I was an NREMT-P (and instructor) for almost 20 years. After becoming a PA, the state of California would not accept my CME (even though it was critical care) as is was not provided by an EMS agency. Sorry, but I need 50 hours a year of CME that is approved by the AMA or a national PA organization to keep licensed and getting additional Paramedic CME was just not possible. I've moved out of California now and the state I'm in relies on the national registry for all certification. I continued to instruct for a couple of years after getting my PA but eventually my certificate lapsed. Now it's been 20 years. For the last 20 years I have been doing cardiothoracic surgery and critical care. I manage critical patients in the ICU pre- and post- cardiac surgery, including all of the meds, vent settings, performing invasive procedures like chest tubes, central line, balloon pumps, trachs, and ACLS, when needed. In the OR, I harvest vein and artery for bypass, assist in all types of surgery from CABG through LVADs and transplant, and can open and close the chest. I am also a pilot and have recently joined the Civil Air Patrol, who wants me to take a lead role in their Emergency Services. I am interested in regaining my NREMT-P in that regard so when were out on a search and rescue mission, I perform at the Paramedic level. I'd also like to get back into instructing. How do I do this sans re-taking the full NREMT-P course again?