerequisites for the EMT-Instructor program:

1. Be a minimum of 21 years of age.
2. Hold a current certification as an EMT or higher and have been certified as an EMT for a minimum of 2 years.
3. Be a high school graduate or equivalent.
4. Obtain a minimum score of 85% on a written Instructor Pre-Test examination.
   1. Instructor pretest results are valid for a period of two years from the date of the written examination.
   2. An applicant failing the written pretest is not eligible to retest for a period of 90 days from the date of the examination.
5. An EMT-Instructor candidate shall demonstrate competency during a formal practical pretest examination. An EMT-Instructor candidate shall provide the Office of EMS the following to be eligible for the practical examination:
   1. An EMT-Instructor candidate affiliated with an EMS agency shall be recommended by the EMS physician serving as the agency’s OMD.
   2. An EMT-Instructor candidate who is not affiliated with an EMS agency shall provide both a recommendation from an EMS physician and a statement from the employer or perspective employer attesting to the need for instructor certification to meet the EMS training needs of the organization. (The Office of EMS will provide an OMD/PCD Endorsement Form for this purpose to candidates passing the written pre-test.)
6. An EMT-Instructor candidate shall receive an invitation from the Office of EMS to attend an Instructor Institute after successful completion of all pre-testing.

The EMT-Instructor holds one of the most responsible positions an individual technician may achieve in Virginia. The EMT-Instructor is authorized to instruct each of the Basic Life Support Programs (First Responder and EMT) offered at both the basic (initial) and refresher lengths.

The EMT-Instructor Institute is a four-day program designed to provide training in adult instruction techniques, use of audio-visuals, test construction and skill demonstration. The administrative procedures involved in conducting each BLS program are also included. EMT-Instructor Institutes are conducted three times each year by the Virginia Office of EMS.

Upon successful completion of the written pre-test and practical examination, each instructor candidate is prioritized for selection to attend an instructor institute. Due to space limitations, an individual instructor candidate may not be selected to attend the first Institute conducted after their successful completion of the entry testing process.

Source: Virginia Office of Emergency Medical Services