Difference between EMT and paramedic
An EMT provides basic emergency care, while a paramedic is the advanced level that adds invasive and cardiac procedures. O*NET's first listed task for EMTs is to "administer first aid treatment or life support care" in prehospital settings; for paramedics it lists emergency cardiac care such as "cardioversion and manual defibrillation" and emergency invasive intervention before a patient reaches the hospital.[sum_emt][sum_para] BLS counts the two as separate occupations, SOC 29-2042 and 29-2043.
| EMT | Paramedic | |
|---|---|---|
| Median pay (BLS, May 2025) | $44,470 | $60,600 |
| Median hourly | $21.38 | $29.13 |
| Take-home at median* | $37,912 | $50,872 |
| Program | State-approved EMT course | CAAHEP-accredited paramedic program (or CoAEMSP Letter of Review) |
| Prerequisite | None at the national level | At least an EMT credential |
| NREMT exam fee (per attempt) | $104 | $175 |
| Recertification (2-year cycle) | 40 hours CE | 60 hours CE |
| Jobs, May 2025 | 180,510 | 100,610 |
*Single filer, 2026 federal income tax, Social Security and Medicare.[irs] Exam, program and CE rules: NREMT.[nremt_emt][nremt_para][nremt_para_ov][nremt_recert] Jobs: BLS OEWS.[oews_api]
Paramedic vs EMT salary by percentile
Paramedics out-earn EMTs at every point of the pay distribution, and the gap grows from $10,100 at the 10th percentile to $22,350 at the 90th.[onet_emt][onet_para]
| Percentile | EMT | Paramedic | Paramedic premium |
|---|---|---|---|
| 10th | $34,130 | $44,230 | +$10,100 (30%) |
| 25th | $37,960 | $49,660 | +$11,700 (31%) |
| Median | $44,470 | $60,600 | +$16,130 (36%) |
| 75th | $50,100 | $73,470 | +$23,370 (47%) |
| 90th | $62,500 | $84,850 | +$22,350 (36%) |
Where the paramedic premium is biggest
The paramedic premium is largest in Washington, where the median gap is $51,620, and smallest in Alabama ($10,730).[onet_emt][onet_para] In every state, the paramedic median is higher than the EMT median.
| State | EMT median | Paramedic median | Gap |
|---|---|---|---|
| Washington | $52,690 | $104,310 | +$51,620 |
| New Jersey | $53,610 | $86,630 | +$33,020 |
| District of Columbia | $46,650 | $78,550 | +$31,900 |
| California | $46,380 | $74,590 | +$28,210 |
| Minnesota | $48,090 | $76,300 | +$28,210 |
| Connecticut | $50,640 | $77,480 | +$26,840 |
| Utah | $38,930 | $65,420 | +$26,490 |
| Oregon | $49,270 | $74,840 | +$25,570 |
| State | EMT median | Paramedic median | Gap |
|---|---|---|---|
| Alabama | $37,810 | $48,540 | +$10,730 |
| Ohio | $40,220 | $51,300 | +$11,080 |
| South Dakota | $36,800 | $48,830 | +$12,030 |
| Georgia | $45,550 | $57,660 | +$12,110 |
| Michigan | $39,870 | $52,080 | +$12,210 |
EMT vs paramedic training
EMT vs paramedic training differs in length, accreditation and prerequisites: an EMT course is the entry level, while paramedic candidates for National Registry certification must already hold at least an EMT credential and be enrolled in a CAAHEP-accredited paramedic program, or one with a CoAEMSP Letter of Review.[nremt_para_ov] BLS lists a postsecondary nondegree award as the typical entry-level education for both, and projects 6% employment growth for EMTs and paramedics combined from 2025 to 2035.[ooh_emt]
- EMT course and NREMT EMT exam. $104 per attempt.[nremt_emt]
- Work as an EMT (optional). Some candidates gain field experience before paramedic school; the NREMT requires only the EMT credential.
- Accredited paramedic program. Required for NREMT paramedic certification.[nremt_para_ov]
- NREMT paramedic exam. $175 per attempt.[nremt_para]
- Recertify every 2 years. 60 hours of continuing education for paramedics, 40 for EMTs.[nremt_recert]
The full cost list and a paramedic school payback calculator are on EMT certification cost.
Is a paramedic higher than an EMT?
Yes. In the National Registry's levels, paramedic is the highest of the four (EMR, EMT, Advanced EMT, paramedic), and it requires an EMT credential first.[nremt_para_ov][nremt_aemt] Whether the step up pays depends on your state: use the calculator above, then see each job in depth on EMT salary and paramedic salary, or compare them with other careers on the allied health careers overview.
Frequently asked questions
What is the difference between an EMT and a paramedic?
Paramedics have more training and a wider scope, including emergency cardiac care and invasive procedures. They must hold an EMT credential and complete an accredited paramedic program.
How much more do paramedics make than EMTs?
$16,130 more at the national median: $60,600 against $44,470 (BLS, May 2025).
Is a paramedic higher than an EMT?
Yes. Paramedic is the highest National Registry level, above EMR, EMT and Advanced EMT.
Do you have to be an EMT before becoming a paramedic?
For National Registry paramedic certification, yes: candidates must hold at least an EMT credential.
Sources
- Summary Report for 29-2042.00 Emergency Medical Technicians (sample job titles)
- Summary Report for 29-2043.00 Paramedics (sample job titles)
- Local Wages: 29-2042.00 Emergency Medical Technicians (state and metro percentiles)
- Local Wages: 29-2043.00 Paramedics (state and metro percentiles)
- OEWS national employment and wage series, May 2025 (BLS Public Data API, series OEUN0000000000000
01 and 13) - Occupational Outlook Handbook: EMTs and Paramedics
- EMT Certification Process (application fee)
- AEMT Certification Process (application fee)
- Paramedic Certification Process (application fee)
- Paramedic Overview (accredited program and EMT prerequisite)
- National Continued Competency Program recertification requirements
- IRS releases tax inflation adjustments for tax year 2026 (Rev. Proc. 2025-32)