In April 2025, North Carolina introduced House Bill 675, a proposal that aimed to standardize EMS certification across the state by requiring National Registry of Emergency Medical Technicians (NREMT) certification for all EMS personnel. Although the bill has since been withdrawn from committee, it sparked significant discussion within the EMS community about the future of credentialing in North Carolina. 

Overview of the Bill 

HB 675 proposed that, beginning January 1, 2026, all individuals seeking EMS credentials in North Carolina including emergency medical responders, emergency medical technicians (EMTs), advanced EMTs, and paramedics would be required to pass the NREMT examination for their respective certification levels. Furthermore, the bill stipulated that by January 1, 2030, all current state-certified EMS providers without NREMT certification would need to obtain it to maintain their credentials.

3 Main Drawbacks

• Financial Burden: Obtaining NREMT certification involves examination fees and potential costs for preparatory courses, which would be a financial strain for EMS providers, especially volunteers and those in rural areas. It should be noted here that the state offers a fee waiver program which would make the additional education likely free to the provider through participating community colleges. In addition many places may offer reimbursement for examination fees. 

• Staffing Challenges: Mandating NREMT certification might exacerbate existing staffing shortages by creating additional barriers for current and prospective EMS personnel.

• Implementation Timeline: The proposed deadlines were considered aggressive, potentially leading to disruptions in EMS services if providers couldn’t meet the new requirements in time.

North Carolina currently credentials nearly 15,000 EMS providers. Forcing those professionals to obtain additional certifications or risk losing the credentials they’ve already earned is, in my view, a step backward for prehospital care. This proposal comes at a time when many counties are already struggling with staffing shortages; in 2022, data from 31 counties showed an average of 12 EMS vacancies per county. Had HB 675 moved forward, it likely would have added unnecessary strain to an already overextended system. 

The Benefits of a National Certification

I believe that moving toward a single national certification is a positive step for the paramedic profession. It aligns us with other healthcare careers like nursing and respiratory therapy, boosting credibility and recognition. National Registry also improves interstate mobility, making it easier to attract experienced providers from other states. Most importantly, it promotes consistent standards of care, reinforcing that paramedicine is not just a trade but a respected and professional partner of the healthcare system.

A Balanced Approach is Needed

As an EMS educator and paramedic, I believe in the value of NREMT certification but also recognize the challenges of implementing such a mandate. A more balanced approach would be:

• Begin with New Students: Require NREMT certification for individuals entering EMS training programs, ensuring future providers meet national standards from the outset.
• Provide Support: Offer resources and assistance to help existing providers obtain NREMT certification over time if they choose to do so.

This phased approach respects the dedication of current EMS professionals while promoting a gradual transition to standardized certification.

Thanks for taking the time to read and consider the complex issues surrounding HB 675 and EMS certification in North Carolina. Whether you agree, disagree, or fall somewhere in between, your voice matters. I encourage you to share your thoughts in the comments. Let’s keep the conversation going and work together to shape the future of our profession.

References 

North Carolina General Assembly. (2025). House Bill 675: EMT Personnel Credentialing Modifications. Retrieved from https://www.ncleg.gov/Sessions/2025/Bills/House/PDF/H675v1.pdf

North Carolina Health News. (2022, February 26). Running calls around the clock: FEMA ambulances assist depleted EMS crews. https://www.northcarolinahealthnews.org/2022/02/26/running-calls-around-the-clock-fema-ambulances-assist-depleted-ems-crews