Licensing

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.

To qualify for an Advanced EMT or Paramedic course, a person must have a current state EMT license or a National Registry of EMTs certification.

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.

Continuing Education Requirements - EMR, EMT, AEMT, Paramedic

Vermont EMS practitioner license renewal requirements mirror those of the National Registry of EMTs. Most of Vermont’s EMS practitioners hold a National Registry of EMTs certification and meet Vermont’s continuing education requirements by renewing that certification. Current practitioners who never held NREMT certification must also meet the NREMT renewal requirements and document their training on their Vermont license renewal application.

Continuing Education Requirements - Vermont Emergency First Responder

To renew a VEFR certification, a person must maintain their American Heart Association Heartsaver First Aid CPR/AED certification (or equivalent) and complete continuing education on the following topics:

• Workforce Safety and Wellness - 2 hours
• EMS System Communications - 1 hour
• Medical/Legal and Ethics - 1 hour

NREMT - National Continued Competency Program

Vermont has used the NREMT’s National Continued Competency Program (NCCP) as its model for continuing education since July 2015. The foundation of this program is continuous quality improvement, lifelong learning and individual self-assessment.

The NCCP started in 2010 when a multi-disciplinary task force consisting of representatives from major regulatory, medical oversight and operational components of EMS met to consider revisions to the NREMT recertification process. The result is a program that evolves over time and allows states, the local EMS community and individual EMS practitioners to choose topics that are most relevant to their educational needs.

There are three components of the National Continued Competency Program. Half of the hours are determined by the NREMT, a quarter are chosen at the State and Local levels and the remaining quarter are chosen by each EMS practitioner based on their interests and self-assessment of educational needs.

The National Registry of EMTs has produced educational guides for each level:

• NREMT Educational Guide - EMR
• NREMT Educational Guide – EMT
• NREMT Educational Guide - AEMT
• NREMT Educational Guide – Paramedic

National Requirements of the National Continued Competency Program

The national requirement topics of the National Continued Competency Program are selected by the National Registry of EMTs based on input from EMS researchers, physicians and practitioner stakeholders and are updated every five years. Topics are chosen from evidence-based medicine and scientific position papers aimed at improving patient care, particularly tasks with low frequency but high criticality.

State/Local Requirements of the National Continued Competency Program

A portion of Vermont’s state and local requirement topics are determined by the EMS office based on state-specific training needs. The remaining hours are determined at the district and/or agency level.

Individual Requirements of the National Continued Competency Program

The remaining portion of each EMS practitioner’s continuing education is determined by the practitioner based on their own areas of interest or possible weakness. Any training that relates to the clinical or operational functions of an EMS practitioner at their license level qualifies for continuing education in this section.

The Statewide EMS Protocols represent the work of all 13 District Medical Advisors, numerous stakeholder groups and a multitude of EMS practitioners, agencies and districts across the state. Wherever possible, protocol updates have been guided by the most recent and best evidence-based EMS literature.

EMS Protocol Education

EMS Protocols (2025) Any mobile device user may choose to download the Vermont Statewide EMS Protocols from this website directly to their phone, to be kept in the file section of their device. In this manner, you can access the hyperlinked protocol document at any time, with or without cellular connectivity.

Ready, Check, Inject

The Ready, Check, Inject program provides a simple, safe and cost-effective alternative to epinephrine auto-injectors and allows trained Emergency Medical Technicians (EMTs) to withdraw epinephrine from a vial and inject the medication intramuscularly.  Ready, Check, Inject is not intended to take the place of autoinjectors; epinephrine auto-injectors are still considered the preferred method of medication administration in anaphylaxis.   

Equipment Requirements

To administer intramuscular epinephrine at the EMT level, an agency must stock:

• 1 mL vials of 1 mg/1 mL (1:1000) concentration epinephrine
  • Larger volume vials and syringes are not allowed at the EMT level
• 1 mL syringes with an accompanying 1-inch intramuscular safety needle
• Ready Check Inject Safety Card
  • Serves as a cross-check reference to prevent medication error
  • Contents are detailed in the Ready Check Inject training document
  • To obtain cards, email the EMS Office with your required amount

NOTE: Consider separating this specific equipment from other ALS supplies to prevent confusion.  Please see the equipment checklist for the complete list of required items.

Training and Credentialing

EMS agencies must credential their EMT level providers to use the new protocol using a two-step process.  Providers will watch a narrated Power Point on CentreLearn (individually or as a class) and then complete an agency-led practical training session overseen by the agency’s or district’s training coordinator. Competency must be confirmed by a licensed practitioner at the AEMT or Paramedic level using the skill sheet included in the training program. Documentation of training and competency verification should be kept on file by the agency. 

Rapid Sequence Intubation

Rapid Sequence Intubation (RSI) is an advanced airway skill only available to Paramedics with additional training, medical direction oversight and participation in an educational and Continuous Quality Improvement (CQI) program approved by the Department of Health.

•  Vermont EMS Rapid Sequence Intubation Course Manual 

For more information about RSI, contact EMS Medical Director Dr. Dan Wolfson.

Training Officer Resources

VT EMS Agency Level Training Officer Guidance Document

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

Additional Resources

• AEMT Testing and Licensing Information: This document guides AEMT instructors on course completion requirements, preparing students for National AEMT testing and applying for Vermont AEMT licensure.
• NASEMSO Advanced Emergency Medical Technician Student Minimum Competency Model Guideline: Additional information about AEMT Competency Guidelines.
• EMS Student Manual: This manual provides important information to students in initial EMS courses about course logistics and prepares them for examinations and licensure.
• Course Medical Director Qualifications
• Peer Mentor Evaluation Form - Presentation (I/C Bridge Course): Use this form if you are an existing Instructor/Coordinator who is mentoring/evaluating a student in an I/C Bridge Course. A separate form must be completed for each presentation the I/C Bridge candidate leads.
• Peer Mentor Evaluation Form - Comprehensive (I/C Bridge Course): Use this form if you are an existing Instructor/Coordinator who is mentoring/evaluating a student in an I/C Bridge Course. This form is to be completed as an overall assessment of the candidate after he or she has delivered all presentations.
• Vermont EMS Rapid Sequence Intubation Course Manual: This manual outlines the RSI education and CQI program requirements for both RSI paramedics and RSI assistants.

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

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.

Introduction for First Time Users

Introduction for Training Officers

Introduction for Practical Exam Coordinators

Introduction for District Chairs

Introduction for Instructor Coordinators

Introduction for Heads of Service

Introduction for District Medical Advisors

Continuing Education