CAUTION: SPOILERS
The field of EMS is unique in that there is no standard pathway for education and progression. Different states have different levels of training and different requirements, and one state doesn’t necessarily transfer to another.
One organization, the National Registry, is the result of an attempt to change that. There are four standard levels: emergency medical responder, basic emergency medical technician, advanced emergency medical technician, and paramedic. Past levels included first responder (now EMR) and intermediate emergency medical technician (which was expanded to advanced). These certification levels have been adopted by many states and make it more likely that one license will find reciprocity in another state.
For example, I moved to Iowa. Iowa does not recognize my Georgia license. However, Iowa does recognize National Registry, so that type of license would have found reciprocity.
The National Registry exam has two parts: written and practical, and the paramedic exam requires a portfolio of experiences demonstrating competence, which is a common part of EMS training for many levels. As medics are trained in the field, they maintain a notebook of notes and skill completions signed off by the medics they work with. There may be run reports of various calls and notes on the number of and how well they completed various skills. This is the notebook that Ron Gordon is carrying with him.
Though the current National Registry paramedic portfolio developed well after this book was written, the same concept was in place then.
This image is similar to the National Registry check-off pages for some of the practical exams. It is for making coffee–a critical EMS skill. It's a poor picture, but you get the basic idea.
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