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revised 2021 NEMSE StandardsRevised Standards Outline Minimum Competencies for EMS Providers

The revised 2021 Standards from the National EMS Education Standards have been released. The “Standards”, as they are referred to as, are developed at the national level, and provide states with a vetted, consensus-driven foundation for EMS education. With that said, however, each state has the right to adopt the Standards as written or adopt and modify them to fit their unique needs.


Adopt and/or Adapt NEMSES for Your EMS Program

classroom learning using ATS and revised NAEMSEWhen applying the National EMS Education Standards to individual programs and classes, EMS educators have the freedom to develop their own curricula. The Standards were intentionally created in a way that allows for various implementation methods to meet local needs and evolving educational practices.  Instructors can use a wide variety of lesson plans and instructional resources that allows them to specifically address individual and community needs. The Standards benefit EMS providers by paving the way for national certification and permitting an easier transition from one locality or state to another.


revisions to NAEMSE changes for 2021NEMSES Continues to Build on Best Practices & Scientific Evidence

This flexible and adaptable format of the Standard also allows for ongoing revisions and updates to EMS educational content.  This ensures that the Standards can be updated and will continue to be relevant when any changes occur due to new scientific evidence, educational practice advances, and updates to community standards of care.

2021 Revised Standards from NEMSES Have Been Redesigned & Rearranged

instructor teaching with ATS products and using the revised NAEMSE standardsDuring the recent update, several sections had become outdated because of changes in evidence-based medicine, best practices, or technology.

Reviewers also thought it would be useful to have a level of specificity within the Education Standards rather than require educators to look in multiple places when seeking guidance to create curricula.

The updates and revisions to the 2021 National EMS Education Standards were to the following areas:

      • Behavioral/Psychiatric
      • Cultural Humility
      • EMS Operations
      • Pharmacology
      • Public Health
      • EMS Safety, Wellness, And Resilience
      • Pediatrics
      • Geriatrics

Summary of Changes to Topics in NEMSES


behavioral emergencies - included in NAEMSE - scene from Action Training Behavioral/Psychiatric

The behavioral/psychiatric section of the Education Standards was revised to include more information regarding acute behavioral crisis and mental health disorders. Greater depth and breadth of knowledge were recommended for areas involving potential safety hazards to patients and EMS providers. Some psychiatric disease and syndrome areas were revised and simplified.

Cultural Humility is part of revised NEMSE standard

Cultural Humility

To increase recognition of the importance of maintaining an awareness of the assumptions and biases related to cultural issues and how they may affect our patients, co-workers, and students.

It is recommended that In EMS Cultural Humility should address education, EMS workforce, and patient care. This would include understanding bias in the classroom, creating a diversified workforce, and providing culturally competent, equitable, and medically appropriate care to every patient regardless of their background.

Caring for geriatrics is part of revised NEMSE standards

EMS Operations

EMS Operations are determined by a variety of factors, including the setting, the clinician’s role, and the EMS system design. Because of this, it is not possible to provide rigid and or simple training requirements across these diverse settings. EMS educators and institutions need to work with local and state agencies to determine the appropriate level of knowledge that providers need to perform their duties safely and efficiently.

EMS Operations Topics Include:

revisions to NEMSE Standard includes save vehicle operations - emergency vehicle operations

Principles of Safely Operating EMS Emergency Response Vehicles:

Includes an overview of emergency response to ensure the safety of EMS personnel, patients, and others during EMS response vehicle operations.


revisions to NEMSE standards include landing zone safetyambulance and air operations Landing Zone Operations:

Provides an overview of operating safely in and around a landing zone during air medical operations and transport. The setting up and operating in a landing zone should be taught by trained experts in the area of air medical transport. The depth and breadth of information that is needed would be determined by state and local regulations.

EMS operations included in revised NEMSE standard- extricating a patient from a vehicle Rescue Operations:

Outlines rescue operations including, but not limited to, vehicle extrication, low/high angle, water, trench, and confined space to ensure the safety of EMS personnel and patients during these events. This overview does not prepare the entry-level student to become competent or qualified to work in these rescue environments.

MCI management included in revision of NEMSE standards - Triage at an MCI Mass Casualty Incidents:

Provides an overview of EMS operations during an MCI or when an MCI plan is activated. Information regarding the clinical management of patients during a MCI is found in the clinical sections of the Standards for each licensure level. The depth and breadth of training achieved by clinicians are determined by state and local requirements.

revisions to NEMSE standards include hostile event response -Active Shooter ResponseMass Casualty Incidents Due to Active Threats and Disaster:

Provides an overview of operating during a terrorist event and natural or man-made disasters. Instruction should be provided by trained individuals. State and local regulations may have additional requirements that are above and beyond federal regulations. Information related to the management of patients exposed to a terrorist event or involved in a disaster is found in the clinical sections of the Standards for each personnel level.

Incident Command & Management Incident Management:

Information related to the clinical management of a patient within components of IMS is found in the clinical sections of the Standards for each licensure level. Information should be delivered by a credentialed instructor for this area. The material may be obtained in-person or through distance learning as determined by state and local requirements.

Hazmat Awareness:

Includes information related to the clinical management of a patient exposed to hazardous materials are found in the clinical sections of the Standard for each personnel level. Training may be a corequisite or prerequisite, or as part of the entry-level course as determined by state and local requirements. Personnel must be trained at the Hazardous Materials Awareness level. State and local regulations may have additional requirements that are above and beyond federal regulations. EMS educators should work in collaboration with local fire or emergency management authorities to determine the proper training level required in their community.

Summaries to Other Topics:

infection control and community health


The pharmacology section has been expanded in the Standards for EMR, EMT, AEMT, and paramedics. It was determined that is not enough to solely teach pharmacology in a traditional didactic manner. It should also include psychomotor and affective instruction. In addition, significant opportunities to practice the skills should be provided before leaving the education program.


Public Health

infection control and public health The changes to the public health section reflect the evolution in EMS. Public health prevention and pandemic preparedness efforts are essential functions in the future as EMS continues to be at the crossroads between health care, public health, and public safety. The new standards are intended to prepare providers to work alongside and collaboratively with specially trained community paramedics, social workers, public health organizations, health care entities, emergency management agencies, and non-governmental organizations in their day-to-day duties, and lay the foundation for advancement into specialized roles.


workforce safety, infection controlEMS Safety, Wellness, and Resilience

Workforce safety and wellness have been expanded to reflect principles of stress management, responder mental health, resilience, and suicide prevention across all levels. An overall greater emphasis on EMS mental health resources is recommended. Standard safety precautions, use of personal protective equipment, illness, and injury prevention, and lifting and moving patients continue to be emphasized. Other areas that have been added include crew resource management across all levels and disease transmission in the EMT, AEMT, and paramedic curricula.


pediatric skills Pediatric & Geriatric Content Competencies

Individual sections for pediatrics and geriatrics have been removed, with education content addressing these special populations now incorporated throughout the education standards. It was determined that concepts related to geriatric and pediatric patients deserve equitable attention and that earlier assimilation resulted when taught repeatedly throughout every section of a course.


NEMSES is Part of The EMS Education Agenda

The National EMS Education Standards are meant to be just one part of a comprehensive system proposed in the EMS Education Agenda.

These elements in the Education Agenda include:

More information about the Agenda for the Future is included in the Update.

In Conclusion – An Integrated System Approach

This integrated system approach to EMS education defines the competencies, clinical behaviors, and judgments required of EMS personnel to perform their roles.CPR for first responders   The revised National EMS Education Standards provides a high-level outline of important topics but does not replace the need to develop a curriculum. They are not intended to limit EMS educational programs; going above and beyond the Standards may be important to provide students with appropriate knowledge and skills and to meet the needs of their community.

For more information about how Action Training Systems EMS products can enhance your training program, please visit  www.action-training.com or call us at 800-755-1440



Information referenced and adapted from the publication distributed by the U.S. Department of Transportation (DOT), National Highway Traffic Safety

2021 NATIONAL EMERGENCY MEDICAL SERVICES EDUCATION STANDARDS  https://www.ems.gov/pdf/EMS_Education_Standards_2021_v22.pdf