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Paramedic (NRP)

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

Entry Requirements

Individuals applying for Paramedic (NRP) certification must meet the following requirements:

  • 18 years of age or older.

  • Possess current National Certification at the EMT level or a current state license at the EMT level or higher.

  • Beginning January 1, 2013 Paramedic applicants must have successfully completed state-approved and CAAHEP-accredited (or one that has a Letter of Review) Paramedic (NRP) program. Paramedic applicants who began their education program before January 1, 2013 must have completed a state-approved Paramedic course that meets or exceeds the National EMS Education Standards for Paramedic. 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 website.

    If your initial Paramedic (NRP) educational program was completed more than two years ago and you are currently state licensed at the Paramedic (NRP) level, you must submit documentation verifying completion of a state-approved Paramedic (NRP) refresher course or 48 hours of equivalent continuing education covering the mandatory and flexible core content topics specified within the past two years.

    If your Paramedic state license has lapsed or your NRP has lapsed for more than two years, see the Paramedic re-entry requirements.

    If you have never held a state license as a Paramedic or NRP and it has been more than two years from the completion of your Paramedic course, you must complete an entire state-approved and CAAHEP-accredited Paramedic program prior to applying for National Certification.

  • Verification from the Program Director that you hold a current CPR-BLS for Healthcare Providers or equivalent credential and have demonstrated competence in Emergency Medical Technician (EMT) skills.

Application Process

  • Create a login on this website.

  • Complete a National Registry online application, including truthfully completing the Licensing Action and Criminal statements. click here for more information on the NREMT Criminal Policy. The NREMT may deny certification or take other appropriate actions in regards to applicants for certification or recertification when a criminal 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 Paramedic (NRP) 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 Paramedic (NRP) Paramedic cognitive exam is a computer adaptive test (CAT). The number of items a candidate can expect on the Paramedic (NRP) 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, Respiration & Ventilation; Cardiology & Resuscitation; Trauma; Medical & Obstetrics/Gynecology; and 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, you must meet a standard level of competency. The passing standard is defined by the ability to provide safe and effective entry level advanced 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 Paramedic (NRP) 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 Paramedic (NRP) to function in the out-of-hospital setting. All skills have been developed in accordance with the 2009 National EMS Education Standards and Instructional Guidelines for EMT and Paramedic, and current AHA 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.

  • Paramedic (NRP) 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



  3. 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.

  4. Cardiac Management Skills



  5. 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.

  6. 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.

  7. Oral Station



  8. 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)


  9. Pediatric Skills



  10. 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.

  11. Random Basic Skills



  12. 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

Paramedic (NRP) 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 Paramedic (NRP) Training Program Director or Physician 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.

Should a candidate fail the third full and final attempt of the psychomotor examination, the candidate must complete a new, state-approved and CAAHEP-accredited Paramedic (NRP) 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 national certification process. Individuals successfully completing the national 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 national certification process between July 1 and December 31 will receive an expiration date of March 31 three years in the future.

For example:

NRP- Expiration Date and Recertification Cycles

Initial Certification

Initial Cycle

Following Cycles

If you successfully completed the national certification process between:

Your initial recertification cycle is:

Every cycle after your initial cycle:

  • January 1-June 30

 

Example:
Completed national certification on February 14, 2014

  • Your initial certification date-March 31, 2 years in the future

 

Example:
February 14, 2014-March 31, 2016

  • April 1-March 31 (2 years)

  

Example:
April 1, 2016-March 31, 2018
(2 years expiring on even years)

  • July 1-December 31

 

Example:
Completed national certification on July 7, 2014

  • Your initial certification date-March 31, 3 years in the future

 

Example:
July 7, 2014-March 31, 2017

  • April 1- March 31  (2 years)

 

Example:
April 1, 2017-March 31, 2019
(2 years expiring on odd years)

Lapsed Certification

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

  1. document successful completion of a state-approved Paramedic (NRP) refresher or 48 hours of equivalent continuing education covering the mandatory and flexible core content topics with the past two years;

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

  3. successfully complete the Paramedic (NRP) cognitive and psychomotor examinations.

If your National EMS Certification has lapsed beyond a two-year period and you are still currently state licensed at the Paramedic (NRP) level, you must:
  1. document successful completion of a state-approved Paramedic (NRP) refresher or 48 hours of equivalent continuing education covering the manadatory and flexible core content topics within the past two years;

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

  3. successfully complete the Paramedic (NRP) cognitive and psychomotor examinations.

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

Paramedic (NRP) Re-Entry Policy

Entry and/or re-entry into the National Registry may be granted to a previously state licensed or Nationally Certified Paramedic (NRP) provided you:

  1. Officially document completion of a DOT Paramedic (NRP) Training Program after January 1, 1977.  *

  2. Show satisfactory evidence to the NREMT of prior state licensure at the Paramedic (NRP) level.

  3. Have current ACLS provider or instructor credential.

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

  5. Have completed a state-approved Paramedic (NRP) refresher or 48 hours of equivalent continuing education covering the mandatory and flexible core content topics specified within the past two years.

  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 for you to obtain state licensure through this process.

  7. Successfully complete the NREMT Paramedic (NRP) cognitive and psychomotor examinations.

* All candidates for NREMT’s National EMS Certification at the Paramedic level whose Paramedic program began on or after January 1, 2013 must have successfully completed Paramedic education from an accredited program sponsored by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) or one who held a valid Letter of Review (LOR) issued by the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP).

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 the Nationally Certified Paramedic (NRP)

Nationally Certified Paramedic (NRP)s must notify the NREMT within 30 days regarding the following matters:

  • change in mailing address.

  • any criminal 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.

Paramedic (NRP) 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 Paramedic skills.

    If you wish to request Inactive Status and this is your first recertification, you must provide documentation that you have worked as a Paramedic in a patient care setting for at least six months.

  2. Demonstrate continued cognitive competency by examination or documentation of continuing education.

  3. Maintain skills as verified by your Physician Medical Director (requires signature or electronic signature on your recertification application validating competency of skills).

  4. Have a BLS-CPR for Healthcare Providers credential that is current on your March 31 expiration date. Verification may be in the form of an instructor's signature on the recertification application or a copy of both sides of the card or a statement of equivalent competency per affirmation of the Medical Director.

  5. Have an ACLS credential that is current on your March 31 expiration date. Verification must include a copy of both sides of the card or statement of equivalent competency per affirmation of the Medical Director.

  6. Submit your completed recertification application by March 31 of the year your certification expires.

Cognitive Competency Options (2)

  1. Exam Option

    The recertfication by examination option enables you to demonstrate continued cognitive competence without requiring you to document your continuing education.

    • Log in to your NREMT account. Complete a recertification by examination application and pay the exam fee. Be sure you are completing the recertification application and not the initial certification application.

    • After 24 - 48 hours, go to the NREMT website, log in to your account and print your Authorization to Test (ATT) letter. Follow the directions on the letter to schedule your exam.

    • Take and pass the exam between October 1 and March 31 of the year your certification expires. You may make one attempt in the last six (6) months of your certification cycle to demonstrate cognitive competency by taking an exam in lieu of documenting continuing education. You will receive an abbreviated recertification application upon successful completion of the exam.

    • Return the completed abbreviated recertification application by March 31 of the year your certification expires with signatures and supporting documentation.

      All other recertification requirements (including criminal statement, CPR certification, ACLS certification, active affiliation/practice, and Physician Medical Director's signature verifying skills) must still be met and verified.

  2. Continuing Education Option

Complete a total of 72 hours of education including:

  • Completion of a state or CECBEMS (F1, F2, F5) approved 48 hour Paramedic refresher or equivalent continuing education as outlined below.

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

  • Pay the $20.00 (US funds only) non-refundable processing fee at the time of submission of documentation.

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

Refresher

Completion of a State or CECBEMS (F1, F2, F5) approved 48 hour Refresher Course OR Continuing Education

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

    • Traditional refresher course -Completion of a State or CECBEMS (F1, F2, F5) approved 48 hour Paramedic refresher course.

    • Continuing education topic hours-Paramedic refresher may be completed by continuing education* and must include the topics and hours listed below.

Refresher - 48 hours total**
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 who is experiencing cardiovascular compromise
  • Provide post-resuscitation care for a cardiac arrest patient

 

Medical Emergencies - 3 hours
  • Assess and provide care to a patient experiencing an allergic reaction
  • Assess a patient who has a possible overdose
  • Assess and provide care to a drowning patient
 
Trauma - 5 hours
  • Perform a primary survey
  • Assess a patient who has a head injury
  • Assess and provide care to a patient with a suspected spinal injury
  • Provide care to a patient who has a chest injury
  • Provide care to a patient who has an open abdominal injury
  • Provide care to a patient who has shock/hypoperfusion
 
Obstetrics and Pediatrics - 8 hours
  • Assess and provide care to an infant or child in cardiac arrest
  • Assess and provide care to an infant or child who has respiratory distress
  • Assess and provide care to an infant or child who has shock/hypoperfusion
  • Assess and provide care to an infant or child who has trauma
 
Flexible Core Content - 24 hours total
 
Airway, Breathing and Cardiology - 8 hours
  • Assess and provide care for an adult patient who has respiratory distress
  • Use oxygen delivery system components
  • Perform techniques to ensure a patent airway
  • Assess and provide care to a patient who is experiencing non-traumatic chest pain/discomfort
 
Medical Emergencies - 5 hours
  • Assess and provide care to a patient who has an altered mental status
  • Assess and provide care to a patient who has a history of diabetes
  • Assess and provide care to a patient who is experiencing a seizure
  • Assess and provide care to a patient who was exposed to heat or cold
  • Assess and provide care to a patient who is experiencing a behavioral problem
  • Assess and provide care to a patient who has a suspected communicable disease
 
Trauma - 1 hour
  • Provide care to a patient who has a painful, swollen, deformed extremity
  • Assess and provide care to a patient who has a burn injury
 
Obstetrics and Pediatrics - 8 hours
  • Assess and provide care to an infant or child who has suspected non-accidental trauma or neglect
  • Assess and provide care to an infant or child who has 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 hours
  • Use body mechanics when lifting and moving a patient
  • Communicate with a patient while providing care
 

*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 CECBEMS approved.

Additional EMS-Related Continuing Education-24 hours

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

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

    • Hour-for-hour credit can be applied for standardized courses (including, but not limited to, ABLS, ACLS, AMLS, EMPACT, EPC, ITLS, PHTLS, PALS, PEPP, etc.)

    • 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.

    • Credit can be applied for college courses that relate to your role as an EMS professional (1 college credit = 8 hours of continuing education, not to exceed 12 hours per topic). For example, but not limited to anatomy, physiology, biology, chemistry, 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, Emergency Medical Responder Course, instructor courses, management/leadership courses, performance of duty, preceptor hours, serving as a skill examiner, and volunteer time with agencies.


Inactive Status

An inactive status is designated for Nationally Certified Professionals who are currently not providing patient care at their certification level. For example, inactive status may be helpful for EMS professionals who:

  • are not actively engaged in ambulance/rescue service or health/patient care activity.
  • must be inactive for a period of time - such as, moving, illness, pursuit of education, family responsibilities, etc.
  • are not actively treating patients at their certification level such as educators, administrators or regulators.
Inactive status can only be requested by Nationally Certified EMS Professionals who have completed at least 6 months of EMS patient care at their certification level during their first registration cycle.

Registrants who wish to declare inactive status must continue to meet the NREMT continuing education recertification requirements in subsequent cycles.

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 Paramedic level do not need to obtain verification of skills from their physician Medical Director. These registrants must complete all refresher, continuing education, CPR and ACLS requirements. These registrants are eligible to recertify by examination if they so choose. CPR and ACLS certification are required for those who pass the examination and request Inactive Status.

Applying for Active Status when registered as Inactive

Nationally Certified NRPs may request return to active status at any time once they gain active affiliation with an ALS service.

A request to return to active status must be accompanied by a completed Inactive to Active Registration form which may be downloaded here.

Download the Paramedic Recertification Requirements Brochure.

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