Licensing

To render patient care within Vermont's EMS system, or instruct an EMS course, a person must hold a current state EMS license or certification.

In Vermont, all initial EMS personnel licenses are based on certification from the National Registry of EMTs (NREMT) and an affiliation with a Vermont-licensed ambulance or first responder agency. A person working at a medical facility providing emergency services may obtain a Vermont EMS personnel license if EMS licensure is a requirement for employment. An instructor is licensed upon completion of training approved by the Vermont Department of Health.

Vermont’s four EMS license levels match the levels of the U.S. Department of Transportation’s National Scope of Practice Model. They are: Emergency Medical Responder (EMR), Emergency Medical Technician (EMT), Advanced EMT (AEMT), and Paramedic. You can find each level’s scope of skills in Appendix 4 of the Vermont Statewide EMS Protocols.

VEFR Certification: In addition to these licenses, a person may obtain a Vermont Emergency First Responder certification.  VEFR is an introductory level certification based on the American Heart Association Heartsaver First Aid CPR/AED certification, and its scope of practice includes bleeding control, basic cardiac arrest management, administration of naloxone and assistance with an inhaler or epinephrine auto-injector.

License and certification applicants must undergo background screening for criminal convictions, tax and child support liabilities and actions taken on other professional licenses. Applicants for personnel licensure at the EMT level or higher must be at least 18 years old.

If you are interested in taking a course to become a Vermont EMS practitioner, consult the EMS Education Resources page. A person who successfully completes a Vermont-approved EMR, EMT, AEMT or Paramedic course and passes the exam will earn a National Registry of EMTs certification. This NREMT certification must be maintained for the duration of your Vermont EMS career.  VEFR certification requires an AHA Heartsaver First Aid CPR/AED certification.

Vermont EMS licenses are timed to expire three months after the NREMT expiration date.  The VEFR certification is timed to expire on December 31st two years after initial certification. See the Supplemental and Continuing Education section of this website for information on renewal requirements. Please note: We cannot guarantee that renewal applications submitted less than 30 days before your expiration date will be processed before your license expires, and you may not practice with an expired license. Early submission of renewal applications is strongly encouraged.

Critical Care Paramedic (CCP) Endorsement

Interfacility transfer (IFT) requires a unique set of skills distinct from the training of most hospital-based or prehospital providers. It is essential that personnel used to provide care during interfacility transfer be properly trained, familiar with the demands of providing care during ground or air transport, legally authorized to perform these skills, and prepared to handle the variety of patient contingencies that may arise during transport. The overriding principle for all aspects of IFT is matching patient needs with adequate provider knowledge and skills, equipment and infrastructure that provide seamless patient flow during transport.

There are several important procedures and medications vital to the safe interfacility transfer of critically ill or injured patients that are beyond the scope of practice for a Vermont Paramedic for which advanced critical care knowledge and skills will be required. The Health Department, therefore, requires specific additional training for Paramedics to provide extended transport of critically ill or injured patients if their clinical needs exceed those otherwise covered by the VT Statewide EMS protocols.

To obtain the new endorsement, a Vermont Paramedic must complete and maintain either the Critical Care Emergency Medical Transport Program (CCEMTP) course credential developed by the University of Maryland Baltimore County (UMBC), or other similar program approved by the Health Department, OR successfully complete and maintain the Board for Critical Care Transport Paramedic Certification (BCCTPC) exam for Critical Care Paramedic Certification (CCP-C), or Flight Paramedic Certification (FP-C).

In addition to providing a course completion certificate or exam certification, the Paramedic will need the endorsement of their District Medical Advisor (DMA) and Head of Service and be affiliated with an EMS agency that has been approved by VT EMS to perform critical care interfacility transfers. On-going credentialing will then be managed at the Agency level with DMA oversight.

Advanced paramedic endorsement

Paramedics that completed critical care training previously in Vermont based on the old scope/curriculum, and operated as such under the old scope, are now called Advanced Paramedics.  There is no mechanism in place to bridge an Advanced Paramedic to the Critical Care Paramedic level. To practice as a Vermont Critical Care Paramedic, the CCEMTP course or CCP-P or FP-C exam must be completed. Current Vermont Advanced Paramedics may continue to function at that level with the continued approval and oversight of the District Medical Advisor and agency until December 31, 2023. At that time, their scope of practice will revert to the Paramedic level unless they obtain a Critical Care Paramedic certification and state endorsement.

Personnel License Application Process

1. Create or log into your account on the Vermont EMS LIGHTS Public Portal
2. Go to Applications in the left-hand navigation menu and select the appropriate application.

Instructor/Coordinator Licenses

Vermont licensed EMS personnel may become eligible for EMS Instructor/Coordinator licensure by:

1. Showing evidence of one of the following:
   1. Successful completion of a 40-hour Vermont Department of Health-sponsored instructor/coordinator course; or
   2. Successful completion of a public safety instructor/coordinator course approximately 40 hours in length; or
   3. Successful completion of Modules 1 and 2 of a National Association of EMS Educators (NAEMSE) instructor/coordinator course; or
   4. A Bachelor’s or higher degree in education; or
   5. A current Vermont state teacher’s license
2. Completing the Vermont EMS Instructor/Coordinator 1-day bridge course sponsored by the Vermont Department of Health (not required for method 1(a) above);
3. Participating in a peer-mentored instructional program, including lecture evaluations
   1. A minimum of 4 hours of peer-mentored observation is required. Additional information will be provided during the I/C Bridge course program.
   2. Additional hours of observation, coaching and remedial education may be required to ensure competency based on the candidate’s performance evaluations.
   3. Holding a current Vermont EMS license and affiliation with a Vermont-licensed EMS agency or medical facility that requires you to hold EMS licensure.

Instructor/Coordinator License Application Process

1. Log into your account on the Vermont EMS LIGHTS Public Portal
2. Go to Applications in the left-hand navigation menu and select Instructor/Coordinator Initial License application.

Challenging the Licensing Exam – RNs, PAs, Military Medics

Registered nurses, physician assistants, hospital corpsmen/medics in the United States Armed Services and veterans who served in these roles may obtain a National Registry certification and a Vermont EMS license at any level without first taking an EMS course when a National Registry Program Director (Vermont Instructor/Coordinator) attests to NREMT that the candidate’s prior training meets the education standards of the desired license level. 

Exam Challenge Application Process

1. Connect with a Vermont licensed Instructor/Coordinator – your district training coordinator can assist with this. All I/Cs are also National Registry Program Directors, and they will be responsible for verifying to the Registry that you have completed the necessary training to qualify for the exams.
2. The I/C will evaluate your prior medical education as compared to the EMS scope of practice, identify any gaps, and then deliver the gap education, if applicable.
   After completing this assessment and additional training, create a National Registry account and initiate a certification application. Choose your I/C as your Program Director. The I/C will then verify your “course completion”, and you can register for the National Registry cognitive exam.
3. For the practical exam, you must complete a Practical Exam Registration Application in the Vermont LIGHTS system. The I/C or the VTEMS website will provide a list of available practical exam sites. 
4. Upon obtaining your National Registry certification, apply for your Vermont license with the LIGHTS system.

Initial EMS Agency License

Before you apply for an initial agency license, please consult the Vermont EMS Rule. EMS Rule 4.0 describes Ambulance Agency licensing requirements and EMS Rule 5.0 covers First Responder Agency licensing.

Prior to submitting your application:

1. Meet with your EMS District Board of Directors
2. Run a public notice in a publication covering your proposed service area announcing your intentions to offer emergency medical services
3. If you are applying for a first responder (non-patient transport) agency, enter into an operational letter of agreement with the primary ambulance agency covering your service area

In addition to the licensing requirements promulgated in EMS Rule 4.0, all licensing applicants should contact the Green Mountain Care Board to request a Jurisdictional Determination related to your proposed project regarding a Certificate of Need. The Certificate of Need process is separate from EMS’s licensing procedures, and EMS cannot determine if an applicant will be required to obtain a Certificate of Need. Please refer to the Green Mountain Care Board’s website for information regarding the Certificate of Need process or contact the Green Mountain Care Board at 802.828.2177.

Application process

1. Create or log into your account on the Vermont EMS LIGHTS Public Portal
2. Go to Applications from the left-hand navigation menu
3. Submit an Agency License Application – Initial Contact Form
4. You will receive an email confirmation with a prompt to begin the full application
5. Upon submission, your application will be reviewed by the EMS District Board of Directors and the District Medical Advisor for their recommendation. 
6. The Vermont Department of Health will review your application and the recommendations of the EMS District.
7. Upon approval, your agency will be issued a license for the remainder of a three-year cycle.   

Renewing an EMS Agency License

1. Prior to September of the final year in the license cycle, log into your account on the Vermont EMS LIGHTS Public Portal
2. Go to Applications in the left-hand navigation menu, click on the View Service Applications button, then select the Agency License Renewal application.
3. The Vermont Department of Health will review your application and the recommendations of the EMS District.
4. Upon approval, your agency will be issued a three-year license.

Changing an EMS Agency License Level

Agency license level changes need the approval of the EMS District Board and District Medical Advisor. To upgrade to a higher license level, an agency must demonstrate that it has the necessary equipment, supplies, medications and access to training to support operations at the new license level.  Additionally, the agency must demonstrate it continues to meet all requirements outlined in EMS Rule 4.5 (ambulance agencies) or EMS Rule 5.4 (first responder agencies), which include maintaining adequate insurance coverage and checking its members and employees in the Vermont Crime Information Center database, the Adult Abuse Registry and the Child Protection Registry.  Finally, the agency must run a public notice in a local newspaper to allow community members to comment on the proposed license level change. 

NOTE: You cannot use this application to obtain a Critical Care Paramedic agency endorsement (See the Agency Critical Care Paramedic Endorsement section.)

License level change application process

1. Log into your account on the Vermont EMS LIGHTS Public Portal
2. Go to Applications in the left-hand navigation menu, click on the View Service Applications button, then select “Agency License Level Change Application.”  
3. The Vermont Department of Health will review your application and the recommendations of the EMS District.
4. Upon approval, your agency will be issued a license for the remainder of a three-year cycle.

Agency Critical Care Paramedic Endorsement

EMS agencies that wish to operate within the Critical Care Paramedicine scope of practice must submit protocols to their District Medical Advisor and the Health Department for approval. Once these CCP protocols are approved and credentialing is completed, agencies may begin to practice under these guidelines.

Note that there are some procedures or medications that will require an additional waiver from the Health Department and therefore are not likely skills that all new Vermont Critical Care Paramedics will engage in. The list of procedures and medications in the CCP scope of practice was developed with the assistance of the IFT workgroup, District Medical Advisors, and input from EMS Heads of Services and Emergency Department Directors. You can find the list in Appendix 5 of the Vermont Statewide EMS Protocols.

Agency critical care paramedic endorsement process

1. Log into your account on the Vermont EMS LIGHTS Public Portal
2. Go to Applications in the left-hand navigation menu, click on the View Service Applications button, then select “Critical Care Paramedic Endorsement (Agency)” 
3. The Vermont Department of Health will review your application and the recommendations of the EMS District.
4. Upon approval, your agency will be issued a CCP endorsement for the remainder of a three-year cycle.

All Vermont-based ambulances must be licensed by the Vermont Department of Health. An ambulance license is issued to a specific vehicle for a specific agency for a period of two years. If the ambulance is transferred to another EMS agency, it must be relicensed.

To be licensed as an ambulance in Vermont, a vehicle must meet all Department of Motor Vehicles inspection requirements, be equipped in compliance with the Vermont Ambulance Equipment List and conform with federal design requirements (see the Ambulance Design Requirements section below).

Ambulance Design Requirements

All ambulances must meet the applicable federal and state safety requirements, including those described by the Code of Federal Regulations, Federal Register, Society of Automotive Engineers, Vermont Statutes as of the date of manufacture, and the annual inspection required by the Vermont Department of Motor Vehicles.

Licensed ambulances must also conform to the design specifications established and updated one year prior to the date of manufacture by one of the following:

• The National Fire Protection Association 1917-2016 standard
• The Commission on Accreditation on Ambulance Services GVS v 1.0; or
• The General Services Administration KKK-A-1822F standard (NOTE: Since initial publication of this document, the GSA has issued a number of Change Notices with updated requirements for ambulance design.)

Temporary Ambulance Licenses

When an agency acquires a new or used ambulance, it must apply to the EMS office for a temporary license. Once the application is approved, the agency may operate the vehicle as an ambulance until it is inspected by an EMS office representative.

Temporary Ambulance License Application Process

1.  Log into your account on the Vermont EMS LIGHTS Public Portal
2. Go to Applications in the left-hand navigation menu, then click on the View Service Applications button.
3. Select the Temporary Ambulance Vehicle License application
4. To remove an ambulance vehicle from your agency’s record, select the Removal of Ambulance Vehicle from Fleet application.

Ambulance Inspections

At least once every two years, the EMS Office inspects each ambulance to be sure that it is safe, clean, and otherwise in conformity with regulations, using a standard equipment list. The inspection includes reviews of the vehicle's insurance, registration, and maintenance records.