Response Emergency and Urgent Care (RQF) This provided a defined scope of practice agreed nationally by ambulance service trusts. Their role title, however, may still be defined by their employer as emergency medical technician. They can work autonomously, making their own clinical decisions within their training and remit. They may also work as a clinical lead working alongside an emergency care assistant or as assistants themselves to a paramedic. As the role does not have a single defined scope, the skills they have can include: Administration of select general sales list, pharmacy and prescription only medicines under provision of the Human Medicines Regulations 2012 Administration of medicines by select parenteral or non-parenteral routes; typically oral, intramuscular, inhaled, nebulised or sublingual Intermediate life support, including manual defibrillation and supraglottic airway placement Ability to discharge patients to different care pathways The term emergency medical technician is not commonly used by members of the public in the United Kingdom. Instead, it is common for all ambulance personnel to be referred to as "paramedics", although the paramedic title is protected under registration of the Health and Care Professions Council. United States Certification In the United States, EMTs are certified according to their level of training. Individual states set their own standards of certification (or licensure, in some cases) and all EMT training must meet the minimum requirements as set by the National Highway Traffic Safety Administration's (NHTSA's) standards for curriculum. The National Registry of Emergency Medical Technicians (NREMT) is a private organization which offers certification exams based on NHTSA education guidelines and has been around since the 1970s. Currently, NREMT exams are used by 46 states as the sole basis for certification at one or more EMT certification levels. A NREMT exam consists of skills and patient assessments as well as a written portion. On June 12, 2019, the NREMT changed the rules regarding age limits for EMTs, AEMTs, and paramedics. There is no longer an age limit for registered personnel. However, applicants must successfully complete a state-approved EMT course that meets or exceeds the NREMT standards within the past two years of applying. Those applying for the NREMT certification must also complete a state-approved EMT psychomotor exam. It is possible for the candidate to be refused access to a state-approved course due to their age within the state. Levels NHTSA recognizes four levels of certification: Emergency medical responder (EMR) Emergency medical technician (EMT)