Paramedic Candidate Handbook · About The Examination | National Registry of Emergency Medical Technicians (2024)

Paramedic Candidate Handbook

Examination Format

Paramedic Candidate Handbook · About The Examination | National Registry of Emergency Medical Technicians (1)You will take the examination on a computer at an authorized Pearson VUE testing center. The examination consists primarily of multiple-choice items. The examination will also contain other item types such as multiple-response items and technology-enhanced items. Some of these items will be linked to a scenario. The examination items are written by members of the EMS community, including educators, practitioners, and medical directors. Each examination has questions that count toward your score and questions that do not. Your examination will have between 110–150 questions; 20 of those questions do not affect your score.

The unscored questions are for testing new concepts to make sure that future questions are fair and appropriate. This is a standard part of making examinations. You will not be able to tell which questions count toward your final score and which do not, so answer each one as if it counts.

The examination is a computer adaptive test (CAT). This means the number and difficulty of test items will vary for each examination session, but the passing standard remains the same for all candidates. The decision regarding passing or failing the examination is based on the following question: “Has the candidate reached the level of entry-level competency (passed) or has the candidate not yet reached entry-level competency (failed)?”

A CAT examination is different from a traditional examination. The more questions you get right, the harder the CAT gets. The goal is to find out if you have enough knowledge compared to the passing standard. If the examination asks a difficult question and you get it right, it will then ask you a more difficult question until you begin to answer incorrectly. Then it will start to ask you easier questions. This way the computer can provide you questions that are at the appropriate level of difficulty for you. All you need to do is demonstrate entry-level competency. As long as you demonstrate competency, you will pass. CAT testing is faster and more accurate than traditional testing.

The Paramedic examination covers the following areas:
Paramedic Candidate Handbook · About The Examination | National Registry of Emergency Medical Technicians (2)Note: Items related to pediatric patient care will be integrated throughout the examination content.

You can find more information on the format of the examination at:
Paramedic Certification Examination Test Plan


The following suggestions may help you prepare for the examination:
Study your textbook and education materials
Review the current American Heart Association’s Guidelines for Cardiopulmonary
Resuscitation and Emergency Cardiovascular Care and the National EMS Education Standards. Both resources are available at:
Review the sample items for the examination, which are available here

More information that will help you prepare for the examination can be found here.

The Registry does not recommend any particular examination preparation materials. If you have any additional questions after reviewing the previous information, ask someone in your education program for more information.

Authorization to Test (ATT)

To get an Authorization to Test (ATT), you need to have completed an application and paid the application fee. Your program director must verify your eligibility. When those steps are complete, our system will give you an ATT, usually within 1-2 business days. The ATT will post to your account.
You can find and print your ATT from the “Application Status” page using these steps:

  1. Log into your Registry account.
  2. Select “Candidate”
  3. Select “My Applications” on the left-hand side.
  4. Select “Application Status/ATTs”
  5. Select the box “Current Applications”
  6. Select the box labeled “Print/View Authorization to Test Letter” on the application
  7. Follow the prompts to print or view the ATT

The ATT tells you how to schedule your examination and gives you important information about testing requirements at Pearson VUE centers.

The ATT is only valid for 90 days from the day it posts to your account. We do not offer extensions for expired ATTs.

If your ATT expires, you must apply again and pay the fee again in order to get a new ATT.
You can find the ATT expiration date and refund policy at:


Paramedic Candidate Handbook · About The Examination | National Registry of Emergency Medical Technicians (3)

Follow the instructions on the ATT to schedule your examination at:

We post all information about your application to your National Registry account. Pearson VUE is an independent testing vendor and has its own way of contacting you. They will send you an email about your examination. The email will confirm the day and time of your examination, the testing location, and the testing rules.

If you do not receive an email confirming your examination appointment, your examination has not been successfully scheduled.

If the email has an error and you do not contact Pearson VUE to correct it, you will not be allowed to take the examination.


If you need to reschedule or cancel your examination, contact Pearson VUE at least one business day (24 hours) prior to your examination appointment. Call 866-673-6896 (M-F 7 a.m. to 7 p.m.
Important Note: If you fail to appear for your scheduled examination appointment, fail to cancel or reschedule within the required time, or are refused admission, you will forfeit your examination fee. You will have to complete an express application and submit the associated application fee to receive a new ATT. The Registry does not issue refunds for failure to appear for your scheduled examination appointment.

No-Show Policy

If you fail to notify Pearson VUE at least one business day (24 hours) before your scheduled examination, your account will be marked with a “no show” and you will forfeit your examination fee.

You can appeal the “no show” status if extenuating circ*mstances are involved. You will need to provide documentation of the circ*mstances if you want to try to reschedule the missed examination at no additional cost.

If you are denied a “no show” appeal, you will need to reapply. Use an Express Application and pay the application fee to receive a new ATT.

To learn more about “no show” policies and procedures, go to:

Contacting the National Registry vs. Pearson VUE

If you have questions about your eligibility for National Registry certification, the application, your ATT, the examination format, examination results, retesting, Registry appeals and disciplinary processes, and maintenance of certification, please contact the Registry at 614-888-4484.

If you have questions concerning Pearson VUE test site rules and regulations, acceptable forms of identification, your Pearson VUE username and password, scheduling an examination appointment at a Pearson VUE Test Center, directions to the Pearson VUE Test Center, and/or your examination appointment, please contact Pearson VUE at 866-673-6896. Please note: Pearson VUE charges a fee for scheduling or canceling an appointment over the phone.

FAQ: What do I do if I do not have a valid ID?

You will need to obtain a valid ID before scheduling your examination.

Taking the Examination

Paramedic Candidate Handbook · About The Examination | National Registry of Emergency Medical Technicians (4)

Pearson VUE Test Center Protocols and Rules

Arrive at the test center at least 30 minutes before your scheduled testing time. You must bring two forms of acceptable identification with you on the day of your examination. Your ATT contains vital information about what documents to bring to the Pearson VUE Test Center. Review the information contained in your ATT carefully before arriving for your confirmed examination appointment.

You are not allowed to bring personal items, including but not limited to, mobile electronic devices, watches, wallets, purses, firearms or other weapons, hats (and other non-religious head coverings), bags, jackets, notes, pens, or pencils into the testing room. There are no exceptions to this policy.
The test center will provide a small locker space to secure personal belongings. All electronic devices must be turned off before storing them in a locker. You are encouraged to leave as many of these as possible at home. Pearson VUE and the Registry are not responsible for lost, stolen, or misplaced personal items at any test center. If you refuse to store your personal items, you will not be permitted to test, and you will forfeit your testing fee.

Before you enter the testing area, the Pearson VUE Test Administrator is required to verify that you are not bringing any unauthorized materials or devices into the room. You may be asked to pull your hair back, pat yourself down, or roll up your sleeves during this process.

Starting the Examination

The test center administrator will bring you to the computer you will use to take your examination. You will first have to read and acknowledge a non-disclosure agreement. The non-disclosure agreement has a maximum time limit of 5 minutes, and if you do not complete the non-disclosure agreement in this time you will not be allowed to begin the examination. It will count as an attempt, and you will forfeit your fee.

You will then have a tutorial on the types of items that will appear in the examination. You will have 10 minutes to complete the tutorial.

After the tutorial, you will begin your examination. You will have 3 ½ hours to complete the examination.

Examination Security

We take examination security seriously. We put security policies and procedures in place to protect examination content and testing session data. These policies help make sure that the examination is given in the same way in every testing center, without inappropriate aid. They also make sure that the person who was given the ATT is the same one taking the examination. As a result, you may be required to:

  • Show identification as described in your ATT
  • Provide a legal signature
  • Have your picture taken
  • Store all belongings prior to entry into the testing room
  • Be recorded (by audio and/or video) during the examination

All National Registry examinations are copyrighted. You may not copy or record any material from the examination in any way. You are prohibited from the following:

  • Disclosing or discussing any information about the examination with anyone, includinginstructors
  • Posting or discussing questions on any internet or social media websites
  • Reconstructing examination content using your memory or the memory of others
  • Seeking help from anyone in answering examination questions
  • Removing examination materials or recorded information from the testing center

If you witness any of the above behavior, or any irregular behavior that may be in violation of the National Registry Candidate Policies, report it to the Registry immediately by calling 614-888-4484. The National Registry reserves the right to terminate a certification, invalidate the results of an examination, and take any other appropriate action against any candidate who violates copyright or engages in any of the above behaviors.

Examination Results

Scoring and Accessing Examination Results

Pearson VUE sends your examination data to us. The Pearson VUE staff does not have access to your results and cannot give you results.
Our system posts your examination results to your Registry account, generally within three business days after you complete your examination. Your results are only available in your Registry account.

To access your examination results, please follow the steps below:

  1. Log into your National Registry account.
  2. Click on “View All Certification Applications”
  3. Click on “Results”.
  4. Click on “Print Examination Results”

Report of Candidate’s Results

If you pass the examination, we do not send you specific details about your examination results.
If you do not pass the examination, we will post more information about your results to your account. Our system scores the examination as a whole. Your score will be presented on a scale from 100-1500. The passing point is indicated by a 950. Your score will be shown as a number on this scale, as well as on a graphical depiction. This will allow you to see how far your attempt was from the passing standard. This difference will allow you to determine how much more preparation you need for your next attempt.

To learn more about scale score system visit:
Scaled Score Key Initiative


Paramedic Candidate Handbook · About The Examination | National Registry of Emergency Medical Technicians (5)

Scoring and Accessing Examination Results

If you did not pass the examination, you may apply to retest 15 days after the last examination.

You have six chances to pass the examination. If you fail three times, we require you to complete remedial education. In order to take the remaining attempts, you will have to send us documentation to Once we receive the documentation and your new application, we will clear you to take the examination again. The remedial education allows you to take the examination three more times. To receive a new attempt, you must submit a new application, pay a new fee, and get a new ATT each time.

To learn more about retesting qualifications, please visit this page.

FAQ: What education can I use for remedial training?

The remedial training requirement can be satisfied through three different options:

  1. Completion of the Paramedic 30-credit National Competency Component from the NCCP model
  2. State or CAPCE-approved 48-hour Paramedic refresher course
  3. The 30 credits or 48-hour requirements can be met with any state-approved education program, including but not limited to community colleges, vocational schools, localEMS agencies, or online education providers. You can complete online education if it isCAPCE or state approved.

Examination Review

The National Registry is committed to a fair and unbiased testing process and follows industry best practices to ensure that all examinations are accurately scored. As a service to the community, the National Registry offers candidates the option to have their examinations rescored by a qualified staff member. Although it is extremely unlikely an examination was incorrectly scored, the rescoring process allows verification of a score.

If a candidate suspects that their score may have been negatively affected by a specific item, or items, delivered on their examination, they may ask for a review of such item(s) as part of their rescoring request. Only items identified in the request will be reviewed. For example, if a candidate suspects that an item asking to interpret a 12-lead ECG was outside the scope of practice for the certification level at which they tested, they must indicate that in their rescoring request. If such items were present on their examination, they will be reviewed to ensure (1) their accuracy, (2) whether they were within the scope of practice for the relevant certification level, and (3) whether they had any impact on the test score.

The rescoring process is not:

  • A review of the content of all items administered during the examination
  • A reconsideration of the passing standard or the acceptability of the testing conditions
  • An opportunity for the candidate to review examination items

How to Request a Review of the Scoring Report

To request a review of the scoring report, please complete the Rescoring Request Form detailing the specific reason for the request. Requests must be submitted within 30 days of the examination date.

A $150.00 fee is due prior to the rescoring process.

Upon completion of the rescoring process, candidates will be provided with a Rescoring Report. If an irregularity is discovered during the review process, the review fee will be refunded, and we will work with the candidate on further accommodations and resolutions.

Part 5: Certification Policies

Paramedic Candidate Handbook · About The Examination | National Registry of Emergency Medical Technicians (2024)


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