National Registry of EMTs

Psychomotor Exams

Advanced EMT and Paramedic level psychomotor examinations are standardized examinations administered in a variety of locations across the United States. Although all advanced level psychomotor exams are monitored by an official NREMT Exam Representative, these exams are coordinated by either the State EMS Office or by educational institutions under authority of the state.

Candidates should begin their search for an examination site by contacting the course instructor. Instructors should be able to guide candidates to the closest recommended exam site. A current listing of open scheduled examination sites are provided on this site. If a candidate lives in a state that offers the examination as part of their licensure process, the state may chose to close the examination to residents of other states. If examinations are listed in a state, call the state EMS office and ask them when and where you can take the next psychomotor examination. For initial state licensure requirements, some states only accept psychomotor examinations administered in their states.

Advanced-EMT 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:

  • Scene Size-Up
  • Initial Assessment/Resuscitation
  • Focused History and Physical Examination - Rapid Trauma Assessment
  • Detailed Physical Examination

Patient Assessment-Medical

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
  • Initial Assessment/Resuscitation
  • Focused History and Physical Examination - Rapid Trauma Assessment
  • On-Going Assessment

Ventilatory Management

Candidates are evaluated over the following two (2) ventilatory management scenarios:

  • Apneic Adult
Given a scenario of having just found an apneic adult patient with a palpable carotid pulse, candidates must demonstrate immediate management of the patient using simple airway maneuvers and adjuncts, bag-valve-mask device, and supplemental oxygen, followed by the placement of a supraglottic airway device (King®,Combitube®, etc.).
  • Pediatric Respiratory Compromise
Given a scenario with an infant in respiratory distress, candidates must demonstrate immediate management of the patient using simple airway maneuvers, adjuncts, and supplemental oxygen. You will then be required to demonstrate bag-valve-mask ventilation as the patient progresses from respiratory distress to respiratory failure.

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

Intravenous Therapy: Candidates are required to establish a patent IV in a manikin arm in accordance with a given scenario.
Intravenous Bolus Medications: After establishing a patient IV line, candidates must administer an IV bolus of medication in accordance with a given scenario.

Pediatric Intraosseous Infusion Skills

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)

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 twelve (12) 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 twelve (12) 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 NREMT examination results are valid for up to twelve (12) months from the date of the examination, provided all other “Entry Requirements” of the NREMT 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.

Paramedic (Traditional) Psychomotor Exam

The Paramedic psychomotor examination consists of twelve skills presented in a scenario-type format. All skills have been developed in accordance with the National EMS Education Standards and Instructional Guidelines (EMT and Paramedic), 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.

  • 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 NREMT Representative in attendance at the examination.

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.

Paramedics 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:

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

Ventilatory Management

Candidates are evaluated over the following two (2) ventilatory management scenarios:

  • Apneic Adult
Given a scenario of having just found an apneic adult patient with a palpable carotid pulse, candidates must demonstrate immediate management of the patient using simple airway maneuvers and adjuncts, bag-valve-mask device, and supplemental oxygen, followed by the placement of a supraglottic airway device (King®,Combitube®, etc.).
  • Supraglottic Airway Device
Given a scenario of having just found an apneic patient with a palpable carotid pulse, candidates must demonstrate immediate management of the patient using simple airway maneuvers and adjuncts, bag-valve-mask device, and supplemental oxygen. Candidates will then complete the adult presentation by placing an endotracheal tube (ET). Additionally, candidates 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. Next, they must place the Combitube®, King LT®, or PTL® in the adult patient.

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.

IV and Medication Skills

Intravenous Therapy: Candidates are required to establish a patent IV in a manikin arm in accordance with a given scenario.
Intravenous Bolus Medications: After establishing a patient IV line, candidates must administer an IV bolus of medication in accordance with a given scenario.

Oral Stations

Oral Station Evaluation Sheet

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)

Pediatric Skills

Candidates are evaluation on the following pediatric skills:

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.)

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).

Random EMT Skills

Each candidate will be evaluated on one of the following randomly selected EMT skills.

Paramedic Phase 1 Psychomotor Exam

Beginning January 1, 2017, the NREMT will implement the new scenario-based psychomotor exam. In the new test model, Paramedic candidates will be tested on a total of six skills. Five skills from the traditional NRP Psychomotor Examination (Patient Assessment – Trauma, Dynamic Cardiology, Static Cardiology, Oral Station Case A, Oral Station Case B) will be tested, with the addition of 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

Oral Station Evaluation Sheet

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)

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.

EMR Psychomotor Exam

Emergency Medical Responder psychomotor exams are coordinated and administered by the State EMS Office in the state where the training program is located. To schedule EMR or EMT exams, candidates should contact their course instructor.

Emergency Medical Responder psychomotor examinations are not scheduled by the NREMT. All EMR psychomotor exams are administered by either the State EMS Office or at the training institution. EMR course instructors will provide candidates information regarding this examination.

All Nationally Certified Emergency Medical Responders are required to demonstrate proficiency on the following skills:

EMR Exam Coordinator Resources

The NREMT Exam Coordinator Manuals and User Guides are provided as a reference to candidates and educational institutions.

EMT Psychomotor Exam

Emergency Medical Technician psychomotor exams are coordinated and administered by the State EMS Office in the state where the training program is located. To schedule EMR or EMT exams, candidates should contact their course instructor.

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 scheduled by the NREMT. All EMT psychomotor exams are administered by the State EMS Office.

All Nationally Certified Emergency Medical Technicians are required to demonstrate proficiency on the following skills:

EMT Exam Coordinator Resources

The NREMT Exam Coordinator Manuals and User Guides are provided as a reference to candidates and educational institutions.

Psychomotor Retest

Advanced EMT



Advanced EMT 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 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 ten (10) skills, provided all other requirements for National Certification are fulfilled. This official documentation must be signed by the AEMT Training Program Director or Physician Medical 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 second full and final attempt of the psychomotor examination, the candidate must complete a new, state-approved Advanced EMT Training Program.



Paramedic



Paramedic candidates are allowed three (3) full attempts to pass the psychomotor 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 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 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 and CAAHEP-accredited Paramedic Education Program.

Psychomotor Exam Complaints

Candidates with a complaint about the psychomotor exam must initiate the complaints in-person with the NREMT Exam representative during the exam. Complaints will not be valid after the exam has concluded and will not be accepted if the complaint is raised after the candidate receives their exam results. Complaints may be filed for only two (2) reasons:

  • The candidate feels they have been discriminated against. Any situation that can be documented in which the candidate believes an unfair evaluation of your abilities occurred might be considered discriminatory.
  • There was an equipment problem or malfunction during the candidate's performance in any skill.

If either of these two things occur, the candidate must contact the NREMT Exam Representative immediately to initiate the complaint process. The NREMT Representative will supply the necessary complaint forms to be completed in writing. The Quality Assurance Committee, comprised of the Physician Medical Director, the Examination Coordinator, and the NREMT Representative, will review the concerns and make a final determination related to the complaint.

Exam Results

Unofficial results are generally provided to the candidates on the day of the psychomotor exam.

Official exam results are posted on the NREMT’s password-secure website through an individual’s login account, within four weeks.

Remember, candidates are required to successfully complete BOTH the psychomotor and the cognitive examinations to qualify for national certification.

Emergency Medical Responder and Emergency Medical Technician psychomotor examinations are managed and approved by the State EMS Office. Due to this, the approval process varies from state-to-state. The methods for reporting pass/fail results regarding psychomotor examinations are also managed in a variety of methods. If you pass the cognitive examination and the NREMT website does not indicate you obtained National EMS Certification then you should contact your instructor to determine who was responsible for reporting your results to the NREMT.

Advanced Level (Advanced EMT, Intermediate/99 and Paramedic) psychomotor exam results are provided to the NREMT by an approved National Registry Advanced Level Representative.

Advanced Level Exam Coordinator Resources

The NREMT Exam Coordinator manuals are provided as a reference to candidates and educational institutions.

Advanced Level Exam Resources

Americans with Disabilities Act Information

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.

EMR & EMT Exam Psychomotor Exam Accommodations

All candidates must complete the psychomotor examination in the same standardized format. The presentation of any skill may not be altered to accommodate a candidate’s request without first obtaining approval from the State EMS Office. The State EMS Official or approved agent is not authorized to individually make any determination for accommodation of the psychomotor examination. For example, it is not appropriate to move the Simulated Patient in the Patient Assessment/Management – Trauma skill from the floor to an examination table at the candidate’s request because the candidate is physically unable to bend down and assess a patient found lying on the floor. The psychomotor examination is intended to present simulated patients with realistic situations that approximate the candidate’s ability to function in the out-of-hospital environment. The State EMS Official or approved agent and all Skill Examiners must remain vigilant for any situation that may alter the normal presentation of any skill other than that which is intended throughout the psychomotor examination. When in doubt, contact the State EMS Office for assistance.