In US it is state by state - they are semi-nationalizing the written exam (NREMT) but you need to take a practical exam in the state you get licensed. Volunteer

In US it is state by state - they are semi-nationalizing the written exam (NREMT) but you need to take a practical exam in the state you get licensed. Volunteer EMS is dwindling a bit but still around. Often the Volunteer org will voucher you once you put in time as an "Observer". I did that for a year and started driving and got my EMT last December.