PARAMEDICAL PERSONNEL; HEALTH DEPARTMENT; EMERGENCY MEDICAL SERVICES;

MEDICAL PERSONNEL;

You asked for information on the National Registry of Emergency Medical Technicians (NREMT) and other certification examinations.

SUMMARY

The NREMT is an independent, nonprofit organization that prepares and scores written examinations in four areas of emergency medical service practice: first responder, EMT-basic, EMT-intermediate, and EMT-paramedic levels. It also prepares a practical exam that tests intermediate and paramedic skill levels.

The Connecticut Department of Public Health (DPH) has used the NREMT basic and paramedic tests for eight years in its licensing process; it is one of 43 states that use NREMT tests for this purpose. Connecticut has 356 certified instructors who prepare applicants for the tests.

The other New England and neighboring states, except Massachusetts and New York, also use one or more NREMT tests. In both of these latter states, staff determine certification standards. Massachusetts contracts with a private firm to develop its tests, while in New York, state employees create the test, which is scored by a private firm.

NREMT TESTING

Test History

NREMT’s tests have evolved over the organization’s 30-year history, in some measure reflecting changes in training curricula. It offered its first EMT-basic test in 1971, its first paramedic test in 1978, and the first EMT-intermediate test in 1980. All exams were updated in 1986 to reflect new American Heart Association standards. A new intermediate written exam was introduced in 1987 reflecting a new U. S. Department of Transportation (DOT) curriculum, and a new paramedic exam was introduced the following year. Basic and paramedic examinations (written and practical) were changed in 1995 to reflect NREMT’s new analysis of EMT practices, while a new intermediate written test was adopted in 1999 (but the 1985 intermediate test is still used). Intermediate and paramedic practical exams were also revised in 1999.

Test Construction

NREMT used a three-step process to create its most recent written tests. First it randomly surveyed people working in the field at EMT-basic, -intermediate, and –paramedic levels to identify the important tasks of their job. Those surveyed were asked to determine importance by balancing the frequency with which they performed a task against its potential for harm and their difficulty in performing it. A committee of national experts reviewed the survey practice analysis and developed a test plan based on them. The first survey was conducted in 1995 and another in 1999.

Based on these results and plan, several committees drafted specific questions to assess knowledge related to the selected tasks. The committees were typically composed of 10 to 20 national experts. They had to reach a consensus that (1) each question was directly related to the practice analysis findings, (2) there was only one correct answer to each question, and (3) the answer could be found in commonly available EMT textbooks. Each item meeting these criteria was further reviewed for reading level and to assure that it contained no race, ethnicity, or gender bias. After the questions were written, they were pilot tested across the country and further refined.

Finally, a standard setting and final review committee determined the exam’s pass/fail score—70% for all exams. NREMT also periodically conducts a statistical analysis of individual questions to make sure they are functioning properly.

STATE TESTING PATTERNS

DPH has used NREMT’s EMT-basic and paramedic tests for eight years. The first-time pass rate on both tests here has averaged about 65% according to department officials. Nationally, the first-time pass rate is 70% for the basic exam and 64% for both the intermediate (1985 version, which is the version used here) and paramedic tests. Statewide, 356 current EMS instructors prepare applicants through EMT initial and refresher courses.

The NREMT website (NREMT) indicates that New Hampshire uses the basic, intermediate, and paramedic exams; Vermont, New Jersey, and Rhode Island use the basic and paramedic; and Maine uses just the paramedic test. NREMT has not yet responded to our request for initial pass rates in these states. We will forward them to you when it does.

New York and Massachusetts do not use NREMT tests. New York certifies five emergency medical service levels: first responder, EMT basic and intermediate, critical care, and paramedic. Its Bureau of Emergency Medical Services (part of the state Health Department) central office staff develop the tests for each level. The bureau contracts with Professional Examination Services to print and score the exams. The tests are based on curricula developed by the State Emergency Medical Advisory Commission, a 29-member body composed of physicians and EMS professionals. These curricula copy completely or partially the U. S. DOT’s curricula. The curricula are taught by instructors certified by the bureau who are hired by “core sponsors,” which are organizations approved by the bureau for two-year periods.

In Massachusetts, the Department of Public Health’s Office of Emergency Medical Services establishes EMT certification standards and requirements. The department contracts with Promissor, a Philadelphia firm that specializes in assessment services for state regulatory agencies and national associations, to develop and administer EMT-basic, -intermediate and -paramedic tests. The Massachusetts tests appear to be the only EMT-related tests Promissor administers.

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