The Cognitive Exam

The National Registry Advanced Emergency Medical Technician (EMT) cognitive exam is a linear computer based test (CBT). Each candidate will answer 135 questions (items). Each exam will have 100 ‘live’ items that count toward the final score. The exam will also have 35 pilot questions that do not affect the final score. The maximum amount of time given to complete the exam is 2 hours and 15 minutes.

The exam will cover the entire spectrum of EMS care including: Airway, Respiration & Ventilation; Cardiology & Resuscitation; Trauma; Medical; Obstetrics/Gynecology; EMS Operations. Items related to patient care are focused on adult and geriatric patients (85%) and pediatric patients (15%). In order to pass the exam, candidates must meet a standard level of competency. The passing standard is defined by the ability to provide safe and effective entry level emergency medical care.

We strongly encourage candidates to review the following information:

• Cognitive Exam Policies
• Cognitive Exam Information

Advanced EMT Cognitive Exam Test Plan

Based on the most recent practice analysis, the National Registry Board approves a cognitive exam test plan. A test plan is a blue-print that tells the computer testing software how to build a candidate's exam. The table below indicates what percent of the test will focus on each topic area.

Cognitive Exam Retest Information

If a candidate is not successful in passing the cognitive exam, the National Registry will provide a candidate feedback on their performance. Candidates may apply to retest 15 days after the last examination.

Candidates are given a total of six opportunities to pass the Advanced EMT cognitive examination, provided all other requirements for National EMS Certification are met. After three attempts, candidates must submit official documentation verifying completion of remedial training. Remedial training must be completed by a state approved instructor or an approved CAPCE course. After remedial training is complete, the candidate is given three additional attempts to pass the Advanced EMT cognitive exam, provided all other requirements for National Certification are met. Candidates who fail to pass after a total of six attempts are required to repeat the entire Advanced EMT course.

Remedial Training Requirements

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

1. Traditional refresher course: Completion of a State or CAPCE(F1, F2, F5) approved 36 hour AEMT refresher course.
2. NCCR 25 hours of continuing education: Completion of the 25 hour National Competency Component from the NCCP model.
3. Continuing education topic hours: Advanced EMT remedial may be completed by continuing education* and must include the topics and hours listed here under Traditional Model.

Note: Some states require the traditional refresher course and will not accept continuing education hours. Please refer to your state's particular requirements. A maximum number of 10 hours can be applied from Distributive Education towards this section and must be state or CAPCE approved.

The Psychomotor 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 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, BVM device, and supplemental oxygen, followed by the placement of a supraglottic airway device.

• 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 BVM ventilations as the patient progresses from respiratory distress to respiratory failure.

Cardiac Arrest Management/AED

IV and Medication Skills

Pediatric Intraosseous Infusion Skills

Random EMT Skills

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

Psychomotor Exam Retest Information

Advanced EMT candidates are allowed two 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 or less skills when taking a full attempt of the psychomotor examination. Candidates are eligible for two retest attempts of the four or less skills failed. If offered, only one retest attempt may be completed on the same day. Failure of any skill on the second retest attempt constitutes complete failure of the entire psychomotor examination. Candidates who fail five or more skills have failed the entire psychomotor examination.

Candidates who fail a full attempt or any portion of a second retest attempt 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 nine skills, provided all other requirements for National Certification are fulfilled.

This official documentation must be signed by a Program Director, Training Officer, or Medical Director that verifies remedial training over all skills has occurred since the last unsuccessful attempt and the candidate has demonstrated competence in all skills.

Documentation may be emailed to support@nremt.org.

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.

• Passed portions of the psychomotor examination remain valid for 24 months. This policy is effective for candidates with a course completion date on or after November 1, 2018. For candidates with a course completion date prior to November 1, 2018, passed portions of each examination is valid for 12 months.