<P> The concept of modern - day Emergency Medical Services (EMS) care is widely noted to begin with the academic paper, "Accidental Death and Disability: The Neglected Disease of Modern Society", (or "White Paper") in 1966, according to EMS textbooks and relevant academia in the field . This paper detailed the statistics of highway accidents resulting in injury and death in the mid-1960s, as well as other causes of injury and death, and used the statistics to confirm that reform was needed in the United States, especially concerning public education and the amount of CPR and BLS / First Aid training received by police officers, firefighters, and ambulance services at the time . </P> <P> The EMT program in the United States began as part of the "Alexandria Plan" in the early 1970s, in addition to a growing issue with injuries associated with car accidents . Emergency medicine (EM) as a medical specialty is relatively young . Prior to the 1960s and 1970s, hospital emergency departments were generally staffed by physicians on staff at the hospital on a rotating basis, among them general surgeons, internists, psychiatrists, and dermatologists . Physicians in training (interns and residents), foreign medical graduates and sometimes nurses also staffed the Emergency Department (ED). EM was born as a specialty in order to fill the time commitment required by physicians on staff to work in the increasingly chaotic emergency departments of the time . During this period, groups of physicians began to emerge who had left their respective practices in order to devote their work completely to the ED . The first of such groups was headed by Dr. James DeWitt Mills who, along with four associate physicians; Dr. Chalmers A. Loughridge, Dr. William Weaver, Dr. John McDade, and Dr. Steven Bednar at Alexandria Hospital, VA established 24 / 7 year - round emergency care which became known as the "Alexandria Plan". It was not until the establishment of American College of Emergency Physicians (ACEP), the recognition of emergency medicine training programs by the AMA and the AOA, and in 1979 a historical vote by the American Board of Medical Specialties that EM became a recognized medical specialty . The nation's first EMT's were from the Alexandria plan working as Emergency Care Technicians serving in the Alexandria Hospital Emergency Room . The training for these technicians was modeled after the established "Physician Assistant" training program and later restructured to meet the basic needs for emergency pre-hospital care . On June 24, 2011, The Alexandria Hospital Celebrated the 50th Anniversary of the Alexandria Plan . In attendance were three of the nation's first ECTs / EMTs: David Stover, Larry Jackson, and Kenneth Weaver . </P> <P> 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) 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 . </P> <P> In order to apply for the NREMT Certification applicants must be 18 years of age or older . A few states allow 16 - and 17 - year olds . Applicants must also successfully complete a state - approved EMT course that meets or exceeds the NREMT Standards within the past 2 years . Those applying for the NREMT Certification must also complete a state - approved EMT psychomotor exam . </P>

Who is the local governing agency that issues certification to work as a prehospital care provider