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EMT / Paramedic
Governing Authority
Maryland Institute for Emergency Medical Services Systems (MIEMSS)
Official website →Some details on this page are not yet confirmed against an official source. See sources below or contact the licensing board to verify.
Yes
NREMT Required?
131
EMT Training Hours
4 levels
Certification Levels
$800 (program) + $104 (NREMT exam)
EMT Initial Cost
3 years
Renewal Period
24 hrs
EMT CE Hours
Training Hours
60 hours
Scope of Practice
Basic emergency care including bleeding control, CPR, AED use, oxygen administration, and basic patient assessment
NREMT Required
Yes
Additional Requirements
Training Hours
131 hours
Scope of Practice
BLS care including patient assessment, vital signs, oxygen administration, BVM ventilation, CPR/AED, splinting, bleeding control, assisted medication administration (epinephrine auto-injector, nitroglycerin, albuterol), emergency childbirth, and spinal motion restriction
NREMT Required
Yes
Additional Requirements
Training Hours
350 hours
Scope of Practice
All EMT-Basic skills plus IV/IO access, fluid administration, supraglottic airway devices, blood glucose monitoring, CPAP, and limited medication administration per protocol
NREMT Required
Yes
Additional Requirements
Training Hours
1,200 hours
Scope of Practice
All AEMT skills plus endotracheal intubation, cardiac monitoring/12-lead ECG, manual defibrillation/cardioversion, transcutaneous pacing, needle chest decompression, surgical cricothyrotomy, comprehensive medication administration, and RSI where authorized
NREMT Required
Yes
Additional Requirements
Training Program Requirements
Verified131
EMT Training Hours
1,200
Paramedic Hours
Notes
Maryland EMT training programs must be approved by MIEMSS. Approximately 131 hours of training required. Annual Maryland Medical Protocols updates are mandatory for all certified providers.
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Exam Requirements
VerifiedRequired
NREMT Certification
Required
Cognitive Exam
Required
Psychomotor Exam
Yes
State-Specific Exam
NREMT Details
Maryland requires NREMT for initial certification at all levels. NREMT recertification is NOT required for EMT/EMR renewal (state CE-based), but IS required for Paramedic recertification. NREMT cognitive exam is CAT format, 70-120 questions for EMT, 2-hour time limit, $104/attempt, scaled score of 950/1500 to pass, up to 6 attempts with 15-day wait between attempts. Psychomotor exam is administered by the state.
State Exam Details
No separate state exam for initial certification; protocol exam required for reciprocity applicants
Passing Score
NREMT uses computer adaptive testing (CAT) with 70-120 questions for EMT level, 2-hour time limit. Scaled passing score is 950/1500. No fixed percentage.
Retake Policy
NREMT allows up to 6 attempts with a 15-day waiting period between attempts. After 3 failed attempts, 24 hours of remedial training required. $80 per attempt.
Didn't pass on the first try? Learn what to do if you fail the NREMT.
Overall licensing difficulty: 1/100
Study recommendation: 1–2 weeks of focused review is usually sufficient
Practice with realistic exam questions
NREMT (EMT Certification Exam)
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EMT Exam Prep Books
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Difficulty rating based on education, exam, and experience requirements. Individual experience may vary.
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NREMT Cognitive Exam
Questions
120 questions
Time Limit
2 hours
Passing Score
NREMT uses computer adaptive testing (CAT) with 70-120 questions for EMT level, 2-hour time limit. Scaled passing score is 950/1500. No fixed percentage.
Format
Computer adaptive testing (CAT)
Cost of failing
Retake fee: $80Invest in preparation to pass the first time.
How long should you study? Most candidates study 2–4 weeks before taking the NREMT Cognitive Exam.
Study Materials & Exam Prep — NREMT Certification Exam
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Study guides and practice tests for the NREMT certification exam.
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What Each Level Can Do
VerifiedOnline Medical Direction (Real-Time)
Real-time physician contact via radio or phone for consultation on patient care decisions beyond standing orders
Offline Medical Direction (Standing Orders)
Standing orders and protocols (Maryland Medical Protocols) developed by MIEMSS that authorize specific treatments without real-time physician contact
Protocol Requirements
All EMS providers in Maryland must operate under MIEMSS Maryland Medical Protocols. Annual protocol updates are mandatory for all certified providers. Providers must be affiliated with an EMS operational program with medical director oversight.
Minimum Age
Education
Background Check
Drug Screening
CPR/BLS Certification
Immunizations Required
Driver's License Required
Not sure if you need a emt license? Check whether your state requires one.
| Fee | Amount |
|---|---|
EMT Course Cost Varies by program and institution | $800-$2,000 |
Paramedic Course Cost Varies by program; community college programs tend to be less expensive | $7,000-$15,000 |
NREMT Exam Fee NREMT EMT cognitive exam fee (increased from $70 in 2025) | $80 |
State Application Fee No separate state certification fee for initial certification | $25 |
Renewal Fee EMT per 2-year renewal cycle. Reciprocity application is $35. | $25 |
Total Initial EMT Cost No separate state certification fee; does not include textbooks or equipment | $800 (program) + $104 (NREMT exam) |
Total Initial Paramedic Cost No separate state certification fee; does not include textbooks or equipment | $7,000 (program) + $104 (NREMT exam) |
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Renewal & CE Requirements
Verified3 years
Renewal Period
24 hrs
EMT CE Hours
48 hrs
Paramedic CE Hours
Required
Skills Verification
NREMT Recertification Accepted for State Renewal
CE Topics
Renewal Fee
$25
No separate state renewal fee for EMT
Regulatory Board
EMS certifications must be renewed on schedule. Most states require continuing education covering patient assessment, trauma care, cardiac emergencies, and applicable protocol updates.
For a deeper dive into CE requirements and deadlines, see our emt license renewal guide.
Out-of-State Reciprocity
VerifiedAccepts Out-of-State Credentials
NREMT-Based Reciprocity Available
Reciprocity Type
NREMT-based; EMS Compact member state
Transfer Details
Maryland accepts out-of-state EMTs through reciprocity with a $35 application fee. Applicants must complete a 12-hour MD EMT Skills Refresher and pass a Maryland protocol exam. Must maintain EMS operational program affiliation in Maryland.
Additional Requirements for Transfer
EMT/Paramedic reciprocity is often facilitated through NREMT certification. States that require NREMT typically allow easier transfer for certified providers. Always verify current reciprocity policies with your state EMS office.
See all EMS Compact (REPLICA) member states & eligibility details →
Moving to another state? Use our Transfer Tool to see what you need →
Compare Maryland with other states →
See how requirements, costs, and timelines differ across all 50 states.
Maryland requires EMS operational program affiliation for all certified providers. MIEMSS (Maryland Institute for Emergency Medical Services Systems) is a unique statewide coordinating body. NREMT recertification is split: NOT required for EMT/EMR but IS required for Paramedic. Reciprocity requires a 12-hour MD EMT Skills Refresher and protocol exam with a $35 fee. No separate state certification fee for initial certification.
Maryland does NOT require NREMT recertification for EMT/EMR renewal; state CE-based renewal instead. Paramedic level DOES require NREMT recertification.
Must maintain affiliation with an EMS operational program at all times.
Annual Maryland Medical Protocols updates are mandatory for all certified providers.
Reciprocity requires a 12-hour MD EMT Skills Refresher course and a protocol exam.
Background check is state-level only, not fingerprint-based for EMT level.
MIEMSS is a unique statewide EMS coordinating body that manages the entire Maryland EMS system.
Maryland is NOT an EMS Compact member state.
EMT requirements in nearby states
| State | Total Cost | Timeline | |
|---|---|---|---|
| Maryland (you) | $800 (program) + $104 (NREMT exam) | 8–24 wks | |
| District of Columbia | $1,200-$3,000 (program) + $104 (NREMT) + $45 (DC cert) | — | → |
| Delaware | $1,000-$2,500 (program) + $104 (NREMT) + $25 (state app) | — | → |
| Pennsylvania | $104 | — | → |
| Virginia | Course + $104 (NREMT) + state fees (not publicly posted) + background check | — | → |
Other professional licenses in Maryland
See how Maryland compares: EMT License Fees by State — Cheapest to Most Expensive →
Maryland is not currently a member of the EMS Compact (REPLICA). EMT licensees must apply through standard reciprocity or endorsement. See which states are in the REPLICA →
Related Guides
Explore requirements for other professional licenses in Maryland.
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EMT requirements in Maryland verified against Maryland Institute for Emergency Medical Services Systems (MIEMSS), March 2026.
Moving to Maryland? Use our free Transfer Tool to see what you need →
Already licensed elsewhere? See how to transfer your EMT license to Maryland →
Transfer your EMT license from Maryland to: Delaware → | Pennsylvania → | Virginia → | West Virginia → | District of Columbia →
Maryland requires NREMT certification for EMS providers. EMT training requires 131 hours. All certification is managed through the Maryland Institute for Emergency Medical Services Systems (MIEMSS).
Requirements vary by state and local jurisdiction. Always verify current requirements with your state EMS office.
EMT Schools in Maryland
Compare approved training programs, costs, and requirements.