Executive Summary
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The National Registry of Emergency Medical Technicians (NREMT) is a national nonprofit corporation that provides a uniform process to assess the knowledge and skills required for competent practice by EMS professionals. The NREMT certifies EMS professionals, but does not license them. The NREMT, together with various State and local Emergency Medical Services (EMS) certification and licensing bodies, is responsible for ensuring the initial and continued clinical competence of Emergency Medical Technician-Paramedics (EMT-Ps). Following initial certification, a difficulty arises in determining whether these EMT-Ps remain competent. This is a complex and costly problem for most licensing and certification agencies.

Among the medical, nursing, health science, and other healing arts professions, continuing education, required practice frequency minimums, and periodic retesting are among the most common methods of ensuring the safe practice of clinicians. However, no standardized procedures have been adopted to ensure that EMT-Ps remain competent, and to date there are no definitive studies that universally support current procedures.

The important health policy question that arises is whether the NREMT reregistration procedures have their intended effect of maintaining competence. Reregistration entails completion of Continuing Medical Education (CME) requirements, completion of nationally standardized EMT-P refresher courses, and verification of skills by the responsible physician--medical director. The principal objective of this research was to determine whether the continued cognitive competence of voluntarily reregistered paramedics differed from those who did not reregister.


The sample consisted of two groups: (1) EMT-Ps who voluntarily reregistered, and (2) those who did not voluntarily reregister after the two-year registration cycle and chose to remain only credentialed by the State. Subjects were sent a letter requesting them to complete a multiple-choice online survey that included a standardized exam similar to their initial certification test, an achievement test, and a demographic and professional practice questionnaire. The responses from cohorts of NREMT-Ps initially certified 2, 4, and 6 years earlier were compared.


NREMT-Ps who reregistered 4 and 6 years after initial registration were twice as likely to pass the exam as their State-certified cohort counterparts who did not reregister with the NREMT. Also, the reregistered cohorts averaged one more correct answer on the achievement portion of the exam compared with the nonreregistered cohorts in all years. The registered group compared to the nonregistered group overall had more self-reported Continuing Medical Education. Taken together, the findings suggest that EMT-Ps who reregister with the NREMT are more knowledgeable than those who do not reregister.