The Practical Examination

The practical section of the examination process consists of twelve (12) skills presented in a scenario-type format to approximate the abilities of the EMT-Paramedic to function in the out-of-hospital setting. All skills have been developed in accordance with the National Standard EMT-Basic Curriculum, the behavioral and skill objectives of the 1999 EMT-Paramedic National Standard Training Curriculum, and current A.H.A. guidelines.   The process is a formal verification of the candidate's "hands-on" abilities and knowledge, rather than a teaching, coaching, or remedial training session. Candidates are permitted to bring their own equipment for the examination, provided it is approved for testing by the National Registry Representative in attendance at the examination. All candidates are urged to review all practical examination criteria in the supplemental brochure "Performance Standards for Advanced Level Practical Examination Candidates" before attempting the examination.

All candidates must complete the practical examination in the same standardized format.  The candidate must demonstrate an acceptable level of competency in each of the following skills:

1. PATIENT ASSESSMENT/MANAGEMENT

Candidates will be required to perform a "hands-on," head-to-toe, physical assessment and voice treatment of a moulaged victim for a given scenario. This skill includes:

a.    Scene Size-Up

b.    Initial Assessment/Resuscitation

c.    Focused History and Physical Examination - Rapid Trauma Assessment

d.    Detailed Physical Examination

2. VENTILATORY MANAGEMENT

The candidate will be evaluated over the following two (2) ventilatory management scenarios:

a.    Adult

b.    Dual Lumen Airway Device

Given a scenario of having just found an apneic patient with a palpable carotid pulse, the candidate must demonstrate immediate management of the patient using simple airway maneuvers and adjuncts, bag-valve-mask device, and supplemental oxygen.  The candidate will then complete the adult presentation by placing an endotracheal tube (ET).  Additionally, each candidate will be given a scenario of having just found an apneic patient with a palpable carotid pulse and must demonstrate immediate management of the patient using simple airway maneuvers and adjuncts, bag-valve-mask device, and supplemental oxygen.  The candidate will then place a dual lumen airway device (Combitube© or PTL©) in the adult patient.

3. CARDIAC MANAGEMENT SKILLS

Each candidate's ability to manage cardiac arrythmias and interpret ECG's will be verified in two portions:

a. Dynamic Cardiology

Each candidate will be evaluated in his/her ability to manage a cardiac arrest situation, including actual delivery of electrical therapy and "voicing" all interpretations and treatments given a scenario. The presentation of this portion will be similar to the "megacode."

b. Static Cardiology

Given four (4) prepared ECG tracings with associated patient information, the candidate must verbalize the interpretation of each rhythm and voice all associated treatments.

4. IV AND MEDICATION SKILLS

a. Intravenous Therapy

All candidates will be required to establish a patent IV in a mannequin arm in accordance with a given scenario.

b. Intravenous Bolus Medications (NREMT Intermediate/99 & NREMT-Paramedic candidates)

After establishing a patient IV line, the candidate will be required to administer an IV bolus of medication in accordance with a given scenario.

5. ORAL STATION (NREMT-Paramedic candidates only0

Each NREMT-Paramedic candidate will be evaluated in his/her ability to verbally manage all aspects of an out-of-hospital call given two (2) separate cases:

a.    Case A

b.    Case B

In each case, the candidate will be evaluated in the following categories:

1.    Scene Management

2.    Patient Assessment

3.    Patient Management

4.    Interpersonal Relations

5.    Integration (verbal report, field impression, and transport decision)

6. PEDIATRIC SKILLS

Candidate's will be evaluated over the following two (2) pediatric skills:

a.    Pediatric Ventilatory Management

Given a scenario of having just found an apneic infant with a palpable brachial pulse, the candidate must demonstrate immediate management of the patient using simple airway maneuvers and adjuncts, bag-valve-mask device, and supplemental oxygen.  The candidate will then be required to place an endotracheal tube (ET).

b.    Pediatric Intraosseous Infusion

The candidate will be required to establish an intraosseous line in a pediatric IO mannequin.

7. RANDOM BASIC SKILLS

All candidates will be evaluated over one (1) of the following EMT-Basic skills tested at random.  All instruments will adhere to the National Registry EMT-Basic Practical Examination material:

a.    Spinal Immobilization (Seated Patient)

b.    Spinal Immobilization ( Supine Patient)

c.    Bleeding Control/Shock Management

NREMT-Paramedic candidates are required to complete twelve (12) skills when taking the entire practical examination.  Grading of the practical examination is on a Pass/Fail basis.  Failure of five (5) or less skills (when taking the entire NREMT-Paramedic practical) entitles the candidate to two (2) retesting opportunities.  If a same-day retest is offered at the examination site, only one (1) retest attempt may be completed at that test.  Retests must be completed in an all-or-none fashion.  The NREMT cannot score or report incomplete practical attempts.   Candidates are not permitted to complete only a portion of the skills that need retested.  The NREMT does not mandate or guarantee same-day retest opportunities at any National Registry Advanced Level practical examination site.

Failure of any portion of the second retest attempt constitutes failure of the entire practical examination.  The candidate is then required to officially document remedial training over all skills before starting the next full attempt of the practical examination and re-examining over all twelve (12) skills on another date, provided all other requirements for National Registration are fulfilled.

NREMT-Paramedic candidates who have successfully completed the entire NREMT-Intermediate/99 practical examination within the preceding twelve (12) months of his/her first attempt on the NREMT-Paramedic practical examination may apply his/her passed NREMT-Intermediate/99 results to the NREMT-Paramedic practical examination.   Passed NREMT-Intermediate/99 practical examination results may only be applied to the first full attempt of the NREMT-Paramedic examination for the following four (4) skills:

1.    Intravenous Therapy

2.    Intravenous Bolus Medications

3.    Pediatric Intraosseous Infusion

4.    Random Basic Skills

Failure of five or less skills when applying passed NREMT-Intermediate/99 practical examination results and testing eight (8) skills as listed (#1, 3a and b, 4a and b, 5a and b, and 7a) entitles the candidate to two (2) retesting opportunities of just the skill(s) failed.  If a same day retest is offered at the examination site, only one (1) retest attempt may be completed at that test.  Retests must be completed in an all-or-none fashion.  The NREMT cannot score of report incomplete practical attempts.  Candidates are not permitted to complete only a portion of the skills that need to be retested.  The NREMT does not mandate or guarantee same-day retest opportunities at any National Registry Advanced Level practical examination site.  Candidates applying passed NREMT-Intermediate/99 results should note that outright failure of the first full attempt or failure of the second retest opportunity of the first attempt on the NREMT-Paramedic practical examination will require re-examination over the entire NREMT-Paramedic practical (all twelve (12) skills) on another date after completing the required remedial training, provided all other requirements for national registration are fulfilled.

Failure of six (6) or more skills constitutes failure of the entire practical examination.  The candidate is then required to officially document remedial training over all skills before starting the next full attempt of the practical examination and re-examining over all twelve (12) skills on another date, provided all other requirements for National Registration are fulfilled.

The passed portion of the examination, either the written or practical, will remain valid for a twelve (12) month period from the date of the examination.  Candidates not completing the failed portion of the examination within that twelve (12) month period will be required to repeat the invalid portion.

Candidates are allowed three (3) full attempts to pass the practical examination (one "full attempt" is defined as completing all twelve (12) skills and two retesting opportunities if so entitled).  Candidates who fail a full attempt or any portion of a second retest must submit official documentation of remedial training over all skills before starting the next full attempt of the practical examination and re-examining over all twelve (12) skills, provided all other requirements for National Registration are fulfilled.  This official documentation must be signed by the EMT-Paramedic Training Program Director or Physician Director of training/operations that verifies remedial training over all skills has occurred since the last unsuccessful attempt and the candidate has demonstrated competence in all skills.   Should a candidate fail the third full and final attempt of the practical examination, the candidate must complete a new, state-approved EMT-Paramedic Training Program.

Skill Sheets