Paramedic (PM)

Occupational Statement:

A GEMR certified Paramedic (PM) is to provide advanced emergency medical care and transportation for emergent patients who access the emergency medical system. The Paramedic is a physician extender whose primary focus is to provide advanced emergency medical care for critical and emergent patients who access the emergency medical system. This individual possesses the complex knowledge and skills necessary to provide patient care and transportation for emergent patients.

Paramedics function as part of a comprehensive EMS response, under medical oversight. Paramedics perform interventions with the basic and advanced equipment typically found on an advanced life support ambulance or response vehicle. The Paramedic is an important link in the health care system.

The duties of a GEMR certified Paramedic include:

A Paramedic (PM) may, under the direction of a Physician Medical Director, may:

Perform all procedures that an Advanced Emergency Medical Technician may perform.
Initiate the following airway management techniques:
1. Endotracheal intubation.
2. Needle Cricothyroidotomy.
3. Surgical Cricothyroidotomy,
4. Transtracheal jet insufflation.
5. Suctioning of the airway, beyond the oral cavity.
6. Remove airway foreign bodies by direct techniques.
7. Perform tracheostomy reinsertion.
Initiate, manage, utilize Continuous positive airway pressure (CPAP).
Initiate, manage, utilize Bilevel positive airway pressure (BIPAP).
Initiate, manage, utilize High flow nasal cannula therapy (HFNCT).
Initiate, manage, utilize Positive End Expiratory Pressure (PEEP).
Initiate, manage, utilize Manometry.
Initiate, manage, utilize Quantitative waveform Capnography (EtCO2).
Initiate, manage, utilize mechanical ventilators to provide ventilatory support/strategy.
Initiate intraosseous needle placement and maintain an intraosseous infusion.
Initiate, manage, utilize, interpret 3, 5, 6, 12, and 24 lead electrocardiogram devices, strips, reports, and findings.
Provide advanced life support in the resuscitation of patients in cardiac arrest.
Perform emergency cardioversion.
Perform external transcutaneous pacing of bradycardia.
Perform electrocardiographic interpretation.
Initiate needle thoracostomy.
Access indwelling catheters and implanted central IV ports for fluid and medication administration.
Initiate, manage, utilize urinary catheters.
Maintain ostomy drainage systems.
Initiate, manage, utilize non-catheter urinary drainage systems
Maintain, monitor, adjust, replace chest tube drainage systems.
Initiate or perform tissue and minor wound care.
Initiate, manage, utilize wound closing techniques and systems.
Initiate, manage, perform fracture care and reduction of dislocations absent distal circulation.
Prepare and administer blood products for emergency transfusion.
Prepare and administer routine or emergency immunizations and tuberculosis skin testing, as part of an EMS Agency’s occupational health program, to the EMS agency personnel, under the Medical Director’s standing order.
Initiate, Perform, and Interpret the Bedside Lung Ultrasound Exam (BLUE) and Rapid Ultrasound in Shock (RUSH) exams with point of care ultrasound.
Prepare and initiate or administer any medications under specific written protocols authorized by the Medical Director, or direct orders from a licensed transferring physician.

The Global Emergency Medical Registry (GEMR) is honored to serve this healthcare workforce with an international standard certification following education, competency evaluation, and testing.

The GEMR Paramedic (PM) Certification is designed to provide industry, governments, regulators, and administrations with a third-party certification for this level of healthcare provider around the globe which is referenceable and can be checked via the gemr.org “Verify Certification or Endorsement” box on the GEMR Home Page.

Paramedic – Initial Candidate Information for Certification

The following section discusses the process for the new graduate of a paramedic educational program to obtain GEMR certification.

Pre-Certification Educational Outcomes:

Upon completion of a program of education, the candidate will:

Be a minimum of 18 years old.
Be prepared for and eligible to take the GEMR Written Examination and skills process to obtain certification from The Global Emergency Medical Registry (GEMR).
Be prepared to upload all Paramedic skills sheets with physician or instructor signature, indicating compliance to the standard during examination of that skill.
Have completed a program of Paramedic education within the past 18 months, which the program attests to meet the objectives and requirements outlined for the certification level and be prepared to upload all educational records to GEMR.
Have a current GEMR (or equivalent) Emergency Medical Technician certification.
Have a current Healthcare Provider level CPR certification from an organization which meets all International Liaison Committee on Resuscitation (ILCOR) standards and upload the certification to GEMR.
Have a current Advanced Cardiac Life Support (ACLS) certification from an organization which meets all International Liaison Committee on Resuscitation (ILCOR) standards and upload the certification to GEMR.
Have a current Pediatric Advanced Life Support (PALS) certification from an organization which meets all International Liaison Committee on Resuscitation (ILCOR) standards and upload the certification to GEMR.
Have a current Trauma education program certification which meets all GEMR standards and uploads the certification to GEMR.

Pre-Educational Recommendations:

GEMR strongly recommends that people planning to attend educational programs teaching to the GEMR Paramedic Standard have a strong background in anatomy and physiology, chemistry, biology, and mathematics. At a minimum, GEMR recommends participants interested in Paramedic level education have completed the following minimum education courses:

Anatomy and Physiology sequence (college level).
Basic mathematics (college level).
Biology (college level).
Chemistry (college level).

Educational Program Expectations:

Educational programs, to meet the GEMR Paramedic objectives, must have a minimum of 2,000 hours of training in the following minimum hours per phase of the educational program the candidate attended:

Didactic:

600 hours

Practical and Skills Lab:

200 hours

Clinical Experience Rotations:

600 hours under the supervision of a mid-level practitioner and/or Physician preceptor, in a clinical setting, where the student is performing skills at the scope of practice for a GEMR Paramedic, with skills sheet or skills log completed for each objective or skill performed to the standard. Scheduled according to hospital or health center availability and typically consists of pre-scheduled eight, ten, or twelve-hour shifts to accommodate the clinical staff and area of placement for each rotation. Students must be available for clinical scheduling at any time during this portion of the program.

The clinical rotations will include a minimum of the following:

100 hours	Emergency Medicine Department
100 hours	Anesthesia (Endotracheal Intubation, Sedation, and Airway Management)
100 hours	Adult Critical Care/Intensive Care
40 hours	Obstetrics/Labor and Delivery
40 hours	Pediatric Clinical Care
40 hours	Pediatric Critical Care
40 hours	Orthopedics
40 hours	Emergency Psychiatry and Crisis Intervention
30 hours	Geriatrics
30 hours	IV Therapy
40 hours	Critical Burn and Wound Care (Burn Unit or Center)

The student must document the following minimum skills accomplished during practical or clinical rotations, performed on patients while supervised (all skills must have an approval signature from a clinical supervisor):

100 Medication administrations – IV route
25 Medication administrations – IV infusion
25 Medication administrations – IM or SQ route
25 Medication administrations – Nebulized route
25 Medication administrations – Oral route
150 Intravenous Access
- Minimum of 25 Large bore above the diaphragm
- Minimum of 25 Pediatric
50 Endotracheal Intubations
- Minimum of 5 Pediatric
25 Supraglottic Airway Placements
- Minimum of 5 Pediatric
100 Patient ventilation management via BVM
25 Patient ventilator management
50 Patient sedation procedure
50 Patient monitoring – Anesthesia
50 Patient monitoring – Critical Care
50 Patient Assessment, History, Physical – Emergency
50 Patient Assessment, History, Physical – Anesthesia
50 Patient Assessment, History, Physical – Pediatric
20 Patient Assessment, History, Physical – Psychiatric
20 Patient Assessment, History, Physical – Geriatric
20 Patient Assessment, History, Physical – Critical Care
20 Patient Assessment, History, Physical - Obstetrics
10 Orthopedic Procedures
10 Childbirth Procedures
- Minimum of one the student performed the delivery
5 Synchronized Cardioversion
5 Transcutaneous and/or Transvenous Pacing
5 Defibrillation
5 Managed Emergency Department Patient Care
5 Managed Pediatric Patient Care
5 Managed Anesthesia Patient Care
5 Managed Critical Care Patient Care

Students may work with nursing professionals during clinical rotations but must be supervised/oversighted by a midlevel practitioner and/or physician. A nursing professional may attest to skills performance on student documentation forms and may assist with the supervision of the student during skills performance.

During this clinical experience phase of education, the student must also participate in a group research and practice discussion with topical review with other cohort students, led by an instructor, on emergency medicine research, this cohort should meet a minimum of 2 hours every two weeks during this phase of education.

Internship:

600 hours under the supervision of a Paramedic (or higher-level EMS certification) and/or Physician Field Training Officer (FTO) in a clinical setting, with daily observation reports done at the end of each workday; all hours must be on an emergency medical services advanced life support (ALS) ambulance. The 600 hours must include a minimum of 150 documented patient contacts in which the candidate provided care within the Paramedic scope of practice.

Minimum Educational and Examination Objectives:

The Global Emergency Medical Registry (GEMR) establishes minimum standard educational objectives for the registry levels. The following are the current minimum educational objectives for an initial Paramedic (PM) education program, the registry written examinations and psychomotor examinations are created from these objectives. GEMR Paramedic Objectives comply with current recommended objectives for paramedic education from the NHTSA’s Office of EMS National EMS Education Standards and National Standard Curriculum, the PERRs Canadian Paramedic Competence Framework for the Advanced Care Paramedic.

Click here for the PDF of the 2025 Paramedic Educational Objectives

Responsibilities of Registry Certified Personnel:

Certified personnel must notify the Registry within 30 days regarding the following matters:

Change in mailing address (the best way to update a mailing address is by editing your account profile)
Any criminal conviction.
Disciplinary action taken by any agency having jurisdiction (or government body) that has resulted in suspension, revocation, or expiration of registration/licensure; termination of right to practice; voluntary surrender of registration/licensure while under investigation.

The Registry considers the individual to be solely responsible for their certification and reporting, any failure to follow process or report as required is solely the failure of the certified person and may result in immediate dismissal of their certification, as well as, immediate notification to any pertinent regulatory agency of their dismissal.

Disciplinary Policy and Rights of Appeal for The Registry can be found on The Registry website.

GEMR Required Skills Attestation for Initial Certification:

All initial Certification Candidates must upload the following skills sheet documentation forms (located at www.gemr.org/library/), signed by the medical director or Course Director, to their transcript page of their profile by creating a “Skills Documentation” course in their transcript and uploading all the following:

Bag Valve Mask Ventilation
Bleeding Control (BLS)
Bleeding Control Combat Application Tourniquet
Blood Glucose Assessment
Bradycardia (Block)
Bradycardia (Sinus Brady)
Cardiac Arrest Ventricular Fibrillation (ALS)
Cardiac Arrest Pulseless Electrical Activity (ALS)
Cardiac STEMI (ALS)
Cardiac Tachyarrhythmia stable (ALS)
Cardiac Tachyarrhythmia unstable (ALS)
Continuous Positive Airway Pressure (CPAP)
Cricothyrotomy (Percutaneous Cricothyrotomy /Transtracheal Jet Insufflation)
Cricothyrotomy (Surgical with Scissor/Tracheal Tube Inducer)
ECG Limb and 12 Lead Acquisition
Endotracheal Intubation in Cardiac Arrest
Endotracheal Intubation with Medication (RSI)
Hand Washing
Intravenous Access
Medication by Auto Injector
Medication by Intramuscular and Subcutaneous Injection Routes
Medication by Intranasal Route
Medication by Intravenous Route
Medication by Nebulization Route
Medication by Oral Chewable Route
Medication by Oral Gel Route
Medication by Oral Route
Medication by Rectal Route
Nasal Pharyngeal Airway
Oral Pharyngeal Airway
PPE Donning and Removing Gloves and Gown
Physical Exam (Adult)
Physical Exam (Pediatric)
Quantitative Waveform Capnography
Respiratory Case (Possible Infectious Disease)
Respiratory Case (Reactive Airway Disease)
Shock Case (Hemorrhagic)
Shock Case (Septic)
Spinal Immobilization ALS Case (IMMO Protocol for Spinal Injury #1)
Supraglottic Airway Respiratory Arrest
Sync Cardioversion
Thoracostomy (Simple)
Transcutaneous Cardiac Pacing
Trauma – Cardiac Arrest
Trauma – Extremity Trauma with Hypotension
Trauma – Polytrauma with hypotension and hypoxia
Trauma – Traumatic Brain Injury

GEMR Written Examination:

At the conclusion of initial training, the candidate must complete their profile on gemr.org, upload all skills sheets, CPR certification, certificate or diploma, and highest level of education completion certificate to their skills and transcript area of their profile.

The candidate will then receive an invitation to test for the GEMR Online Testing System, the candidate must score a minimum of 85% to show compliance with the standard and successfully complete the examination process.

Initial Certification Completion:

Once all the above steps have been completed, and the candidate has been audited and completed the GEMR Exam with a score of 85% or greater, the candidate will be able to complete their registration payment and receive their certification.

Paramedic (PM) - Renewal Certification:

The GEMR Certification expires two years from the time of initial certification. During that two-year period, the certified individual must complete the following process to renew their certification.

GEMR Required Continuing Medical Education:

The certified individual must complete, document, and upload to their GEMR profile transcript the following continuing medical education (CME), prior to the end of their certification period. All CME must be from an accredited organization and the CME certificate must include the topic, the number of hours, the date, the instructor or course director, the name of the organization and contact information, as well as the CME certificate must bear the accreditation logo(s) and accreditation number for the educational program. A maximum of fifty percent (50%) of the CME may be done online.

The following 65 hours are the required CME for Paramedic Renewal:

3.5 hours	Airway, ventilation, capnography, and oxygenation.
8.5 hours	Cardiovascular (Cardiac arrest, post cardiac arrest, ventricular assist devices, cerebrovascular accident, congestive heart failure, acute coronary syndromes).
7 hours	Trauma (Trauma triage, hemorrhage, central nervous system, special needs, fluid resuscitation, blood administration, trauma assessment, chest trauma, orthopedic trauma).
9 hours	Medical (Special healthcare needs, OB emergencies, Infectious disease, Pharmacology, Medication delivery, Pain management, Psychiatric and behavioral emergencies, Toxicological emergencies, Neurological emergencies, Endocrine emergencies, Immunological emergencies).
7 hours	Operations (At risk populations, ambulance safety, casualty incidents, EMS safety, EMS hygiene, Vaccines, Culture of safety).
15 hours	Medical Director required content topics.
15 hours	Country/State/Local/Agency Having Jurisdiction (AHJ) required content topics.

GEMR Required Skills Attestation:

The GEMR Certified Paramedic must complete their skills documentation on their profile page, and those skills must be attested to by a medical director or designee through their own GEMR profile, all the following skills competencies are required for renewal:

Bag Valve Mask Ventilation
Bleeding Control Combat Application Tourniquet
Bradycardia (Block)
Bradycardia (Sinus Brady)
Cardiac Arrest Ventricular Fibrillation (ALS)
Cardiac Arrest Pulseless Electrical Activity (ALS)
Cardiac STEMI (ALS)
Cardiac Tachyarrhythmia stable (ALS)
Cardiac Tachyarrhythmia unstable (ALS)
Continuous Positive Airway Pressure (CPAP)
Cricothyrotomy (Percutaneous Cricothyrotomy /Transtracheal Jet Insufflation)
Cricothyrotomy (Surgical with Scissor/Tracheal Tube Inducer)
ECG Limb and 12 Lead Acquisition
Endotracheal Intubation in Cardiac Arrest
Endotracheal Intubation with Medication (RSI)
Intravenous Access
Medication by Auto Injector
Medication by Intramuscular and Subcutaneous Injection Routes
Medication by Intranasal Route
Medication by Intravenous Route
Medication by Nebulization Route
Medication by Oral Chewable Route
Medication by Oral Gel Route
Medication by Oral Route
Medication by Rectal Route
Nasal Pharyngeal Airway
Oral Pharyngeal Airway
PPE Donning and Removing Gloves and Gown
Physical Exam (Adult)
Physical Exam (Pediatric)
Quantitative Waveform Capnography
Respiratory Case (Possible Infectious Disease)
Respiratory Case (Reactive Airway Disease)
Shock Case (Hemorrhagic)
Shock Case (Septic)
Spinal Immobilization ALS Case (IMMO Protocol for Spinal Injury #1)
Supraglottic Airway Respiratory Arrest
Sync Cardioversion
Thoracostomy (Simple)
Transcutaneous Cardiac Pacing
Trauma – Cardiac Arrest
Trauma – Extremity Trauma with Hypotension
Trauma – Polytrauma with hypotension and hypoxia
Trauma – Traumatic Brain Injury

GEMR Written Examination:

No written exam is required for renewal certification

Renewal Certification Completion:

Once all the above steps have been completed, and the candidate has been audited, the candidate will be able to complete their registration payment and receive their certification.

Reciprocity:

A person with one, or more, of the following, may apply for GEMR Paramedic certification through reciprocity:

The candidate who holds a current certification with the National Registry of Emergency Medical Technicians (NREMT), at this level or higher, may apply for reciprocity at this level; current CME training and skills confirmation requirements must meet the CME requirements and scope of practice listed for this level of care. NREMT NRP candidates should anticipate demonstrating additional skills beyond the NRP level.
The candidate who holds a current license with a Province of Canada, at Advanced Care Paramedic level or higher, may apply for reciprocity at this level; current CME training and skills confirmation requirements must meet the CME requirements and scope of practice listed for this level of care.
The candidate who holds a current license with a Freely Associated State of the United States, at this level or higher, may apply for reciprocity at this level; current CME training and skills confirmation requirements must meet the CME requirements and scope of practice listed for this level of care.
The candidate who holds a current license with a State in the United States, at this level or higher, may apply for reciprocity at this level; current CME training and skills confirmation requirements must meet the CME requirements and scope of practice listed for this level of care.
The candidate who holds a current registration with the Paramedicine Board of Australia (PBA), at the MICP level or higher, may apply for reciprocity at this level; current CME training and skills confirmation requirements must meet the CME requirements and scope of practice listed for this level of care.
The candidate who holds a current certification with the Pre-Hospital Emergency Care Council (PHECC), at this level or higher, may apply for reciprocity at this level; current CME training and skills confirmation requirements must meet the CME requirements and scope of practice listed for this level of care.
The candidate who holds a current certification with the Health & Care Professionals Council (HCPC), at this level or higher, may apply for reciprocity at this level; current CME training and skills confirmation requirements must meet the CME requirements and scope of practice listed for this level of care.
The candidate who holds a current certification with the Health Professions Council of South Africa (HPCSA), at this level or higher, may apply for reciprocity at this level; current CME training and skills confirmation requirements must meet the CME requirements and scope of practice listed for this level of care.
The candidate who holds a current position with the National Fire Agency of Korea (NFA) and has completed the national examination process, at this level or higher, may apply for reciprocity at this level; current CME training and skills confirmation requirements must meet the CME requirements and scope of practice listed for this level of care.
The candidate who holds a federal or state qualification in Germany (Rettungssanitäter, Notfallsanitäter/Notfallsanitäterin), at this level or higher, may apply for reciprocity at this level; current CME training and skills confirmation requirements must meet the CME requirements and scope of practice listed for this level of care.

The candidate must upload all CME and skills confirmation to their profile skills, CME, and transcript sections for consideration at this level of certification. Additionally, the candidate must upload a front and back copy of their current Paramedic license or certification.

In addition to the above, the candidate must show they have met all requirements for Certification Renewal at the time of application; if they are unable to do so, they must follow the initial application for certification process.