EMT-Paramedic / Paramedic

Contents:
    Entry Requirements
    Application Process
    Certification Process
    Cognitive Examination
    Cognitive Exam Retest Information
    Psychomotor Examination
    Psychomotor Exam Retest Information
    Expiration Date
    Lapsed Certification
    EMT-Paramedic / Paramedic Re-Entry Policy
    ADA Compliancy
    Disciplinary Policy and Rights of Appeal
    Responsibilities of Certified EMT-Paramedic / Paramedic
    EMT-Paramedic / Paramedic Recertification
    Inactive Status

Entry Requirements

Individuals applying for EMT-Paramedic / Paramedic certification must meet the following requirements:

• 18 years of age or older.

• Possess current National Certification at the EMT-Basic level or current state certification at the EMT-Basic level or higher.

• Successful completion of a state-approved EMT-Paramedic / Paramedic course that meets or exceeds the U.S. Department of Transportation (DOT) Paramedic National Standard Curriculum. You must have completed the course within the past two years. Your Program Director must verify your successful completion of the course on the NREMT web site.
  
  If your initial EMT-Paramedic / Paramedic educational program was completed more than two years ago and you have maintained state licensure at the EMT-Paramedic / Paramedic level, you must submit documentation verifying completion of a EMT-Paramedic / Paramedic refresher training program within the past two years. If your initial EMT-Paramedic / Paramedic education program was completed more than two years ago and you never gained state licensure at the EMT-Paramedic / Paramedic level, you must complete an entire state-approved EMT-Paramedic / Paramedic course prior to applying for certification.

• Verification from the Program Director that you hold a current CPR credential for health care providers and have demonstrated competence in EMT-Paramedic / Paramedic skills.

Application Process

• Create a login on this website.

• Complete a National Registry online application, including truthfully completing the Licensing Action and Felony statements. click here for more information on the NREMT Felony Policy. The NREMT may deny certification or take other appropriate actions in regards to applicants for certification or recertification when a felony conviction has occurred.

• Pay the application fee of $110.00 (US funds). The application fee is non-transferable and non-refundable. This fee is charged for each attempt of the cognitive examination.

• You will receive an Authorization to Test (ATT) once you are eligible for the exam. The ATT letter contains scheduling instructions and important details concerning proper identification required at testing centers.

Certification Process

National EMT-Paramedic / Paramedic certification requires successful completion of both a cognitive and psychomotor exam. Passed portions of the exam (both cognitive and psychomotor) remain valid for a twelve (12) month period.

Cognitive Examination

The NREMT EMT-Paramedic / Paramedic cognitive exam is a computer adaptive test (CAT). The number of items a candidate can expect on the EMT-Paramedic / Paramedic exam will range from 80 to 150. 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, Ventilation, Oxygenation; Trauma; Cardiology; Medical; and EMS Operations. Items related to patient care are focused on adult patients (85%) and pediatric patients (15%). In order to pass the exam, you 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.

Cognitive Exam Retest Information

In the event you are unsuccessful passing the cognitive exam, the NREMT will provide feedback on your performance. You may apply to retest 15 days after your last examination.

Candidates are given six 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. The candidate is given three additional attempts to pass, 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-Paramedic / Paramedic course.

Psychomotor Examination

The psychomotor section of the examination process consists of twelve (12) separate skills presented in a scenario-type format to approximate the abilities of the EMT-Paramedic / 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. As a result, you will not be provided with any specific feedback on your performance.

• You are encouraged to review all the Practical Exam information and worksheets, click here, before attempting the examination.

• EMT-Paramedic / Paramedic candidates may take the psychomotor evaluation (practical exam) following completion of the didactic and laboratory portions of an approved program if permitted by the program director and the State EMS Licensing Agency.

• 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 must complete the psychomotor examination in a standardized format. All candidates must demonstrate an acceptable level of competency in each of the following skills:

1. Patient Assessment-Trauma
   
   You will be required to perform a "hands-on," head-to-toe, physical assessment and voice treatment of a simulated patient for a given scenario, including:

• Scene Size-Up

• Initial Assessment/Resuscitation

• Focused History and Physical Examination - Rapid Trauma Assessment

• Detailed Physical Examination




2. Ventilatory Management



You will be evaluated over the following two (2) ventilatory management scenarios:

• Adult

• Dual Lumen Airway Device




Given a scenario of having just found an apneic patient with a palpable carotid pulse, you must demonstrate immediate management of the patient using simple airway maneuvers and adjuncts, bag-valve-mask device, and supplemental oxygen. You will then complete the adult presentation by placing an endotracheal tube (ET). Additionally, you will be given a scenario of having just found an apneic patient with a palpable carotid pulse and must demonstrate immediate management of the patient using simple airway maneuvers and adjuncts, bag-valve-mask device, and supplemental oxygen. You will then place the Combitube® or PTL® in the adult patient.



3. Cardiac Management Skills



Your ability to manage cardiac arrhythmias and interpret ECGs will be verified in two portions:



• Dynamic Cardiology


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."



• Static Cardiology


Given four (4) prepared ECG tracings with associated patient information, you must verbalize the interpretation of each rhythm and voice all associated treatments.



4. IV and Medication Skills





• Intravenous Therapy


You will be required to establish a patent IV in a mannequin arm in accordance with a given scenario.



• Intravenous Bolus Medications


After establishing a patient IV line, you will be required to administer an IV bolus of medication in accordance with a given scenario.



5. Oral Station



You will be evaluated on your ability to verbally manage all aspects of an out-of-hospital call given two (2) separate cases:



• Case A

• Case B



In each case, you will be evaluated in the following categories:

1. Scene Management

2. Patient Assessment

3. Patient Management

4. Interpersonal Relations

5. Integration (verbal report, field impression, and transport decision)




6. Pediatric Skills



You 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, you must demonstrate immediate management of the patient using simple airway maneuvers and adjuncts, bag-valve-mask device, and supplemental oxygen. You will then be required to place an endotracheal tube (ET).



• Pediatric Intraosseous Infusion


You will be required to establish an intraosseous line in a pediatric IO mannequin.



7. Random Basic Skills



You will be evaluated over one (1) of the following EMT-Basic skills tested at random. All instruments for these skills will adhere to the National Registry EMT-Basic Practical Examination material:



• Spinal Immobilization (Seated Patient)

• Spinal Immobilization (Supine Patient)

• Bleeding Control/Shock Management

Psychomotor Exam Retest Information

EMT-Paramedic / Paramedic candidates are allowed three (3) full attempts to pass the psychomotor examination (one "full attempt" is defined as completing all 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 psychomotor examination and re-examining over all twelve (12) skills, provided all other requirements for National Certification are fulfilled. This official documentation must be signed by the EMT-Paramedic / 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 psychomotor examination, the candidate must complete a new, state approved EMT-Paramedic / Paramedic Training Program.

Any passed portion of the examination, either the cognitive or psychomotor, will remain valid for a twelve (12) month period from the date of the examination, provided all other requirements for National Certification are fulfilled. Candidates not completing the failed portion of the examination within that twelve (12) month period will be required to repeat the invalid portion.

Expiration Date

Initial expiration dates are determined by the date of successful completion of the entire certification process. Individuals successfully completing the certification process between the dates of January 1 - June 30 will receive an expiration date of March 31 two years in the future. Individuals successfully completing the certification process between July 1 and December 31 will receive an expiration date of March 31 three years in the future.

For example:

successful completion of February 14, 2009, certification expiration=March 31, 2011

successful completion of July 7, 2009, certification expiration=March 31, 2012

Lapsed Certification

If your National EMS Certification has lapsed within a two-year period, you must:

1. document successful completion of EMT-Paramedic / Paramedic refresher training that meets all objectives of the National Standard EMT-Paramedic Refresher Curriculum within the past two years;

2. complete an online application and pay the application fee and

3. successfully complete the EMT-Paramedic / Paramedic cognitive and psychomotor examinations.

1. document successful completion of EMT-Paramedic / Paramedic refresher training that meets all objectives of the National Standard EMT-Paramedic / Paramedic Refresher Curriculum within the past two years;

2. complete an online application and pay the application fee and

3. successfully complete the EMT-Paramedic / Paramedic cognitive and psychomotor examinations.

If your National EMS Certification has lapsed beyond a two-year period and state certification at the EMT-Paramedic / Paramedic level has not been maintained, you must apply to re-enter the National Registry via the EMT-Paramedic / Paramedic Re-entry Policy that follows:

EMT-Paramedic / 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 / Paramedic provided you:

1. Officially document completion of a DOT EMT-Paramedic / Paramedic Training Program after January 1, 1977.

2. Show satisfactory evidence to the NREMT of prior state certification (licensure) as an EMT-Paramedic / Paramedic.

3. Have current status as a provider or instructor in ACLS by the American Heart Association.

4. Completed either PHTLS or ITLS as a provider or instructor within the past two (2) years.

5. Have completed a state approved DOT EMT-Paramedic / Paramedic Refresher Training Program or completed forty-eight (48) hours of ALS training that overviews the topical content of the DOT EMT-Paramedic / Paramedic Refresher Training Program.

6. Have a letter of approval from the state EMS office in the state where you work or are to work. The letter should show the state's support of the candidate's taking the examination.

7. Successfully complete the NREMT EMT-Paramedic / Paramedic cognitive and psychomotor examinations.

ADA Compliancy

The NREMT 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 NREMT Accommodations Disability Policy can be found here.

Disciplinary Policy and Rights of Appeal

The NREMT has disciplinary procedures, rights of appeal and due process within its policies. Complete information about the NREMT Disciplinary Policy and Rights of Appeal can be found here. Requests to appeal must be submitted within forty-five (45) days of receipt of notice of determination.

Download a Certification Brochure.

Responsibilities of Certified EMT-Paramedic / Paramedic

Certified EMT-Paramedic / Paramedics must notify the NREMT within 30 days regarding the following matters:

• change in mailing address.

• any felony conviction.

• disciplinary action taken by any state has resulted in - suspension, revocation, or expiration of state registration/license; termination of right to practice; voluntary surrender of state registration/license while under investigation.

The NREMT considers the individual to be solely responsible for their certification.

EMT-Paramedic / Paramedic Recertification

In applying for recertification, certified EMS professionals agree to comply with all recertification requirements, rules and standards of the National Registry of Emergency Medical Technicians (NREMT). The recertification applicant bears the burden of demonstrating and maintaining compliance at all times.

To Apply For Recertification You Must:

1. Be actively working within an emergency medical service, rescue service, or patient health care facility using your ALS skills.

2. Complete all requirements prior to March 31.

3. Complete the recertification report in its entirety and submit the completed report prior to March 31.

4. Demonstrate continued cognitive (knowledge) competency through continuing education or examination.

Continuing Education Option

Complete a total of 72 hours of education including:

• Completion of an approved 48 hour DOT National Standard EMT-Paramedic / Paramedic Refresher

• Completion of 24 hours of additional continuing EMS related education as outlined below

• Pay the $20.00 (US funds only) recertification application fee at the time of submission of documentation



All continuing education hours, to include the refresher, must be completed within the current recertification cycle. Education completed prior to the previous March 31 expiration date will NOT be accepted. If this is the first recertification period, only education completed after the date of initial certification will be accepted. See information below for detailed recertification requirements.

Exam Option

Certified EMS professionals may make one attempt to demonstrate continued cognitive competency by taking an examination (in lieu of documenting continuing education) within six months of their expiration date (October 1 through March 31).

• Log in to the NREMT website. Complete an application for recertification by examination. Pay the $110.00 (US funds only) examination fee.

• After 24-48 hours, login to your account and print your Authorization To Test (ATT) letter.

• Take and pass the exam between October 1 and March 15 (of the year your certification expires). You will receive an abbreviated recertification application upon successful completion of the exam.

• Return the abbreviated recertification application by March 31 (of the year your certification expires) with signatures and supporting documentation.
  
  All other recertification requirements (including felony statement, CPR/ACLS certification active affiliation/practice, verification of skills, Physician Medical Director signature, etc.) must still be met and verified.

Detailed Continuing Education Requirements

1. Complete an approved EMT-Paramedic / Paramedic Refresher

The EMT-Paramedic / Paramedic refresher course can be completed through two different options:

• Traditional refresher course - an approved DOT National Standard EMT-Paramedic / Paramedic Refresher*

• Continuing education topical hours** - EMT-Paramedic / Paramedic refresher may be completed by continuing education equivalent to a Refresher Course. You may count hours received in lectures, standardized courses (such as ABLS, ACLS, PEPP, PALS, PHTLS, ITLS, etc.), college courses, in service training, case reviews, conferences, etc*. and must include both mandatory and flexible content.

You must ensure that you cover every topic within the four divisions of the mandatory core content.  You must also cover each of the five divisions of the flexible core content; however, you are not required to cover each topic.

Mandatory Core Content - 24 hours total

Airway, Breathing and Cardiology - 8 hours Provide ventilatory support for a patient Attempt to resuscitate a patient in cardiac arrest Provide care to a patient experiencing cardiovascular compromise Provide post resuscitation care to a cardiac arrest patient

Medical Emergencies - 3 hours Assess and provide care to a patient experiencing an allergic reaction Assess a patient with possible overdose Assess and provide care to a near-drowning patient

Trauma - 5 hours Perform a rapid trauma assessment Assess a patient with a head injury Assess and provide care to a patient with a suspected spinal injury Provide care to a patient with a chest injury Provide care to a patient with an open abdominal injury Provide care to a patient with shock/hypoperfusion

Obstetrics and Pediatrics - 8 hours Assess and provide care to an infant or child with cardiac arrest Assess and provide care to an infant or child with respiratory distress Assess and provide care to an infant or child with trauma Assess and provide care to an infant or child with shock/hypoperfusion

Flexible Core Content - 24 hours total

Airway, Breathing and Cardiology - 8 hours Assess and provide care for respiratory distress in an adult patient Use oxygen delivery system components Perform techniques to assure a patent airway Assess and provide care to a patient experiencing non-traumatic chest pain discomfort

Medical Emergencies - 5 hours Assess and provide care to a patient with an altered mental status Assess and provide care to a patient with a history of diabetes Assess and provide care to a patient experiencing a seizure Assess and provide care to a patient exposed to heat or cold Assess and provide care to a patient experiencing a behavioral problem Assess and provide care to a patient with suspected communicable disease

Trauma - 1 hour Assess and provide care to a patient with a painful, swollen, deformed extremity Assess and provide care to a patient with a burn injury

Obstetrics and Pediatrics - 8 hours Assess and provide care to an infant or child with suspected abuse or neglect Assess and provide care to an infant or child with a fever Assess and provide care to an obstetric patient Provide care to a newborn Provide care to a mother immediately following delivery of a newborn

Operational Tasks - 2 hour Use body mechanics when lifting and moving a patient Communicate with a patient while providing care

* A Maximum number of 10 hours can be applied to refresher education.

**Some states require the traditional refresher course and will not accept continuing education hours. Please refer to your state's particular requirements.





2. Additional EMS Related Continuing Education-24 hours

The following are maximum hours per course that can be applied towards Additional Continuing Education hours:

• A maximum number of 12 hours can be applied from any one topic area

• A maximum of 12 hours can be applied from each of the following courses: ABLS; ACLS; AMLS; BTLS; ITLS; NALS; PALS; PEPP; PHTLS; EPC

• A maximum number of 12 hours can be applied from each of the following courses: Teaching CPR - Emergency Driving - Dispatch Training

• A maximum number of 12 hours can be applied from Distributive Education towards this section and must be state or CECBEMS approved.

College Courses

A maximum of 12 hours can be applied for college courses that relate to your role as an EMS professional (for example, but not limited to: anatomy, physiology, biology, chemistry, microbiology, pharmacology, psychology, sociology, statistics, etc.)

Hours from the following courses can be applied hour for hour with no maximum: Advanced Trauma Life Support, EMS Course Instruction, and Wilderness EMS Training.

Courses that cannot Be applied towards additional continuing education hours: Clinical Rotations, CPR, First Responder Course, home study programs, instructor courses, management/leadership courses, performance of duty, preceptor hours, serving as a skill examiner, and volunteer time with agencies.




3. CPR Certification

Submission of approved CPR credential for the professional rescuer. Credential must be current through March 31. Verification may be in the form of an instructor's signature on the recertification application or copies of both sides of a current card.

4. Verification of Skills Competence

Maintain skills as verified by your Physician Medical Director. (Requires signature on your recertification application validating psychomotor competency).

Inactive Status

Inactive status can only be requested by NREMTs who have completed at least 6 months of EMS patient care during their first registration cycle.

Inactive status with the NREMT signifies a National Certified provider who is currently not providing patient care. Often this is misunderstood. Registrants who wish to declare inactive status must continue to meet the NREMT recertification requirements. The NREMT confirms that “inactive” EMS providers are “not working.” Therefore, inactive status is useful for administrators, educators, managers, etc., but not for those who have left EMS and also failed to maintain competency via completion of the recertification education requirements.

Inactive status is not for those unable to obtain and meet the educational requirements or those who have had limitations or revocation of a health care license.

Registrants who request inactive status at the EMR and EMT levels do not need to obtain verification of skills from their training officers. Again, these registrants must complete all refresher, continuing education and CPR requirements. These registrants are eligible to recertify via examination if they so choose. CPR certification remains a requirement even for those who pass the examination.

Registrants who request inactive status at the AEMT or Paramedic levels do not need to obtain verification of skills from their medical directors. Again, these registrants must complete all refresher, continuing education and both CPR and ACLS requirements. These registrants are eligible to recertify via examination if they so choose. CPR and ACLS remain a requirement even for those who pass the examination.

Applying for Active Status when registered as Inactive

Movement from Inactive to Active status requires the registrant to complete Section III of the re-certification requirements. Fundamentally the registrant must work with their future or current employer so that he/she is willing to verify competency of the skills found on the recertification form. In order to do this the registrant must retrieve the form from the NREMT website Click here, have the form completed and then forward it to the NREMT. No fee is required to move from inactive to active status.

Download the Paramedic Recertification Requirements Brochure.

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