Psychomotor Exam

On January 1, 2017, the NREMT implemented the new scenario based psychomotor exam. Paramedic candidates are tested on (6) skills, including an integrated out-of-hospital (IOOH) scenario. The scenario will reflect either a pediatric, geriatric or adult patient. Each candidate will be provided with a trained paramedic partner and evaluated on his/her ability to manage a call, lead the team, effectively communicate, and maintain professionalism throughout the simulated patient encounter.

Regional Workshops

NREMT & NAEMSE are partnering to bring a brand new educational opportunity entitled Regional Scenario Development Workshop. This is a registration free workshop designed to provide you with hands-on experience developing formative and summative scenarios for use in your classroom. Workshops are limited to 50 participants who will be guided through the scenario development process by NREMT staff. Topics that will be covered are scenario writing, calibration, and evaluation in the workshop. Scenarios created in the workshop will be available for use following the event.

History and Rationale

In 2017, the National Registry of EMTs (NREMT) changed the way it verifies psychomotor competency for National Registry Paramedic (NRP) Certification. Several factors prompted the NREMT to change its psychomotor examination. The first was a desire to ensure protection of the public by assessing psychomotor competency in a way that simulates actual practice in a simulated environment. The second factor is that EMS employers often find that while newly certified paramedics know how to perform individual skills, they cannot move to the next level and integrate those skills into scene and patient management. Finally, the NREMT now requires that all paramedic candidates graduate from a CAAHEP-approved paramedic program or one that holds a current Letter of Review (LoR) from the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP). Scenario examinations allow the NREMT to incorporate essential attributes of Team Leadership along with scene and patient management, thus better reflecting actual out-of-hospital care as opposed to continuing to test 12 isolated skills.

The NREMT developed a portfolio of vital skills that each paramedic student must master to qualify for the NRP Certification examination. The program tracks each student's portfolio throughout the formative and summative phases of education in the laboratory, clinical, and field internship settings. The completed portfolio provides a mass of evidence that documents a candidate’s acquisition of psychomotor competency in the skills we currently evaluate on the 12-skill NRP Psychomotor Examination. All students that begin their paramedic program on or after August 1, 2016 are required to complete a portfolio that becomes a part of their permanent educational file and is a prerequisite to seeking NRP Certification.

2017 Transition

Starting on January 1, 2017, Paramedic candidates had three potential pathways to satisfy the psychomotor examination.

pathways to satisfy the psychomotor examination.

What is the Integrated Out of Hospital Scenario?

A Critical Fail Example: Integrated Out of Hospital Scenario

Detailed Overview of the Integrated Out of Hospital Scenario (IOOH)

How an IOOH Scenario is Scored

History of Paramedic Psychomotor Competency Portfolio (02/24/2015)

Paramedic Psychomotor Competency Portfolio Update (05/19/2015)

Paramedic Scenario Psychomotor Exam & Psychomotor Competency Portfolio Update (11/17/2015)


The Psychomotor Exam (Phase 1 Scenario Based)

Beginning January 1, 2017, the NREMT will implement the new scenario-based psychomotor exam. In the new test model, Paramedic candidates will be tested on a total of six skills. Five skills from the traditional NRP Psychomotor Examination (Patient Assessment – Trauma, Dynamic Cardiology, Static Cardiology, Oral Station Case A, Oral Station Case B) will be tested, with the addition of an Integrated Out-Of-Hospital Scenario.

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
  • Primary Survey/Resuscitation
  • History Taking
  • Secondary Assessment

Cardiac Management Skills

The candidate is evaluated on their ability to manage cardiac arrhythmias and interpret ECGs. This will be verified in two portions:

You will be evaluated on your 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 the portion will be similar to a "megacode."

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

Oral Station - Scenario A & B

 New Oral Station 

You will be evaluated on your ability to verbally manage all aspects of an out-of-hospital call given two (2) separate cases: Oral A & Oral B

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

  • Scene Management
  • Patient Assessment
  • Patient Management
  • Interpersonal Relations
  • Integration (verbal report, field impression, and transport decision)

Integrated Out-Of-Hospital Scenario

The Integrated Out-Of-Hospital Scenario (IOOH) will reflect either a pediatric, geriatric or adult patient. The candidate will be provided with a professional paramedic partner and evaluated on their ability to manage a call, lead a team, effectively communicate, and maintain professionalism throughout the simulated patient encounter.



Portfolio Forms

Download all the Paramedic Portfolio Forms in a single binder

Individual Forms


Scenario Tools

Sample Scenarios

These sample IOOH scenarios were created by Regional Scenario Development Workshop (RSDW) attendees in 2016 for the purpose of giving paramedic education programs a strawman resource to prepare for IOOH scenario based ALS exams. Many of the attendees who created them are paramedic educators/program directors from across the U.S. They were not created by NREMT. NREMT gives permission for these samples to be tweaked and utilized in EMS education programs for formative and summative assessments.


  • These sample scenarios have NOT been vetted or reviewed for medical accuracy
  • These sample scenarios have NOT been reviewed for grammar, spelling, writing style, etc
  • Aesthetically, they are similar to the scenarios utilized for the ALS exams; however, the content, while similar, is NOT the same as that on the operational scenarios used for certification exams
  • The Mandatory Actions and Critical Criteria are not included in these samples for exam security purposes
  • NREMT does NOT endorse any equipment or resource brand named in any of these sample scenarios

Select a scenario type and a patient type to view a list of matching scenarios.