How to Become an EMT in Texas

While becoming an emergency medical technician isn’t a glamorous job, it’s a growing position. According to the Bureau of Labor Statistics, the projected employment of EMTs through 2029 is six percent—two percent faster than the average. The Texas Demographic Center stated that while Texas makes up almost nine percent of the country’s population, 32.4 percent of the country’s population growth from 2019 to 2020 occurred in the state. 

With this massive growth in population and projected need for EMTs, it’s no question that the state of Texas needs skilled EMTs to protect the growing number of individuals making it their home. But what do you have to do in order to become an emergency medical technician in the Lone Star State?

How do I become an EMT in Texas?

To become an emergency medical technician in Texas, a candidate must be 18 years old, have a high school diploma or GED, have a valid driver’s license, be able to communicate using English, be a legal resident of the United States, and must meet physical and vaccine requirements. Candidates must attend a state certified program, take a practical and written exam, submit to a background check, and then apply for licensure. 

But what does an emergency medical technician do, and what does the state of Texas require you know before you take the exam? What if you’re already an EMT somewhere else, and want to work in Texas? Read on to find out.

What is an Emergency Medical Technician?

How to Become an EMT in Texas

An Emergency Medical Technician, or an EMT, provides emergency care outside of a hospital and transports patients through the emergency medical services system. According to the National Registry of Emergency Medical Technicians, EMTs are required to have basic non-emergency and routine medical knowledge and skills that are used to stabilize and transport patients who range from critical to non-critical in nature. 

EMTs provide care based on what is included in their ambulance and are the first line of defense between a medical emergency and the hospital. 

Other Levels of the Texas EMT Program

In Texas, you do not have to become an EMT. There are several other levels throughout the program; a range of skills are required for each. 

The least amount of training is given to emergency care assistance, who simply provides pre-hospital care and basic life support. The emergency medical technician-basic does everything an ECA does, including airway management and patient assessment. 

Building off the last level, the emergency medical technician-intermediate is the common conception of what an EMT is—they do all the previous work, including managing cardiac issues, respiratory emergencies, and similar situations needing higher education. 

An emergency medical technician-paramedic is further education off the intermediate stage where they can train to become licensed paramedics.

Requirements for EMT Programs

How to Become an EMT in Texas

Before you even consider becoming an EMT, there are certain requirements you need to meet. All positions require you to be 18 years old and have a high school diploma.

Candidates must also have a valid driver’s license, be able to communicate using English, and have at least a tenth grade reading level. All candidates must be legal residents of the United States. 

Physical requirements include the ability to lift 125 pounds without assistance and 250 pounds with assistance. 

Candidates should also have rubella, measles, mumps, and hepatitis B vaccinations, along with Tdap against tetanus, pertussis, diphtheria, and chicken pox. Drug tests are required for all candidates. 

Learn the difference between a Firefighter EMT & a Paramedic!

EMT Programs in Texas

How to Become an EMT in Texas

In order to receive national certification, you must first complete a state-approved course. These courses should meet or exceed the standards set by NREMT, and candidates must be certified within two years of completing the course for it to remain valid. 

Candidates are also required to complete Basic Life Support training like that provided by the American Heart Association. The course teaches future EMTs how to both recognize a heart emergency and know how to mitigate the issues caused by one, including how to deliver the right ventilations, use an automatic external defibrillator, and give the appropriate chest compressions. 

It also teaches cardiopulmonary resuscitation, or CPR, techniques, along with how to mitigate any sort of foreign-body airway obstruction in both adults and children.

Most EMT programs last an entire semester, and program cost varies across institutions. Typically, they range from about $2,000 to $7,000. 

The Certification Process

To complete certification, complete an approved EMS training, submit an application, submit a background check; and pass the National Registry exam. 

Candidates must complete the NREMT’s cognitive and psychomotor exams for their state—these are both written and practical exams. 

The Cognitive Exam

How to Become an EMT in Texas

The NREMT’s cognitive exam is completed online; a candidate will have to consider between 70 to 120 items that may be on the exam, in addition to ten ‘pilot’ questions that are not counted towards your performance. The exam must be taken within a two-hour window. 

The test is a computerized adaptive test, which lets the test be more concise and individualized for your knowledge. While all candidates require to meet a certain level for their certification, it is a quicker, more precise test. 

Candidates wanting to receive their Advanced-EMT certification are required to take a computer based linear test, which is an online version of your standard physical exam. 

The cognitive exam covers every possible subject that you may face on the job, states the NREMT website. Subjects include but are not limited to:

  • Airway, Respiration, & Ventilation
  • Cardiology & Resuscitation
  • Trauma
  • Medical
  • Obstetrics & Gynecology
  • EMS Operations

While most of the test focuses on adult patients, you will also be tested on how to work with children. In terms of subject, the majority of the test will cover medical, obstetrics & gynecology, and cardiology & resuscitation. 

Because the exam is created through national standards, note that protocols could be different through local or state departments. 

Preparation for the test can be done through your appropriate textbooks and by using the information provided through the American Heart Association

All tests are provided through NREMT at the Pearson VUE testing locations, and the cognitive exam is $98 per attempt. If you do not pass the test, you will receive feedback and can reapply for the exam fifteen days after the last exam. You will have six attempts to take the exam but will have to complete remedial training after three attempts. 

The Psychomotor Exam

How to Become an EMT in Texas

This exam, in comparison with the cognitive exam, is practical. You will have to show that you can assess a patient, manage a trauma patient, manage a medical patient, manage cardiac arrest, use an AED, ventilate someone who cannot breathe, immobilize broken bones or dislocations, traction splint, control bleeding, and handle oxygen issues. These are all skills you will learn during your EMT training. 

These exams are not completed by the NREMT—you will have to go to the Texas EMS office, or it can be completed at your training institution. 

Final Steps

After you receive your test results, you will need to undergo a background check. Typically, your course instructor can assist you through this process. 

Following the completed background check, you can apply for licensure. The online application for Texas can be found at the Department of State Health Services website

A license certifies an EMT for four years starting at the date of issuance, and before they are permitted to staff an EMS vehicle, that certification has to be verified, typically by checking their identification card against the department’s certification webite. 

Other Avenues: EMS Reciprocity

Going through the certification program and taking the tests in Texas are not the only way to become an EMT in the Lone Star State. If you have been trained in another state, you can still become an EMT based on the EMS Reciprocity Certification. 

How to Become an EMT in Texas

The reciprocity requirements are similar to the initial requirements to attend an EMT program—candidates must be 18 years old, have a high school diploma or GED, and must have a valid out of state certification or National Registry of Emergency Medical Technicians certification. These should be current through the certification process. 

Candidates will be required to apply and pay a fee, along with taking the Texas Assessment Exam if they are not certified through NREMT. They must also take the State of Texas Jurisprudence continued education course and take the exam. This course and test are the state’s version of a renewal exam and covers Texas laws, rules, and regulations.   

While some states follow NREMT guidelines, Texas is one that requires either NREMT or a different training as a prerequisite to recertification. Regardless of what state you are coming from, you will have to complete the continued education courses if you move to Texas, except for the Basic Life Support training that you received through the American Red Cross or the American Heart Association. 

After the courses and exams are taken, verification forms will be sent to each state in which the candidate has been certified. A background check will be completed before verification. 

Other Avenues: Equivalency

How to Become an EMT in Texas

If you’re coming into the United States from a different country, you’re in luck if you want to work as an EMT in Texas. To apply for equivalency, Texas state law says a candidate is eligible if they have completed EMS training outside of the U.S., is certified in another healthcare discipline, has had their licensure expire for over a year, or has held inactive status for over four years. 

They must submit their curriculum and work history to a training institution for review, and after verification that all curriculum requirements have been met, they can apply for certification and complete the appropriate exams. As long as the candidate is properly immunized against disease and can follow the EMS personnel responsibilities, the candidate is likely to be approved. 

Other Avenues: Military Applicants

How to Become an EMT in Texas

The Department of State Health Services states that current military service members, veterans, and spouses with EMT training and have a current NREMT certification can apply to become an EMT in Texas. Anyone associated with the military must follow the same out of state and reciprocity process as stated above.  

Whether you come to Texas from another state or go through the certification process there, going through the program is not for the faint of heart. Still, with the prospects of employment only growing in Texas, you will have tons of opportunities open to you across the state!


Do I have to be a firefighter to become an EMT in Texas?

While all firefighters are required to go through emergency medical technician training in Texas, emergency medical technicians do not have to attend a fire academy. 

How much does an EMT earn in Texas?

An EMT makes an average of $37,000 with an hourly rate of about $18, according to the Bureau of Labor Statistics. Texas is one of the states with the highest employment level for EMTs and paramedics. 

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Please note: This blog post is for educational purposes only and does not constitute legal advice. Please consult a legal expert to address your specific needs.

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