The problem is that there are only so many people who are capable of doing the work to be licensed as EMT-B or higher, and even fewer after they've gone through their first license renewal. The way the deck is stacked against EMS people is absurd. I'll give you an example:

I hold both a EMT-B and a RN license. The EMT-B license requires at least 55 hours of training to renew every two years.

If I were a EMT-P? Heh. Here's the required time and skills you need to renew a Paramedic cert:

Renewal Requirements.xlsx (wyo.gov)

That's pretty daunting in a rural setting, especially with the EMS MD's wanting to get away from the old practice that "everyone gets a throat full of plastic." Now, you need to have a pretty strong reason why you're going to drop an ET into someone. Many FF/EMT-P's have to hang out in hospitals, shadowing a RT (Respiratory Therapist) to get their required ET applications signed off - and they often have to do some of that on their own time. 

Both RN's and EMT's need AHA Provider CPR/AED renewal every two years. Any advanced EMS provider (EMT-A and above) you need ACLS and PALS renewed every two years.


My RN license? I just have to work as a RN, send in my $65 (which the state pays for), renew my CPR/AED, and Bob's my uncle.