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:

• Cognitive Exam Policies
• Cognitive Exam 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 blue-print 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.

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:

1. Traditional refresher course: Completion of a State or CAPCE(F1, F2, F5) approved 48 hour Paramedic refresher course.
2. NCCR 30 hours of continuing education: Completion of the 30 hour National Competency Component from the NCCP model.
3. Continuing education topic hours: Paramedic remedial may be completed by continuing education* and must include the topics and hours listed here under Traditional Model.

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:

• Scene Size-Up
• Primary Survey/Resuscitation
• History Taking
• Secondary Assessment

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:

• Scene Management
• Patient Assessment
• Patient Management
• Interpersonal Relations
• Integration (verbal report, field impression, and transport decision)

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• Oral Stations Template 
• Oral Station Sample 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 full attempts to pass the psychomotor examination (one "full attempt" is defined as completing all six skills and two retesting opportunities if so entitled).

Candidates are eligible to retest three or less skills when taking a full attempt of the psychomotor examination. Candidates are eligible for two retest attempts of the three or less skills failed. If offered, only one retest attempt may be completed on the same day. Failure of any skill on the second retest attempt constitutes complete failure of the entire psychomotor examination. Candidates who fail four or more skills have failed the entire psychomotor examination.

Candidates who fail a full attempt or any portion of a second retest attempt 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 six skills, provided all other requirements for National Certification are fulfilled. This official documentation must be signed by a Paramedic Training Officer, Program Director or Medical Director that verifies remedial training over all skills has occurred since the last unsuccessful attempt and the candidate has demonstrated competence in all skills.

Documentation may be emailed to support@nremt.org.

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.

• Passed portions of the psychomotor examination remain valid for 24 months. This policy is effective for candidates with a course completion date on or after November 1, 2018. For candidates with a course completion date prior to November 1, 2018, passed portions of each examination is valid for 12 months.

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