The EMT-B course, even in the civilian arena, focuses on a lot of immediate response entry into an incident area, moving the dead and injured, and triage that the paramedic course presumes the individual emergency medic is competent and proficient in doing.
The paramedic course focuses on much more advanced surgical intervention and treatments.
I emphasized 'may'
in red as the course description is insufficient in identifying the level of competency and proficiency the PJ student, and not necessarily the 4N student, is expected to be able to perform at after completing the required courses for entry into the PJ apprentice course (the 4N completing these courses at the PJ School do not proceed into the PJ Apprentice course.
As far as the presumption "I let it lapse. Guess the joke is on me", such a leap is unreasonable. I've not kept abreast of NREMT certifications and recertification, they have changed over the years, but to get Paramedic does require completing the Basic course either separate from the initial Paramedic qualification program or as part of (incorporated into) the initial paramedic qualification program.
Pararescue doesn't use the certification as indicating level or quality of medical capability being provided to trauma patients, but rather to get access to continuation and proficiency training through memorandum of understanding agreements with high trauma volume EMSs and at trauma centers. PJ Med-The Home of Pararescue Medicine
is run by the current USAF (Board Certified) Emergency Medicine Physician in charge of Pararescue medical programs. The media page has a few links concerning hands-on continuation and proficiency training. Also Intro to PJ Medicine PJ MED
1. PJ MED guidelines built from medical guidelines, but modified based on what is practical and feasible for the environment or situation, with the skills and training a PJ has
2. Generally based on Consensus or Expert Opinion, SOCOM ATP (Advanced Tactical Paramedic) and TCCC Guidelines, TCCC, Wilderness Medical Principles, etc. But PJ MED goes beyond this as needed to do our job, and is a unique type of medicine related to Rescue
3. Use meds and gear which have multiple uses, and take up the smallest cube and lightest weight possible
4. Interventions are created to be the response to specific physical findings or injuries checklist based to give you the principles you need to adapt to other situations
5. Diagnostic and therapeutic maneuvers are focused on the most likely injuries and illnesses
6. Training should be progressive so first the cognitive skills are learned, then the skills and knowledge are practiced thru drills/ table top/ etc. and then practiced in scenario based training
7. Treatment is well defined so the PJ will know his limits and be confident he has performed all care he can
8. Perform medical care as time and tactics permit
9. Perform advanced procedures you have been trained on and are comfortable with
I've not written much of pararescue's contribution to developing EMT certifications in the civilian arena as much of the source documentation got destroyed when the archive storing it ended up twenty feet under water back ca. 2000.
On the other hand, former HQ ARS Command Surgeon Clifford J. Buckley, USAF, MC. FS is still alive to recreate the history if I can ever convince him to do so.
The short summary is even prior to the Military Assistance to Safety and Traffic (MAST) Program (1969) and Public Law 93-54, EMS Systems Act of 1973", the Air Force's Air Rescue Service (subsequently Aerospace Rescue and Recovery Service) command surgeons and a few PJs were directly involved in setting up several State EMT certification programs during the 1960s and early 1970s. Ohio and Idaho are two I know of for certain.