A prerequisite for EMT-Paramedic is the EMT Certification. The second level of training in the EMT career structure is the Paramedic course. This training program includes field and clinical experience necessary to render invasive techniques and advanced life support skills. The knowledge and skill objectives include, but are not limited to pharmacology, endocrine emergencies, respiratory and cardiovascular emergencies, shock and fluid therapy, infectious diseases, pediatrics, and geriatric emergencies. National standards have been established which specifically define the role and performance criteria of the EMT-Paramedic. Based upon those standards, a curriculum was developed under the auspices of the U.S. Department of Transportation (DOT). The EMT-Paramedic includes the following knowledge and skills in these 6 divisions: