Advanced Level Psychomotor Examinations

On January 1, 2017, the National Registry implemented the new scenario-based psychomotor examination. Paramedic candidates are tested on six (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 their ability to manage a call, lead a team, effectively communicate, and maintain professionalism throughout the simulated patient encounter.

History and Rationale of the Paramedic Portfolio

In 2017, the National Registry of EMTs changed the way it verifies psychomotor competency for National Registry Paramedic (NRP) Certification. Several factors prompted the National Registry 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 National Registry 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 National Registry 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 National Registry 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.
What is the Integrated Out-of-Hospital (IOOH) Scenario?

A Critical Fail Example: Integrated Out-of-Hospital (IOOH) Scenario

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

How an Integrated Out-of-Hospital (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)


Information on the Paramedic Psychomotor Examination can be found on the Advanced Level Psychomotor Examination page.



Portfolio Forms

Download all the Paramedic Portfolio Forms in a single binder.

Individual Forms


Scenario Tools

Sample Scenarios

These sample Integrated Out-of-Hospital (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 Integrated Out-of-Hospital (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 the National Registry. The National Registry 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
  • The National Registry 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.