What is ALS Redesign?

The National Registry Board of Directors has voted to update and refine the Advanced Life Support (ALS) assessments to better protect the public, to align more closely with the needs of the EMS community, and to better align with emerging and best practices in the certification industry.  

The National Registry is in the beginning phases of developing an updated assessment process for the AEMT and Paramedic certification levels. This framework will be based on the Standards for Educational and Psychological Testing will be compliant with National Commission on Certifying Agencies (NCCA) accreditation standards. The redesign process will conducted with the advice and guidance of a panel of distinguished ALS subject matter experts who meet monthly to ensure the EMS Community is part of the process. The initial phase is expected to take about two years.  

The ALS redesign plan has four major components:

  1. Replacing the current portfolio requirement with an eligibility requirement.  Educational programs will need to attest to the competency of each candidate in essential physical skills as identified by the most recent ALS practice analysis. For paramedic, we are working with CoAEMSP to develop guidelines for educational programs to help them appropriately assess competency in physical skills. For the AEMT level,  we will work with NASEMSO to set up a similar process.  
  2. Strengthening and Expanding the Cognitive Examination. Multiple response items added to all cognitive examinations. Technology enhanced items will continue to be added to the examinations in order to better test knowledge, skills, and abilities. New systems are being to developed to improve and increase the number of new items being developed for the examination. These include advanced training for item writers, and increasing our item pipeline.   Dr. Paul Rosenberger has been hired by the Registry to serve as the Examinations Content Manager and is responsible for developing new process. 
  3. Sunsetting the Psychomotor Examination. As we move away from the psychomotor examination, we begin expanding the current cognitive examination to include new material related to communications, leadership and clinical judgment. The expanded examination will focus on soft skills and the EMS process.
  4. Communication and Community Involvement. Unlike the other major components, this last one focuses on the involvement and collaboration of the EMS field as a whole to ensure the final product is something everyone can be proud of. In addition to the ALS expert panel, smaller groups will be brought together to work on specific design issues such a new item formats, processes for moving transitioning, and communicating the changes with the EMS community. 

Our Milestone Tracker

The ALS Redesign milestone tracker was created so we can visualize our journey through the next several years of working through this effort. 

We understand that many things need to be accomplished to reach the finish line, and here we can see those significant events. It is vital that we lead with patience and celebrate every small win along the way. 

Each time we accomplish a new milestone, we will fill it in with color to show where we currently are and where we are headed. 

The image below is what the milestone tracker will look like once we finish the project. 

We encourage you to follow along our journey with us and help us share the great news to come. 

Milestone Updates

Below you will find more information about our completed milestones. We encourage you to read about our updates and follow along on our journey with us!  

  • Milestone 1: An initial charter was completed and an Expert Panel was launched. These expert panels meet monthly to discuss new topics related to ALS Redesign. A summary of meeting notes can be found on the sidebar of this page.
  • Milestone 2: ALS Practice Analysis and report was completed.
  • Milestone 3: A new process for developing test content was completed. To read more about this and our new item types, click here.


The mission to deliver an insightful, helpful score report 

While change is inevitable, progress should never be optional.  

It is in that spirit the National Registry of Emergency Medical Technicians (National Registry) is constantly looking....

Learn more>

The National Registry’s ALS examination is evolving 

The EMS community has provided feedback over the past several years that it was time for adjustments to the Advanced Life Support (ALS) examination – specifically, the psychomotor examination. 

Learn more>


October 2021 - Executive Director Bill Seifarth took the opportunity to discuss the ALS Redesign during the October 2021 Program Director Webinar. During the webinar, he discusses the importance of input and feedback from the EMS Community and the refinements and improvements ahead for ALS.

January 2022 - Chief Science Officer Greg Applegate delivers an update on the ALS Redesign Initiative.

July 2022 - As a part of the ALS Redesign, the National Registry is evolving its examinations to provide a more authentic testing experience through the addition of new scenario-based items, or questions.   

Stemming from a recent clinical judgment study published in Prehospital Emergency Care, the new scenarios deeply measure the knowledge and skills required to be a competent practitioner.

July 2022 - Check out the ALS Redesign Vendor Summit Session #1 Recap here!

August 2022 – Get caught up on the ALS Redesign Vendor Summit Session #2 by reading the Recap here


ALS Redesign Panel

The Registry wanted to ensure this project had input from many different areas of expertise. This multidisciplinary panel was created with one goal in mind, inclusivity and diversity of thought. 

The members of ALS Redesign Expert Panel are:  

Tom Platt, Chair

Jeff Anderson

Travis Baker

Amanda Bates

Paul Berlin

Nichole Bosson

Terrell Buckson

Carol Cunningham

Philip Dickison

Bryan Ericson

Bruce Evans

Dawn Felt

Art Hsieh

Ryan Kerr

Sahaj Khalsa

Jeffery Lindsey

Connie Mattera

Chris Mercer

Mike Miller

Kenneth Navarro

Todd Nicholson

Aarron Reinert

Ritu Sahni

Lindsey Simpson

Matt Zavadsky