We often hear the terms “certification” and “licensure” in the context of practicing EMS in the field, but it is not always clear what separates the two. To make matters worse, the two terms are often used interchangeably, which can increase confusion and make it difficult to understand what needs to be obtained in order to practice in the field.
The federal government defines certification as “the process by which a non-governmental organization grants recognition to an individual who has met predetermined qualifications specified by that organization.”1 Whereas licensure is defined as “the state's grant of legal authority, pursuant to the state’s police powers, to practice a profession within a designated scope of practice.”1 Essentially, licensure is the legal clearance provided to an individual who demonstrates competency within their scope of practice allowing them to legally practice their acquired skillset. On the other hand, certification (by definition), while helpful and sometimes required by various agencies, has no affect on an individual’s ability to legally practice. It simply provides an additional level of testing and approval to ensure competency in a given skillset.
Additionally, it is important to understand whether or not a process is defined as “certification” or “licensure.” For example, if your state says that a certain practice (e.g. acting as an EMS professional) can only legally be provided to an individual with a specified skillset and scope of practice, then that approval process equates to licensure. In the most simple terms, licensure is mandatory while certification is voluntary (again various agencies might mandate certification for their employees, however, it is not mandated at a federal level).
In the context of EMS and for paramedics in particular, all 50 states in the U.S. do require an individual to “pass the NREMT [National Registry for Emergency Medical Technicians] paramedic exam or a state certification exam to become licensed.”2 This means that the NREMT provides a national certification process that is a prerequisite for obtaining licensure. In this instance, while certification still does not provide the legal clearance to practice, it becomes a mandatory means of ensuring a set standard of knowledge and skill level for any individual seeking licensure.
While these terms can be confusing, especially when used incorrectly, it is helpful to understand that certification and licensure processes are often used in conjunction with one another. In this context, the NREMT works closely with the federal licensing process to ensure the public has a standardized level of care in the field.