The founding of the NREMT in 1970 came as a result of recommendations made by President Lyndon Johnson’s
Committee on Highway Traffic Safety. The committee proposed the establishment of uniform standards for training
and examination of personnel active in the delivery of emergency ambulance service. Since then, uniform standards
have been established for training and examination of the people who provide out-of-hospital emergency medical
care. As a non-profit, non-governmental, independent certification agency, the NREMT provides four distinct
areas of service:
Entry level competency assessment
A Registry of nationally certified EMS professionals
Re-registration certification process
Research that benefits the EMS community
The NREMT is governed by a Board of Directors representing the broad EMS community. The Board consists
of twenty-one individuals—including physicians, state EMS office officials, EMS professionals, educators, and members
of the public—highly regarded in their respective areas of practice. We encourage you to review the biographical
outlines that cover the accomplishments of the distinguished members of our Board of Directors.
Accreditation by the National Commission For Certifying Agencies (NCCA) is the highest assurance that the health,
welfare and safety of the public is being met through a credible exam and certification process. Accreditation also
ensures that the NREMT complies with the standards outlined in the “Standards for Education and Psychological Testing”,
developed jointly by the American Psychological Association (APA), American Educational Research Association (AERA)
and National Council on Measurement in Education (NCME).
All individuals applying for NREMT-Paramedic registration must meet the following requirements to be eligible for national registration:
Applicant must be 18 years of age or older.
Current National Registry or state certification at the EMT-Basic, EMT-Intermediate/85 or EMT-Intermediate/99 level.
Successful completion of a state-approved EMT-Paramedic educational program, within the past two (2) years, that equals or exceeds the behavioral objectives
of the EMT-Paramedic National Standard Curriculum as developed and promulgated by the U.S. Department of Transportation.
If the candidate's initial EMT-Paramedic educational program was completed more than two (2) years ago and the candidate has maintained state certification at
the EMT-Paramedic level, the candidate must submit documentation verifying completion of a current EMT-Paramedic refresher-training program within the past
two (2) years.
If the candidate's initial EMT-Paramedic educational program was completed more than two (2) years ago and the candidate has not maintained state certification
at the EMT-Paramedic level, the candidate should refer to the "NREMT-Paramedic Re-entry Policy" section on this page.
If the candidate's initial EMT-Paramedic education program was completed more than two (2) years ago and the candidate had never gained state certification at
the EMT-Paramedic level, the candidate must complete a new, state-approved EMT-Paramedic educational program prior to application.
Truthfully complete the Licensing Action and Felony Statements on the application and supply the documentation if necessary.
Possess current CPR credential at the healthcare provider or equivalent level.
Successful completion of the NREMT-Paramedic cognitive and practical examinations.
A non-refundable/non-transferable application fee of $110.00 payable to the National Registry of Emergency Medical Technicians must
be submitted to cover the cost of processing the application. Authorization to test will not be issued until all entry
requirements are verified and the application fee is received by the NREMT.
Note - Each examination attempt will require an additional application and an
additional application fee.
Initial expiration dates are established in reference to the date of successful completion of the examination. Individuals initially registered during the first six months of the year will revert to the beginning of that year for an anniversary date. Those initially registered during the last six months of the year will begin their biennium the first day of the following year. All subsequent registration periods will be for the full two-year period running from April 1 through March 31.
For example:
Individuals successfully completing the examination between the dates of January 1, 2007, and June 30, 2007, will receive an expiration date of March 31, 2009.
Individuals successfully completing the examination between the dates of July 1, 2007, and December 31, 2007, will receive an expiration date of March 31, 2010.
To be reinstated once EMT-Paramedic National Registration has lapsed, the candidate must:
If lapsed within a two-year period, document successful completion of paramedic refresher training that meets all objectives of the
National Standard EMT-Paramedic Refresher Curriculum within the past two (2) years; submit a new application and fee; and successfully complete the
NREMT-Paramedic cognitive and practical examinations.
If lapsed beyond a two-year period and still currently state-certified at the EMT-Paramedic level, document completion of
paramedic refresher training that meets all objectives of the National Standard EMT-Paramedic Refresher Curriculum within the past two (2) years; submit
a new application and fee; and successfully complete the NREMT-Paramedic cognitive and practical examinations.
If lapsed beyond a two year period and state certification at the EMT-Paramedic level has not been maintained, the candidate must
apply to re-enter the Registry via the EMT-Paramedic Re-entry Policy.
Entry and/or re-entry into the National Registry may be granted to a previously state-certified or Nationally Registered EMT-Paramedic provided he/she:
Officially documents completion of a DOT EMT-Paramedic Training Program after January 1, 1977.
Shows satisfactory evidence to NREMT of prior state certification as an EMT-Paramedic.
Has current status as a provider or instructor in ACLS by the American Heart Association.
Completed either PHTLS or BTLS as a provider or instructor within the past two (2) years.
Has completed a state approved DOT EMT-Paramedic Refresher Training Program or completes forty-eight (48) hours of ALS training that overviews the topical content of the DOT EMT-Paramedic Refresher Training Program.
Has a letter of approval from the state EMS office in the state where the applicant works or is to work, supporting the applicant's taking the examination.
Successful completion of the NREMT-Paramedic cognitive and practical examinations.
The NREMT cognitive (knowledge) examination has been developed to provide the most precise definition of entry-level competency in a
fair method. The NREMT uses a computer adaptive test (CAT) to deliver the NREMT-Paramedic examination. With computer adaptive testing each question
is tailored to the individual candidate’s ability. This means that when a candidate answers a question correctly, the next question will be slightly
more challenging. If a candidate answers a question incorrectly the next question will be slightly easier. A CAT examination re-estimates the candidate’s
ability after each set of questions. This allows the test to adjust to the candidate’s ability and as the examination progresses the ability
estimate becomes more precise. No two tests are alike. Every test experience is tailored to the individual. The purpose of the examination is to
determine the ability to reach entry-level competency. At the NREMT-Paramedic level an examination will range from 80 to 150 items. The maximum amount
of time once the test begins is 2 hours and 30 minutes.
All examinations have pilot items that do not count toward the pass/fail decision. These pilot items can be used in future examinations. There is no way
to identify a pilot item, so candidates should answer every question to the best of their ability. A candidate can not “trick” the computer by missing
items and then attempting to pass. It is important that candidates take their time to answer each question. This is not a “speeded” test; there is
plenty of time to answer each question.
A candidate should know that there is no minimum number or percent of correct items needed to pass as with a traditional pencil-paper
examination. Typically strong and weak candidates finish more quickly and those near the entry-level of competency have more questions to demonstrate
their true ability. All candidates will think the test is difficult because the test will be reaching toward their maximum ability. Candidates should
not conclude they have failed the test because it was difficult.
The National EMS Certification for the NREMT-Paramedic has a test plan that is based upon research findings of the practice of EMT-Paramedics
from throughout the nation. The percentage of the test plan for each area is as follows:
Test Plan Topics
Percent of overall test
Airway and Breathing
18.3%
Cardiology
17.7%
Trauma
16.7%
Medical
15.0%
Obstetrics and Pediatrics
15.6%
Operations
16.7%
TOTAL
100%
If you want further information on the specifics of how the examination was constructed you should review,
About the Cognitive Examination
Candidates are given three opportunities to pass the cognitive examination provided all other requirements for National EMS
Certification are met. After three attempts candidates must submit official documentation verifying completion of
48 hours
of remedial training. Remedial training is designed to provide further education to change the performance of the candidate taking subsequent
examination attempts. It is suggested that this education be over areas within the test plan where the candidate has been identified on their result
letters to be near or below the passing standard. Following remedial training the candidate is given three more attempts to pass the examination,
provided all other requirements for National EMS Certification are met. Candidates who fail to pass after a total of six attempts are
required to complete an entire state approved EMT-Paramedic education program.
If you want to watch a video of what will occur at a Pearson
Professional Center you can see this by referring to Tour a Pearson VUE Testing Center
If you have any questions regarding your application status
you should log-into the NREMT website (www.nremt.org)
and check your application status.
Candidates who pass the examination will be sent National EMS Certification materials. Candidates who fail the examination will be sent a results
letter from the NREMT which will identify by test plan the areas on the examination where the candidate performance was near or below the passing
standard. Candidates should tailor their studying and any remedial training necessary toward the tasks that make up the areas where they were near or below
the standard. Because each examination experience is completely different it is important for candidates to change their ability level by studying further
for the examination. If the candidates ability is not improved the likely outcome on the examination will be consistent.
The National Registry reserves the right to investigate any irregularities that occur in conjunction with the application process, course
completion verification and/or in conjunction with any test experience. The NREMT has disciplinary actions that may be taken in these cases. Rights of
appeal of NREMT decisions are outlined in the NREMT Disciplinary Policy.
The Practical Examination
The practical section of the examination process consists of twelve (12) skills presented in a scenario-type format to approximate the abilities of the EMT-Paramedic to function in the out-of-hospital setting. All skills have been developed in accordance with the National Standard EMT-Basic Curriculum, the behavioral and skill objectives of the 1999 EMT-Paramedic National Standard Training Curriculum, and current A.H.A. guidelines. The process is a formal verification of the candidate's "hands-on" abilities and knowledge, rather than a teaching, coaching, or remedial training session. Candidates are permitted to bring their own equipment for the examination, provided it is approved for testing by the National Registry Representative in attendance at the examination. All candidates are urged to review all practical examination criteria in the supplemental brochure "Performance Standards for Advanced Level Practical Examination Candidates" before attempting the examination.
All candidates must complete the practical examination in the same standardized format. The candidate must demonstrate an acceptable level of competency in each of the following skills:
1. Patient Assessment/Management
Candidates will be required to perform a "hands-on," head-to-toe, physical assessment and voice treatment of a moulaged victim for a given scenario. This skill includes:
Scene Size-Up
Initial Assessment/Resuscitation
Focused History and Physical Examination - Rapid Trauma Assessment
Detailed Physical Examination
2. Ventilatory Management
The candidate will be evaluated over the following two (2) ventilatory management scenarios:
Each candidate's ability to manage cardiac arrythmias and interpret ECG's will be verified in two portions:
Dynamic Cardiology
Each candidate will be evaluated in his/her 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 this portion will be similar to the "megacode."
Static Cardiology
Given four (4) prepared ECG tracings with associated patient information, the candidate must verbalize the interpretation of each rhythm and voice all associated treatments.
4. IV and Medication Skills
Intravenous Therapy
All candidates will be required to establish a patent IV in a mannequin arm in accordance with a given scenario.
After establishing a patient IV line, the candidate will be required to administer an IV bolus of medication in accordance with a given scenario.
5. Oral Station (NREMT-Paramedic candidates only)
Each NREMT-Paramedic candidate will be evaluated in his/her ability to verbally manage all aspects of an out-of-hospital call given two (2) separate cases:
Case A
Case B
In each case, the candidate will be evaluated in the following categories:
Scene Management
Patient Assessment
Patient Management
Interpersonal Relations
Integration (verbal report, field impression, and transport decision)
6. Pediatric Skills
Candidate's will be evaluated over the following two (2) pediatric skills:
Pediatric Ventilatory Management
Given a scenario of having just found an apneic infant with a palpable brachial pulse, the candidate must demonstrate immediate management of the patient using simple airway maneuvers and adjuncts, bag-valve-mask device, and supplemental oxygen. The candidate will then be required to place an endotracheal tube (ET).
Pediatric Intraosseous Infusion
The candidate will be required to establish an intraosseous line in a pediatric IO mannequin.
7. Random Basic Skills
All candidates will be evaluated over one (1) of the following EMT-Basic skills tested at random. All instruments will adhere to the National Registry EMT-Basic Practical Examination material:
Spinal Immobilization (Seated Patient)
Spinal Immobilization ( Supine Patient)
Bleeding Control/Shock Management
NREMT-Paramedic candidates are required to complete twelve (12) skills when taking the entire practical examination. Grading of the practical examination is on a Pass/Fail basis. Failure of five (5) or less skills (when taking the entire NREMT-Paramedic practical) entitles the candidate to two (2) retesting opportunities. If a same-day retest is offered at the examination site, only one (1) retest attempt may be completed at that test. Retests must be completed in an all-or-none fashion. The NREMT cannot score or report incomplete practical attempts. Candidates are not permitted to complete only a portion of the skills that need retested. The NREMT does not mandate or guarantee same-day retest opportunities at any National Registry Advanced Level practical examination site.
Failure of any portion of the second retest attempt constitutes failure of the entire practical examination. The candidate is then required to officially document remedial training over all skills before starting the next full attempt of the practical examination and re-examining over all twelve (12) skills on another date, provided all other requirements for National Registration are fulfilled.
NREMT-Paramedic candidates who have successfully completed the entire NREMT-Intermediate/99 practical examination within the preceding twelve (12) months of his/her first attempt on the NREMT-Paramedic practical examination may apply his/her passed NREMT-Intermediate/99 results to the NREMT-Paramedic practical examination. Passed NREMT-Intermediate/99 practical examination results may only be applied to the first full attempt of the NREMT-Paramedic examination for the following four (4) skills:
Intravenous Therapy
Intravenous Bolus Medications
Pediatric Intraosseous Infusion
Random Basic Skills
Failure of five or less skills when applying passed NREMT-Intermediate/99 practical examination results and testing eight (8) skills as listed (#1, 3a and b, 4a and b, 5a and b, and 7a) entitles the candidate to two (2) retesting opportunities of just the skill(s) failed. If a same day retest is offered at the examination site, only one (1) retest attempt may be completed at that test. Retests must be completed in an all-or-none fashion. The NREMT cannot score of report incomplete practical attempts. Candidates are not permitted to complete only a portion of the skills that need to be retested. The NREMT does not mandate or guarantee same-day retest opportunities at any National Registry Advanced Level practical examination site. Candidates applying passed NREMT-Intermediate/99 results should note that outright failure of the first full attempt or failure of the second retest opportunity of the first attempt on the NREMT-Paramedic practical examination will require re-examination over the entire NREMT-Paramedic practical (all twelve (12) skills) on another date after completing the required remedial training, provided all other requirements for national registration are fulfilled.
Failure of six (6) or more skills constitutes failure of the entire practical examination. The candidate is then required to officially document remedial training over all skills before starting the next full attempt of the practical examination and re-examining over all twelve (12) skills on another date, provided all other requirements for National Registration are fulfilled.
The passed portion of the examination, either the cognitive or practical, will remain valid for a twelve (12) month period from the date of the examination. Candidates not completing the failed portion of the examination within that twelve (12) month period will be required to repeat the invalid portion.
Candidates are allowed three (3) full attempts to pass the practical examination (one "full attempt" is defined as completing all twelve (12) skills and two retesting opportunities if so entitled). Candidates who fail a full attempt or any portion of a second retest must submit official documentation of remedial training over all skills before starting the next full attempt of the practical examination and re-examining over all twelve (12) skills, provided all other requirements for National Registration are fulfilled. This official documentation must be signed by the EMT-Paramedic Training Program Director or Physician Director of training/operations that verifies remedial training over all skills has occurred since the last unsuccessful attempt and the candidate has demonstrated competence in all skills. Should a candidate fail the third full and final attempt of the practical examination, the candidate must complete a new, state-approved EMT-Paramedic Training Program.
An inactive status is designated for Nationally Registered EMTs who are not actively engaged in the EMT - Paramedic services at the time of re-registration. Educators, administrators, or regulators who are not actively treating patients should consider this status. Inactive status will be awarded only to those who have fulfilled all refresher, CPR, and continuing education requirements. A registrant may not request inactive status in his/her initial registration period if he/she has never been affiliated with an ALS EMS service or functioned in a patient health care setting as an NREMT-Paramedic for a period of at least six (6) months.
A request to return to active status must be accompanied by a completed
Inactive to Active Registration form which may be download here, or
obtained by calling the NREMT Re-registration Department.
It is the policy of the National Registry of Emergency Medical Technicians to administer its certification examinations
in a manner that does not discriminate against an otherwise qualified applicant. An applicant with a disability, who is
otherwise eligible to take the certification examination may file a request for reasonable testing accommodations if, by
virtue of a disability, the applicant cannot demonstrate under standard testing conditions that he/she possesses the
knowledge and skills to be certified as an EMS provider at the level of certification requested. The NREMT will make
reasonable accommodations to individuals with documented disabilities unless such an accommodation fundamentally alters
the measurement of the examination or the established eligibility requirements for gaining National
Registration.
The National Registry of Emergency Medical Technicians offers reasonable and appropriate accommodations for the written
and practical components of the registration examination for those persons with documented disabilities,
as required by the Americans with Disabilities Act (ADA). At a minimum, all requests for accommodations must be received
by the NREMT no less than three (3) weeks before the scheduled test date. The NREMT urges candidates requesting any
accommodation to submit such requests as early as possible to provide adequate time to resolve any documentation issues
that may arise. The NREMT will review each request on an individual basis and make decisions relative to appropriate
accommodations based on the following general guidelines:
In order to be considered for accommodations under the ADA, an individual
must present documentation indicating that his/her disability substantially limits some major life activity.
Only individuals with disabilities who, with or without reasonable
accommodations, meet the eligibility requirements for certification at the
level of the requested examination are eligible for accommodations.
Accommodations being requested must be reasonable and appropriate for the documented
disability and must not fundamentally alter the examination’s
ability to assess the essential functions of pre-hospital care, which the
test is designed to measure.
Documents relative to current functioning of a candidate must be no older than three
(3) years to help ensure accommodations are based on assessment of the
current impact of the candidate’s disability on the examination activity.
Professionals conducting assessments, rendering diagnoses of specific disabilities
and/or making recommendations for appropriate accommodations must be
credentialed to do so.
The NREMT realizes that each candidate’s circumstances are unique and a case
by case approach to review the documentation is required.
Candidates requesting accommodations for the cognitive component of the examination should go to our
Examination Accommodations Policy for further details.
NREMT has disciplinary procedures, rights of appeals and due process within its policies. Individuals
applying for registration or re-registration, who wish to exercise these rights should read our
Disciplinary Policy. Requests to appeal must be submitted within
thirty (30) days of receipt of notice of determination.
