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Emergency Medical Technicians provide out-of-hospital emergency medical care and transportation for critical and emergent patients who access the emergency medical services (EMS) system. EMTs have the basic knowledge and skills necessary to stabilize and safely transport patients ranging from non-emergency and routine medical transports to life-threatening emergencies. Emergency Medical Technicians function as part of a comprehensive EMS response system, under medical oversight. Emergency Medical Technicians perform interventions with the basic equipment typically found on an ambulance. Emergency Medical Technicians are a critical link between the scene of an emergency and the health care system.

[From the: National EMS Scope of Practice Model]
Certification Process
Individuals applying for the Emergency Medical Technician national certification must meet the following requirements:
Notes
If the initial Emergency Medical Technician (EMT) educational program was completed more than two years ago, and the candidate is currently state-licensed at the EMT level, the candidate must document successful completion of a state-approved EMT refresher course or 24 hours of equivalent continuing education topic hours within the past two years.
If the candidate is not currently state licensed as an EMT and it has been more than two years from the completion of an approved EMT course, the candidate must complete a new state-approved EMT course prior to applying for National Certification.
Application Process
Responsibilities of Nationally Certified EMS Personnel
Certified Emergency Medical Technicians (EMTs) must notify the National Registry within 30 days regarding the following matters:
The National Registry considers the individual to be solely responsible for their certification.
Disciplinary Policy and Rights of Appeal
The National Registry has disciplinary procedures, rights of appeal and due process within its policies. Complete information about the National Registry Disciplinary Policy and Rights of Appeal can be found here.
Americans with Disabilities Act
The National Registry complies with the Americans with Disabilities Act (ADA) of 1990 and offers reasonable accommodations for individuals with disabilities. Pearson VUE test centers are also ADA compliant. Complete information about the National Registry Accommodations Disability Policy can be found here.
The Cognitive Exam
The National Registry Emergency Medical Technician (EMT) cognitive exam is a computer adaptive test (CAT). The number of items a candidate can expect on the EMT exam will range from 70 to 120. Each exam will have between 60 to 110 ‘live’ items that count toward the final score. The exam will also have 10 pilot questions that do not affect the final score. The maximum amount of time given to complete the exam is two hours.
The exam will cover the entire spectrum of EMS care including Airway, Respiration & Ventilation; Cardiology & Resuscitation; Trauma; Medical; Obstetrics/Gynecology; EMS Operations. Items related to patient care are focused on adult and geriatric patients (85%) and pediatric patients (15%). In order to pass the exam, candidates must meet a standard level of competency. The passing standard is defined by the ability to provide safe and effective entry-level emergency medical care.
We strongly encourage candidates to review the following information:
EMT Cognitive Exam Test Plan
Based on the most recent practice analysis, the National Registry Board approves a cognitive exam test plan. A test plan is a blueprint that tells the computer testing software how to build a candidate's exam. The table below indicates what percent of the test will focus on each topic area.
Content Area:
Percent of Exam:
Adult / Pediatric Mix:
Cognitive Exam Retest Information
If a candidate is not successful in passing the cognitive exam, the National Registry will provide a candidate feedback on their performance. Candidates may apply to retest 15 days after the last examination.
Candidates are given a total of six opportunities to pass the EMT cognitive examination, provided all other requirements for National EMS Certification are met. After three attempts, candidates must submit official documentation verifying completion of remedial training. Remedial training must be completed by a state-approved instructor or an approved CAPCE course. After remedial training is complete, the candidate is given three additional attempts to pass the EMT cognitive exam, provided all other requirements for National Certification are met. Candidates who fail to pass after a total of six attempts are required to repeat the entire EMT course.
Remedial Training Requirements
The EMT remedial training requirement can be satisfied through three different options:
Note: Some states require the traditional refresher course and will not accept continuing education hours. Please refer to your state's particular requirements. A maximum number of 10 hours can be applied from Distributive Education towards this section and must be state or CAPCE approved.
The Psychomotor Exam
Throughout your Emergency Medical Technician (EMT) educational program you must demonstrate competence in a wide range of emergency care skills. Your instructor must attest that you have demonstrated competence in the following skills during your course: patient assessment/management of a trauma patient, patient assessment/management of a medical patient, cardiac arrest management/AED, bag-valve-mask ventilation of an apneic patient, spinal immobilization (both seated and supine patient), long bone fracture immobilization, joint dislocation immobilization, traction splinting, bleeding control/shock management, upper airway adjuncts and suction, mouth-to-mouth ventilation with supplemental oxygen, and supplemental oxygen administration to a breathing patient.
You must also successfully complete a state-approved Emergency Medical Technician (EMT) psychomotor examination. Speak with your instructor or State EMS Office about the format and logistics of completing a state-approved Emergency Medical Technician (EMT) psychomotor exam.
Emergency Medical Technician psychomotor examinations are not administered by the National Registry. All EMT psychomotor exams are administered by either the State EMS Office or at the training institution (with approval and oversight provided by the State EMS Office). EMT course instructors should provide candidates information regarding this examination.
The following performance checklists are a guide for the verification of required skills. The State EMS Office or training institution may use different forms.
To locate a Psychomotor Exam, visit nremt.org.
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The primary focus of the Advanced Emergency Medical Technician is to provide basic and limited advanced emergency medical care and transportation for critical and emergent patients who access the emergency medical system. This individual possesses the basic knowledge and skills necessary to provide patient care and transportation. Advanced Emergency Medical Technicians function as part of a comprehensive EMS response, under medical oversight. Advanced Emergency Medical Technicians perform interventions with the basic and advanced equipment typically found on an ambulance. The Advanced Emergency Medical Technician is a link from the scene to the emergency health care system.
[From the: National EMS Scope of Practice Model]
Certification Process
Individuals applying for the Advanced-Emergency Medical Technician national certification must meet the following requirements:
Notes
Application Process
Responsibilities of Nationally Certified EMS Personnel
Certified Advanced Emergency Medical Technicians (EMTs) must notify the National Registry within 30 days regarding the following matters:
The National Registry considers the individual to be solely responsible for their certification.
Disciplinary Policy and Rights of Appeal
The National Registry has disciplinary procedures, rights of appeal and due process within its policies. Complete information about the National Registry Disciplinary Policy and Rights of Appeal can be found here.
Americans with Disabilities Act
The National Registry complies with the Americans with Disabilities Act (ADA) of 1990 and offers reasonable accommodations for individuals with disabilities. Pearson VUE test centers are also ADA compliant. Complete information about the National Registry Accommodations Disability Policy can be found here.
The Cognitive Exam
The National Registry Advanced Emergency Medical Technician (EMT) cognitive exam is a linear computer-based test (CBT). Each candidate will answer 135 questions (items). Each exam will have 100 ‘live’ items that count toward the final score. The exam will also have 35 pilot questions that do not affect the final score. The maximum amount of time given to complete the exam is 2 hours and 15 minutes.
The exam will cover the entire spectrum of EMS care including Airway, Respiration & Ventilation; Cardiology & Resuscitation; Trauma; Medical; Obstetrics/Gynecology; EMS Operations. Items related to patient care are focused on adult and geriatric patients (85%) and pediatric patients (15%). In order to pass the exam, candidates must meet a standard level of competency. The passing standard is defined by the ability to provide safe and effective entry-level emergency medical care.
We strongly encourage candidates to review the following information:
Advanced EMT Cognitive Exam Test Plan
Based on the most recent practice analysis, the National Registry Board approves a cognitive exam test plan. A test plan is a blueprint that tells the computer testing software how to build a candidate's exam. The table below indicates what percent of the test will focus on each topic area.
Content Area:
Percent of Exam:
Adult / Pediatric Mix
Cognitive Exam Retest Information
If a candidate is not successful in passing the cognitive exam, the National Registry will provide a candidate feedback on their performance. Candidates may apply to retest 15 days after the last examination.
Candidates are given a total of six opportunities to pass the Advanced EMT cognitive examination, provided all other requirements for National EMS Certification are met. After three attempts, candidates must submit official documentation verifying completion of remedial training. Remedial training must be completed by a state-approved instructor or an approved CAPCE course. After remedial training is complete, the candidate is given three additional attempts to pass the Advanced EMT cognitive exam, provided all other requirements for National Certification are met. Candidates who fail to pass after a total of six attempts are required to repeat the entire Advanced EMT course.
Remedial Training Requirements
The Advanced EMT remedial training requirement can be satisfied through three different options:
Note: Some states require the traditional refresher course and will not accept continuing education hours. Please refer to your state's particular requirements. A maximum number of 10 hours can be applied from Distributive Education towards this section and must be state or CAPCE approved.
The Psychomotor Exam
The Advanced EMT psychomotor examination consists of ten skills presented in a scenario-type format. All skills have been developed in accordance with the U.S. Department of Transportation National EMS Education Standards (EMT and/or AEMT), the American Heart Association Guidelines for CPR and ECC, and the U.S. Department of Health and Human Services Centers for Disease Control and Prevention National Trauma Triage Protocol.
The psychomotor examination process is a formal verification of the candidate's "hands-on" abilities and knowledge. Apart from Pass or Fail, candidates are not provided with specific feedback regarding their exam performance.
Advanced Emergency Medical Technicians are required to demonstrate proficiency on the following skills:
Patient Assessment-Trauma
Candidates are required to perform a "hands-on," head-to-toe, physical assessment and voice treatment of a simulated patient for a given scenario, including:
Patient Assessment-Medical
Ventilatory Management
Pediatric Respiratory Compromise
Candidates are evaluated over the following two (2) ventilatory management scenarios:
Cardiac Arrest Management/AED
Candidates will be evaluated on their ability to manage a cardiac arrest situation the proper use of an AED and 1-rescuer CPR.
IV and Medication Skills
Pediatric Intraosseous Infusion Skills
Pediatric Intraosseous Infusion
Candidates are required to establish an intraosseous line in a pediatric IO manikin. (Manual insertion with a Jamshidi® needle or battery-powered drill-type devices are permitted.)
Spinal Immobilization (Supine Patient)
Spinal Immobilization - Supine
Candidates are required to immobilize an adult patient who is found supine with a suspected unstable spine using a long spine immobilization device. An EMT assistant will be provided, but the candidate is responsible for communicating with and directing the EMT assistant.
Random EMT Skills
Each candidate will be evaluated on one of the following randomly selected EMT skills.
Psychomotor Exam Retest Information
Advanced Emergency Medical Technician candidates are allowed two (2) full attempts to pass the psychomotor examination (one "full attempt" is defined as completing all skills and two retesting opportunities if so entitled).
Candidates are eligible to retest four (4) or less skills when taking a full attempt of the psychomotor examination. Candidates are eligible for two (2) retest attempts of the four (4) or less skills failed for no more than twenty-four (24) months from the date of the examination, provided they meet all other current requirements for National EMS Certification. If offered, only one (1) retest attempt may be completed on the same day. Candidates not completing the failed portion of the examination within that twenty-four (24) month period will be required to repeat the invalid portion. Failure of any skill on the second retest attempt constitutes complete failure of the entire psychomotor examination. Candidates who fail five (5) or more skills have failed the entire psychomotor examination. Candidates who fail the entire psychomotor examination must submit official documentation of remedial education before attempting the entire psychomotor examination (all ten [10] skills) on their second and final attempt of the psychomotor examination. Passed National Registry examination results are valid for up to twenty-four (24) months from the date of the examination, provided all other “Entry Requirements” of the National Registry are met.
Should a candidate fail the second full and final attempt of the psychomotor examination, the candidate must complete a new, state approved Advanced Emergency Medical Technician Training Program.
To locate a Psychomotor Exam, visit nremt.org/locate-exam.
The Paramedic is an allied health professional whose primary focus is to provide advanced emergency medical care for critical and emergent patients who access the emergency medical system. This individual possesses the complex knowledge and skills necessary to provide patient care and transportation. Paramedics function as part of a comprehensive EMS response, under medical oversight. Paramedics perform interventions with the basic and advanced equipment typically found on an ambulance. The Paramedic is a link from the scene into the health care system.
[From the: National EMS Scope of Practice Model]
Certification Process
Individuals applying for National Paramedic Certification (NRP) must meet the following requirements:
Notes
The Application Process
Responsibilities of Certified Paramedics
Nationally Certified Paramedics must notify the National Registry within 30 days regarding the following matters:
The National Registry considers the individual to be solely responsible for their certification.
Disciplinary Policy and Rights of Appeal
The National Registry has disciplinary procedures, rights of appeal and due process within its policies. Complete information about the National Registry Disciplinary Policy and Rights of Appeal can be found here.
Americans with Disabilities Act
The National Registry complies with the Americans with Disabilities Act (ADA) of 1990 and offers reasonable accommodations for individuals with disabilities. Pearson VUE test centers are also ADA compliant. Complete information about the National Registry Accommodations Disability Policy can be found here.
The Cognitive Exam
The National Registry Paramedic (NRP) cognitive exam is a computer adaptive test (CAT). The number of items a candidate can expect on the NRP exam will range from 80 to 150. Each exam will have between 60 to 130 ‘live’ items that count toward the final score. The exam will also have 20 pilot questions that do not affect the final score. The maximum amount of time given to complete the exam is 2 hours and 30 minutes.
The exam will cover the entire spectrum of EMS care including Airway, Respiration & Ventilation; Cardiology & Resuscitation; Trauma; Medical; Obstetrics/Gynecology; EMS Operations. Items related to patient care are focused on adult and geriatric patients (85%) and pediatric patients (15%). In order to pass the exam, candidates must meet a standard level of competency. The passing standard is defined by the ability to provide safe and effective entry-level emergency medical care.
We strongly encourage candidates to review the following information:
Paramedic Cognitive Exam Test Plan
Based on the most recent practice analysis, the National Registry Board approves a cognitive exam test plan. A test plan is a blueprint that tells the computer testing software how to build a candidate's exam. The table below indicates what percent of the test will focus on each topic area.
Content Area:
Percent of Exam:
Adult / Pediatric Mix:
Cognitive Exam Retest Information
If a candidate is not successful in passing the cognitive exam, the National Registry will provide a candidate feedback on their performance. Candidates may apply to retest 15 days after the last examination.
Candidates are given a total of six opportunities to pass the Paramedic cognitive examination, provided all other requirements for National EMS Certification are met. After three attempts, candidates must submit official documentation verifying completion of remedial training. Remedial training must be completed by a state-approved instructor or an approved CAPCE course. After remedial training is complete, the candidate is given three additional attempts to pass the Paramedic cognitive exam, provided all other requirements for National Certification are met. Candidates who fail to pass after a total of six attempts are required to repeat the entire Paramedic course.
Remedial Training Requirements
The Paramedic remedial training requirement can be satisfied through three different options:
Note: Some states require the traditional refresher course and will not accept continuing education hours. Please refer to your state's particular requirements. A maximum number of 10 hours can be applied from Distributive Education towards this section and must be state or CAPCE approved.
The Psychomotor Exam
Paramedic candidates are tested on six skills: Patient Assessment: Trauma, Dynamic Cardiology, Static Cardiology, Oral Station Case A, Oral Station Case B, and an Integrated Out-Of-Hospital Scenario.
Patient Assessment-Trauma
Candidates are required to perform a "hands-on," head-to-toe, physical assessment and voice treatment of a simulated patient for a given scenario, including:
Cardiac Management Skills
The candidate is evaluated on their ability to manage cardiac arrhythmias and interpret ECGs. This will be verified in two portions:
You will be evaluated on your ability to manage a cardiac arrest situation, including actual delivery of electrical therapy and "voicing" all interpretations and treatments given a scenario. The presentation of the portion will be similar to a "megacode."
Given four (4) prepared ECG tracings with associated patient information, you must verbalize the interpretation of each rhythm and voice all associated treatments.
Oral Station - Scenario A & B
You will be evaluated on your ability to verbally manage all aspects of an out-of-hospital call given two (2) separate cases: Oral A & Oral B
In each case, you will be evaluated in the following categories:
Integrated Out-Of-Hospital Scenario
Integrated Out-Of-Hospital Scenario
The Integrated Out-Of-Hospital Scenario (IOOH) will reflect either a pediatric, geriatric or adult patient. The candidate will be provided with a professional paramedic partner and evaluated on their ability to manage a call, lead a team, effectively communicate, and maintain professionalism throughout the simulated patient encounter.
Paramedic Psychomotor Exam Retest
Paramedic candidates are allowed two (2) full attempts to pass the psychomotor examination (one "full attempt" is defined as completing all six (6) skills and two retesting opportunities if so entitled).
Candidates are eligible to retest three (3) or less skills when taking a full attempt of the psychomotor examination. Candidates are eligible for two (2) retest attempts of the three (3) or less skills failed for no more than twenty-four (24) months from the date of the examination, provided they meet all other current requirements for National EMS Certification. If offered, only one (1) retest attempt may be completed on the same day. Candidates not completing the failed portion of the examination within that twenty-four (24) month period will be required to repeat the invalid portion.
Candidates who fail a full attempt or any portion of a second retest must submit official documentation of remedial training overall skills before starting the next full attempt of the psychomotor examination and re-examining over all six (6) skills, provided all other requirements for National Certification are fulfilled. This official documentation must be signed by the Paramedic Training Program Director or Physician Director of training/operations that verifies remedial training overall skills have occurred since the last unsuccessful attempt and the candidate has demonstrated competence in all skills.
Documentation may be emailed to exams@nremt.org, faxed to (614) 888-8920, or sent to 6610 Busch Blvd., Columbus, OH 43229.
Should a candidate fail the second full and final attempt of the psychomotor examination, the candidate must complete a new, state-approved and CAAHEP-accredited Paramedic Education Program.
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