Exam Overview for The Paramedic Certification Exam (page 3)
The National Registry of Emergency Medical Technicians (NREMT) was established in 1970 in response to a suggestion by the U.S. Committee on Highway Safety. Today, the NREMT is an independent, nonprofit agency whose job is to certify that EMTs and paramedics have the knowledge and skills to do their jobs—to save lives and preserve health. By setting uniform national standards for training, testing, and continuing education, the NREMT helps ensure patient safety throughout the United States.
In all 50 states, the National Registry and state offices of Emergency Medical Services work together to establish certification requirements for EMTs and paramedics. All states test individuals seeking to become EMTs or paramedics. Some states make sole use of NREMT tests, while others offer state tests.
The curriculum for paramedic education and testing comes from the Department of Transportation National Highway Traffic Safety Administration National Standard Curriculum (DOT/NHTSA NSC). The curriculum was phased in as the basis for educational programs and testing. The NREMT tests and the state tests are all based on this curriculum.
Minimum Certification Requirements
In order for an individual to become certified as a nationally registered NREMT-Paramedic, he or she must meet the following requirements:
- be at least 18 years old
- hold current National Registry or state certification at the EMT-Basic, EMT-Intermediate/85, or EMT-Intermediate/99 level
- successfully complete a state-approved EMTParamedic program that reaches or exceeds the behavioral objectives of the EMT-Paramedic National Standard Curriculum (NSC) within the last two years*
- truthfully complete the “Licensing Action and Felony Statements” on the NREMT application and provide documentation as required for any positive criminal history
- possess current CPR for the healthcareprovider certification
- successfully complete the NREMT-Paramedic cognitive and psychomotor examinations
* If the applicant’s initial EMT-Paramedic training was completed more than two years prior and the individual has maintained state certification at the EMT-Paramedic level, the individual must submit documentation verifying completion of an EMT-Paramedic refresher course within the past two years.
If the applicant’s initial EMT-Paramedic training was completed more than two years ago and the individual has never obtained state or NREMT certification, the individual must complete another state-approved EMT-Paramedic training program in its entirety.
If the individual’s initial EMT-Paramedic training was previously certified by NREMT or a state agency, reentry into the National Registry may be granted providing the individual
submits official documentation of successful completion of DOT EMT-Paramedic training after January 1, 1977.
shows satisfactory evidence of prior state certification as an EMT-Paramedic.
has current status as an American Heart Association Advanced Cardiac Life Support (ACLS) provider or instructor.
has completed either Prehospital Trauma Life Support (PHTLS) or Basic Trauma Life Support (BTLS) within the past two years.
has completed a state-approved DOT EMT-Paramedic Refresher training program or 48 hours of ALS training similar to that of the DOT EMTParamedic Refresher training program.
has a letter of approval from the state EMS office in the state where the individual works or intends to work, supporting such recertification.
successfully completes the NREMT-Paramedic cognitive and psychomotor examinations.
NREMT-Paramedic certification requires successful completion of both cognitive (knowledge-based) and psychomotor (practical skills–based) exams. Successful completion of each exam remains valid for a period of 12 months. If you fail to successfully complete the remaining portion within that 12-month period, you will be required to repeat the original exam as well. For example, if you pass the cognitive exam but fail one of the stations in the practical exam, you will have 12 months to pass the practical exam or you will be required to retake the cognitive exam. Successful completion of both the practical and cognitive examinations must occur within two years of the completion of a state-approved EMT-Paramedic training program.
How to Apply
Once you have met all of the requirements previously outlined and are ready to take the certification exams, go to the NREMT website at www.nremt.org to obtain an application and find testing locations. You will need to create a registrant account and obtain the online application. Once you access your account, you will be able to apply for the certification exams and track your progress in the certification process.
Once the NREMT has confirmed your eligibility, someone will inform you how and where to arrange to take the certification exams. Do not delay making contact with the National Registry, as it is the source of significant useful information on the certification process.
The EMT-Paramedic Cognitive Exam
In January 2007, the NREMT moved from a paper-andpencil “written” examination to computer-adaptive testing (CAT) for the cognitive portion of the certification requirements. With the CAT, each test is tailored specifically for each candidate. Exams begin with an easy question. If you answer that question correctly, the next question will be slightly more challenging. If the question is answered incorrectly, the next question will be slightly easier. With each correct answer, the computer algorithm statistically estimates your competence. As the exam progresses, the estimation of competence becomes more precise.
Once the CAT algorithm is confident that you have proven competence, it will terminate the exam. This generally occurs after 80 to 110 questions, but may take as many as 150 questions. Based on the way the CAT exam works, no two exams are exactly the same, although the test-question bank the computer draws from is the same for all exams. The EMT-Paramedic candidate is allowed two-and-a-half hours to complete the examination.
Based on research findings of the actual practice of EMT-Paramedics nationwide, NREMT developed a test plan that determined the breakdown of questions for the CAT examinations. While specific test-question selection will be different for each candidate with varying difficulty, the percentage of the exam from each topic area will be the same, as follows:
Remedial EMT-Paramedic Training
In addition to validated test questions, exams also include pilot test questions, which have been written but not yet validated. These questions are being evaluated for possible inclusion in future examinations. It is impossible to identify which questions are validated and which are pilot questions, so answer each question to the best of your ability. Pilot questions are not counted toward or against your exam results.
Exam questions appear on the computer screen one question at a time. Once you provide an answer, the next question will appear. You are not able to go back and change an answer or to mark an answer to come back to later. As such, take your time to adequately read and analyze each test question. Do not rush through your answers. If you do not know the answer, take your best guess and move on.
While the old written certification examination contained 180 questions, requiring 75% accuracy to pass, there is no minimum number of test questions or minimum percentage of correct answers needed to pass the CAT exam. Rather, the algorithm decides when and if the candidate has demonstrated competency based on questions answered.
At some point, the computer will terminate the testing session. Based on your answers to questions, the computer will determine that you have demonstrated competency, in which case you have passed the exam, or that there is no need to continue because you have already demonstrated a lack of competency, in which case you have failed. Typically, both strong and weak candidates will finish after answering fewer questions than those near entry-level competency.
You will not know when you leave the testing site whether you have passed or failed the exam. Since the exam is tailored to challenge each individual candidate to the limit of his or her ability, everyone taking the exam will think it is difficult. Generally, you will be able to find your results through the NREMT secure website within a couple days. If you fail the exam, you will be provided information detailing in which areas you are in need of improvement.
Candidates are given three opportunities to pass the CAT exam, provided other criteria for NREMT certification are met. After three unsuccessful attempts, the candidate must complete a 48-hour remedial training program as identified in Table 1.1. Following remedial training, the candidate is given three additional attempts to successfully complete the exam. This must all occur within two years of completion of the initial EMTParamedic training program. Candidates who fail to pass after a total of six attempts or within the two-year time limit are required to repeat the state-approved EMT-Paramedic training program in its entirety prior to being able to retake the certification exams.
Candidates who successfully complete the examination will be sent National EMS Certification materials. Candidates who fail the exam will be sent a letter from the NREMT identifying the areas where the candidates performance was near or below the passing standard. Should this occur, studying should be tailored to those areas where the candidate is weak.
For additional information on the specifics surrounding the certification process and how the CAT was developed and how it works, visit the NREMT website at www.nremt.org.
A Word about the CAT Environment
With the implementation of CAT, security measures were also implemented to ensure the person taking the exam is the actual EMT-Paramedic candidate. This security process has been described as extreme. Be prepared for this, so as to not become anxious prior to starting the CAT exam.
All CAT exams are given at a registered Pearson VUE testing center. You will be able to locate a center through the NREMT website.
Testing candidates will be taken to a private, secure room. You will be required to empty your pockets to ensure that they do not contain notes or other information. No cell phones are permitted in the room. You will be fingerprinted to confirm identity. In the event that you need to use the restroom, you must call the moderator, who will stop the exam, escort you to the restroom, stand outside the restroom, escort you back to the exam room, and then refingerprint you. Do not be alarmed when this occurs, as it is standard procedure for all candidates.
For additional information on what will occur at a Pearson Professional Center, visit the NREMT website at www.nremt.org.
The EMT-Paramedic Practical Exam
After a lengthy period of review, revision, and pilot testing in the 1990s, the National Registry presented new practical exam instruments for EMT-Paramedics in October 2000. The revised Advanced Level Practical Exam is intended to assess the abilities of new EMTParamedics to do their job on the scene, out of a hospital setting. Skills are assessed by means of scenarios in which the candidate plays the part of the EMT- Paramedic called on for help.
The National Registry emphasizes that the practical exam is designed not as a teaching instrument but as a testing instrument; the candidate must go into the exam prepared to function as an EMT-Paramedic, not expecting to learn how to become one. The National Registry’s practical tests assess skills in accordance with the 1994 EMT-Basic National Standard Curriculum and the behavioral and skill objectives of the 1999 EMT-Intermediate and EMT-Paramedic National Standard Curricula, as well as current American Heart Association guidelines for ACLS and BCLS.
EMT-Paramedic candidates taking the National Registry practical exam are tested on 12 skills when taking the full test:
- Patient Assessment—Trauma
- Ventilatory Management—Adult
- Ventilatory Management—Dual Lumen Airway Device
- Cardiac Management Skills—Dynamic Cardiology
- Cardiac Management Skills—Static Cardiology
- Oral Station—Case A
- Oral Station—Case B
- IV and Medication Skills—Intravenous Therapy
- IV and Medication Skills—Intravenous Bolus Medications
- Pediatric Ventilatory Management
- Pediatric Intraosseous Infusion
- Random Basic Skills—one of the following: Spinal Immobilization (Seated Patient); Spinal Immobilization (Supine Patient); Bleeding Control/Shock Management
Candidates for EMT-Paramedic certification who have already passed the NREMT-Intermediate/99 practical exam within the preceding 12 months have a leg up: They can apply the results of the Intermediate exam to their first full attempt of the NREMT-Paramedic exam for these four skills:
- IV Therapy
- IV Bolus Medications
- Pediatric Intraosseous Infusion
- Random Basic Skills
If you take this route (applying the four passed Intermediate skills to your Paramedic practical test), the rules for Pass/Fail are similar to those just outlined. However, if you fail, and fail both retests, you must undergo remedial training in all 12 skills and then take the practical exam again, but this time on all 12 skills.
No matter what the approach, failing six or more skills means the candidate fails the entire practical exam. In that case, he or she must document remedial training on all 12 skills before retesting. The maximum number of times a candidate may take the full practical exam is three (a full practical exam being a test on all 12 skills with two opportunities for retesting on failed skills). If a candidate failed the full exam three times, he or she would have to complete a new stateapproved EMT-Paramedic training program in order to test again.
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