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skills, and abilities (KSAs) required in the EMS practice settings. The information gathered by practice
analysis studies is then used to determine the content of the examinations, also known as a “test plan.”
The 2019 National EMS Practice Analysis examined the knowledge needed for the paramedic as it
related to patient impression data. The patient presentations followed the historical division of four
areas: 1) Airway, Respiration & Ventilation, 2) Cardiology & Resuscitation, 3) Trauma, and 4)
Medical/Obstetrics/Gynecology. Additionally, the study explored the domain of EMS Operations.
Based on the results of the 2019 National EMS Practice Analysis and additional feedback from the EMS
community, in 2019 the National Registry’s Board of Directors undertook an initiative, “Advanced Life
Support (ALS) Assessment Redesign,” which was intended to improve the processes of assessing entry-
level competency using technology and emerging practices in the testing industry. As a part of the ALS
redesign initiative, one major change to the program was to discontinue the existing psychomotor
examination and embed new content into the cognitive examination that measures the critical skills of
communication, leadership, and clinical judgment. This new domain, Clinical Judgment, was defined
through the 2021 National EMS Practice Analysis Addendum.
Content for the Paramedic Certification Examination
Cognitive Domains
The 2019 National EMS Practice Analysis evaluated clinical impressions for the five areas, or “domains,”
which were described above. Tasks performed by the provider for these domains were also determined.
These five domains are collectively referred to as the “cognitive domains”:
1. Airway, Respiration, & Ventilation
2. Cardiology & Resuscitation
3. Trauma
4. Medical, Obstetrics & Gynecology
5. EMS Operations
Clinical Judgment
In accordance with the findings of the 2021 Practice Analysis Addendum and subject-matter expert (SME)
recommendations, the clinical judgment domain also samples information from two additional knowledge
areas, communication and leadership in an EMS response, as well as from each step of the processing
information cycle (Gugiu, McKenna, Platt, & Panchal, 2022). The steps of the processing information cycle
are: (a) recognize cues, (b) analyze cues, (c) define hypothesis, (d) generate solutions, (e) take action, and
(f) evaluation. As the EMS clinician moves from each setting within the EMS response, they re-evaluate
and move through the processing information cycle again.