A recent study compared the number of Emergency Medical Service (EMS) Refresher (ER) course completions last year with 2018 and 2019. The large Commission on Accreditation for Prehospital Continuing Education database was used to analyze educational format delivery types. Also examined over the three-year period was the total number of format types, including classic live in person (LIP), classic online/distributive learning (DL) and virtual instructor lead training (VILT). All told, there were 4,163,754 ER course completions, with 1,922,783 in 2020; 1,166,335 in 2019; and 1,074,636 in 2018 — a 179% increase over the study period. Asynchronous DL course completions totaled 1,830,513 in 2020, 1,078,580 in 2019, and 987,749 in 2018. Monthly means for asynchronous DL last year differed significantly, while those for LIP and VILT did not. An association for an increasing trend in DL and VILT course completions during the COVID-19 pandemic did not support causation. Last year saw 70% growth in DL courses completions from 2019 and 185% growth from 2018, possibly due to atypical peaks in May and June being fueled by the National Registry of Emergency Medical Technicians extending the 2020 recertification deadline from March 31 to June 30. A trend away from LIP course completions is also implied as LIP accounted for only 1% of all ER course completions nationwide in 2020. "As DL continues to grow, future studies should examine the advantages and disadvantages of DL education," the authors recommend.