**This page is archived for transparency and historical purposes. Information contained within may have been updated since this was published.**

The EMS community has provided feedback over the past several years that it was time for adjustments to the Advanced Life Support (ALS) examination – specifically, the psychomotor examination. The data from the 2019 ALS Practice Analysis [LINK] supported the feedback. It was clear to the National Registry that it was time to evolve the way candidates are assessed for minimum competency by introducing a refined ALS examination while also sunsetting the current ALS psychomotor examination.  

So what is happening with ALS assessment?  

Replacing the current portfolio requirement with an eligibility requirement.  Educational programs will need to attest to the competency of each candidate in essential physical skills as identified by the most recent ALS practice analysis. For paramedic, we are working with CoAEMSP to develop guidelines for educational programs to help them appropriately assess competency in physical skills. For the AEMT level, we will work with NASEMSO to set up a similar process. 
Strengthening and Expanding the Cognitive Examination. Multiple response items have been added to all cognitive examinations. Additionally, technology enhanced items will continue to be added to the examinations in order to better test knowledge, skills, and abilities. New systems are being developed to improve and increase the number of new items being developed for the examination. These include advanced training for item writers, and increasing our item pipeline.    Dr. Paul Rosenberger has joined the Registry' as the Examinations Content Manager and will lead the development of these new processes.   
Sunsetting the Psychomotor Examination. As we discontinue the psychomotor examination, we begin expanding the current cognitive examination to include new material related to communications, leadership and clinical judgment.  The expanded examination will focus on soft skills and the EMS process.     
Communication and Community Involvement. Unlike the other major components, this last one focuses on the involvement and collaboration of the EMS field as a whole to ensure the final product is something everyone can be proud of. In addition to the ALS expert panel, smaller groups will be brought together to work on specific design issues such a new item formats, processes for moving transitioning, and communicating the changes with the EMS community.     

There is one important question that many people are asking, and that is “Who is leading this initiative?” While the National Registry is leading the ALS redesign, it was important to note that we have involved the entire community. A multidisciplinary panel was created to foster collaboration and input throughout the process. The ALS Redesign Expert Panel ensures inclusivity, diversity of thought and input from many different areas of the EMS community.  

“The ALS Redesign Project is an excellent example of how the Registry is partnering with the EMS Community to keep the assessment process current and relevant,” says Dr. Greg Applegate, chief science officer for the National Registry. “It is also an excellent example of how the EMS community works together to establish standards and practices that protect the public and advance EMS.”  

The ALS Redesign project will be phased in over time in multiple stages. We anticipate full implementation by mid-2023.