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National Registry Paramedic




1. The National Registry Paramedic test can be shortened by around fifty percent while remaining more precise than a linear test. The adaptive algorithm won’t waste time presenting questions that are too hard or too easy for the test-taker. This shortens the amount of time required to take the paramedic exam and the number of question that the test-taker has to answer.


2. Can show results quickly after testing is completed. Technically the CAT makes results available as soon as the test is complete. In the case of the NREMT paramedic exam, test results will be posted within two business days on the candidate’s National Registry of EMT account. This requires the candidate to log in with their password at the National Registry of EMT website.



1. Candidate can’t go back and change answers, mark a question to review later, review their answers, or skip a question. Each question administered on the National Registry Paramedic test needs to be taken seriously, thought over, and answered well at the time it is given.


2. Candidates aren’t able to accurately judge or budget time allowed for each and every question. Since the paramedic exam is adaptive and the number of questions will vary based on a candidate’s performance, the candidate can not judge whether their test will have closer to 80 or 150 questions.


This means the candidate needs to remain flexible and focus on answering the paramedic questions correctly rather than rapidly.


Don’t Panic – If you begin the NREMT Paramedic exam and the questions seem to become difficult very quickly, it may be a good thing. Some individuals begin to panic because the National Registry Paramedic exam starts out ok and suddenly seems very hard after answering a few questions.


A candidate may feel like the paramedic test is hard questions with a few easier questions sprinkled in here or there. (This was my experience when I took the NCLEX for Nursing, which is also CAT.) If this happens to you during the test – don’t panic, it could be a sign you are doing well on the test.


After all, if you answer a question correctly, the National Registry Paramedic test administers more difficult questions until you show competency. This means if you are answering the lower level questions correctly, the test may begin administering harder and harder questions on each area of content. More correct answers means more hard questions.


Obviously, a candidate can be getting questions that seem very hard while doing poorly on the paramedic exam. In a situation where a candidate isn’t familiar with the material or is unprepared for the NREMT Paramedic Cognitive Exam, the questions may seem very difficult even though they are being administered easier and easier questions.


Another reason test-takers panic is because their test ends at 80 questions (60 test and 20 pilot questions). Once again this can be very good or very bad.


It means that within 60 questions the paramedic exam was able to determine with 95% confidence that the candidate is competent in ALL content areas, or the candidate will not be able to reach the minimum level of competency under any test circumstances.


Twenty questions in each NREMT Paramedic exam are “Pilot Questions” being tested for future candidates and do not count toward your test score.


When the National Registry Paramedic test stops after administering the minimum required items it usually means the candidate did very well or very poorly.


If a candidate studied well through Paramedic school and performed well, they should have an idea which group they fall into. Candidates who fail may have done well on most of the National Registry Paramedic exam, but did very poorly on a specific area or areas of content.


If the algorithm determines early that a candidate can not pass a required area of content it may end the test around 80 questions. The good news is if a candidate fails, the National Registry of EMTs will indicate how well they did on the content areas of the paramedic exam.


This will give the candidate a good idea of what content needs to be studied before attempting to retake the NREMT Paramedic exam.

National Registry Paramedic Cartoon Patient Care


National Registry Paramedic – Psychomotor Exam


Any candidate planning on taking the National Registry Paramedic Psychomotor Exam should be aware that significant changes were made to the test starting August 1 2016.


The previous paramedic test was a straightforward hands on exam which tested 12 basic skills. Information for that test is outdated because the new psychomotor paramedic exam is focused on reality based experiences which are tested for using 6 scenarios.


Studies indicated that students had trouble taking skills learned out of context, and transferring them to real life experiences on patients. Paramedic school now focuses more on taking skill testing from mannequins to real life scenarios as soon as the student is competent.


There is also a bigger focus on the role of a paramedic and the entire team dynamic. In the field, good team dynamics is very important not only for paramedics but to all emergency medical services (EMS).


The paramedic portfolio reflects this focus on team dynamics with it’s focus on both being a team member and team leader as a paramedic in training.

Paramedic Psychomotor Exam Scenario Testing


The new paramedic psychomotor exam consists only of 6 scenarios held at six stations instead of the previous twelve tests. All of these scenarios must be successfully passed. These six scenario stations are:


Patient Assessment: Trauma
Dynamic Cardiology
Static Cardiology
Oral Station Case A
Oral Station Case B
Integrated Out-Of-Hospital Scenario (OOHS)

The first station, Patient Assessment: Trauma

This is the most similar to EMT school testing. It will require studying the skill sheet and successfully transferring the knowledge into hands on skills. The candidate is required to perform a head-to-toe, physical assessment and voice treatments on a simulated patient after being given a scenario.


This hands on patient care will include Scene Size-up, Primary Survey/Resuscitation, History Taking, and the Secondary Assessment skills.


Here are the basic requirements of the Patient Assessment: Trauma, but it will be up to the candidate to determine at what point in the scenario to initiate the assessment.


Also, the candidate may need to change the order of or repeat certain parts of the assessment based on the live scenario. (Check the actual skill sheet for the critical criteria to avoid fatal mistakes.)

Patient Assessment: Trauma

A. Take or verbalizes appropriate PPE precautions
B. Determine the scene and situation is safe
C. Determine the Mechanism of injury/ Nature of illness
D. Determine number of patients
E. Request additional help if needed
F. Consider stabilization of the spine
G. Verbalize general impression of the patient
H. Determine responsiveness/level of consciousness
I. Determine chief complaint/apparent life-threats
J. Airway:
   a. Open and assess airway
 Insert adjunct as needed

K. Breathing:
   a. Assess breathing
   b. Assure adequate ventilation
   c. Initiate appropriate oxygen therapy
Manage any injury which may compromise breathing/ventilation

L. Circulation:
   a. Check pulse
   b. Assess skin color, temperature, or condition
   c. Assess for and control any major bleeding
   d. Initiate shock management

M. Identify priority patients/make transport decision based upon calculated GCS
N. Obtain, or direct assistant to obtain, baseline vital signs
O. Attempt to obtain SAMPLE history
P. Head:
   a. Inspect mouth, nose, and assess facial area
   b. Inspect and palpate scalp and ears
   c. Assess eyes for PERRL

Q. Neck:
   a. Check position of trachea
   b. Check jugular veins
   c. Palpate cervical spine

R. Chest: Inspect, palpate, and auscultate chest
S. Abdomen/pelvis:
   a. Inspect and palpate abdomen
   b. Assess pelvis
   c. Verbalize assessment of genitalia/perineum as needed

T. Lower extremities: Inspect, palpate, and assess motor, sensory, and distal circulatory functions
U. Upper extremities: Inspect, palpate, and assess motor, sensory, and distal circulatory functions
V. Posterior thorax, lumbar, and buttocks:
   a. Inspect and palpate posterior thorax
   b. Inspect and palpate lumbar and buttocks area

W. Manage secondary injuries and wounds appropriately
X. Reassess patient

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