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In the United States, the licensing of prehospital emergency medical providers and oversight of emergency medical services are governed at the state level. Each state is free to add or subtract levels as each state sees fit.
The United States EMS Compact, officially known as the Recognition of EMS Personnel Licensure Interstate CompAct (REPLICA), is an interstate compact designed to facilitate the day-to-day practice of emergency medical services personnel across state lines. The compact provides a framework for states to extend a "privilege to practice" for ...
The Department of Labor and Industries was created by an act of the state legislature in 1921, overseeing industrial insurance, worker safety, and industrial relations. [2] [3] The new agency superseded the Bureau of Labor, created in 1901 to inspect workplaces, and minor state boards and commissions monitoring worker health, safety, and insurance claims.
The earliest ambulances were usually accompanied by a physician on emergency call. [2] However, by the 1960s, ambulance services, while becoming ubiquitous, were poorly supported and staffed and unevenly trained. 50% of the ambulance services were provided by morticians, primarily because their hearses were able to accommodate patients on litters. [2]
National EMS standards for the US are determined by the U.S. Department of Transportation and modified by each state's Department of EMS (usually under its Department of Health), and further altered by Regional Medical Advisory Committees (usually in rural areas) or by other committees, or even individual EMS providers.
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An EMS provider's post-nominal (listed after the name) credentials usually follow his or her name in this order: Highest earned academic degree in or related to medicine, (e.g. "MD") Highest licensure or certification (e.g. "NRP")
Nationally Registered Emergency Medical Responder (NREMR): This is the entry level into emergency medical services (EMS). They are trained in CPR, advanced first aid, automated external defibrillator usage, and patient assessment. Most police and fire services require their employees to be emergency medical responders at a minimum.