in tennessee when you take either emt or paramedic course. your state exam is the national registry. from personal experience i think that the national registry is a joke!!! and that the people that are running it don,t have the fogiest idea what they are doing, as the old saying the blind leading the blind, i once was a national registered paramedic and when it came time to renew . i had taken a 16 hour state coarse, acls,pals,btls,phtls,pepp,both the acls and the pals were the 16 hour courses not the refresher, i had went far beyond the c.e.u. hours required to renew my liscense, after i had sent the renewal information back in, i recieved a letter from them stating that my renewal had been rejected because they wanted me to take a 16 hr. intubation coarse that the state of tennessee does not even offer. i called them and talked to some lady there and she stated that was correct that i needed to take the coarse. i tried to explain to her that TN. does not offer that particular coarse. and that if they would bother to look on the form sent back to them . that there was more than 16 hrs. of intubation training in all the coarses that i had already taken. but they were to stupid to figure that out. needless to say i never retained my national registry, i do however have my state paramedic liscense,the state board is lloking to do away with the national registry because it is such a joke of an orginization. an d replace it with something else, :-({|= :D/