How to Become an EMT in Missouri

Who can apply

• You must hold current National Registry (NREMT) certification as an EMT (or higher). Missouri accepts only current NREMT certification for initial licensure.
• You must complete a state and FBI fingerprint background check through the Missouri State Highway Patrol before BEMS can issue a license.
• You must certify that you can speak, read and write English.
• You must disclose any criminal convictions or pleas, including suspended impositions of sentence, and attach the court documents.
• You must disclose any past discipline or surrendered health care license in any state.

Step by step

1. Complete an EMT course that meets the National EMS Education Standards.
2. Pass the NREMT EMT exams and earn current NREMT EMT certification.
3. Get fingerprinted at an IdentoGO location using the BEMS initial-licensure fingerprint form, and keep your TCN number.
4. Check on the Missouri Automated Criminal History System (MACHS) site that your fingerprint results are complete.
5. Submit the initial license application on the Missouri EMS licensing portal (missouri.imagetrendlicense.com) with proof of current NREMT certification.

Official application →

Training and exam

Training: State law bases EMT education on the National EMS Education Standards and any changes DHSS sets by rule. In practice the training requirement is met through the course you need to earn NREMT certification, which Missouri requires for initial licensure.

Exam: Missouri does not give its own EMT exam. You must hold current NREMT EMT certification, which requires passing the NREMT cognitive and psychomotor exams. NREMT charges $104 per cognitive exam attempt.

What it costs in Missouri

Fixed amounts are set by the state. Items marked “your quote” are priced by private sellers, so enter what you’re quoted.

Keeping your certification

Renewal: Missouri EMT licenses last five years. Apply for relicensure no more than 120 days and no less than 30 days before expiration. Send proof of current NREMT EMT certification, or certify 100 hours of continuing education in the five-year period (48 core hours plus 52 hours of elective topics, or all 100 as core) plus current CPR. Keep CE records for five years. If you lived outside Missouri at any time in the last five years, you must also submit fingerprints before relicensing.

Good to know in Missouri

New training requirement for 2027: Under a 2026 change to RSMo 190.142 (effective August 28, 2026), every EMT must complete a one-time four-hour course on sex and human trafficking as a condition of relicensure. It applies to any relicensure with an effective date after March 31, 2027. The training must be free and may be online.

Licenses do not transfer: EMS licenses from other states cannot be transferred to Missouri. Out-of-state EMTs must apply for initial licensure with current NREMT certification and a Missouri fingerprint check.

Military applicants: Current service members, and veterans honorably discharged within the past two years, may request an EMT-B United States Armed Forces license by attaching a DD-214, NGB-22, or common access card.

Expired license: If your Missouri license has been expired for more than two years, you must meet the initial licensure requirements again, including current NREMT certification.

EMS Compact: Missouri participates in the EMS Compact. If you hold a current, unrestricted EMT license from another participating Compact state, you can work in Missouri under a Privilege to Practice with no separate application or fee, as long as you work for an authorized EMS agency under a medical director and follow Missouri's scope of practice and protocols.

Sources

• Missouri DHSS - EMT and Paramedic Licensing Information
• Missouri DHSS - Reciprocity
• Missouri BEMS - Required continuing education hours (EMT)
• Missouri BEMS - Background procedure for initial applicants
• RSMo 190.142 - Emergency medical technician license requirements
• 19 CSR 30-40.342 - Application and licensure requirements for EMTs
• NREMT - EMT Candidate Handbook, Certification Process
• EMS Compact - Participating States