Why is a Paramedic Refresher Course Required?

A paramedic refresher course is necessary because a paramedic’s certification is valid for two years. Paramedics are required to keep their certification up to date so that they can continue to work in the emergency medical field. Because the medical field is one of rapid change and advances in technology, the refresher course provides training in the newest medical techniques, as well as allowing the paramedic to brush up on the mandatory core topics (which will be reviewed later in the article).

Forty-six of the 50 states require that the paramedic, in order to be certified, must pass the NREMT—National Registry of Emergency Medical Technicians—exam. A paramedic who has failed the NREMT exam previously would be advised to take the course in order to be certain that his or her cognitive competency meets the level needed to provide optimum emergency medical care.

Taking the Paramedic Refresher Course

For the more than 225,000 paramedics in the United States, taking the refresher course in order to be recertified is an ongoing part of the training process that keeps their skills honed in order to provide effective and up-to-date emergency medical service. The NREMT outlines the recertification requirements, courses, fees, and exam details in a brochure which can be downloaded at www.nremt.org. This brochure provides an excellent synopsis of information for the paramedic pursuing recertification.

Check your state for the schools or training sites that offer the refresher courses. Contact information for The National Association of State EMS Officials can be found at: NASEMSO State EMS Listing

Here is a brief list of sites where the course is offered, but there are many, many others all throughout the country.

Gadsden State Community College
Gadsden, AL

Colorado Mountain College 
Edwards, CO
EMT-B.I: 970/453-6757 X2621
EMT-P: 970/569-2924

UCLA Paramedic Education
Inglewood, CA 90301

Central Florida Community College 
Ocala, FL

Mercy Medical Center 
Mercy College of Health Sciences
Des Moines, IA

Paramedic Refresher Course Topics

The national registry requires specific information that must be taught during paramedic refresher classes, including cardiology, pediatrics, and trauma, and the use of medications, as well as medical procedures such as chest decompression. In order to be recertified, the paramedic needs to complete 72 hours of instruction. The mandated requirements include the refresher course; additional EMS-related continuing education, advanced cardiovascular life support (ACLS), and CPR certification.

The refresher course offers two different options from which the paramedic may choose: 1) the traditional refresher course, which is the satisfactory completion of 48 hours of Department of Transportation (DOT) National Standard Paramedic Refresher, or the Continuing Education Coordinating Board for Emergency Medical Services-(CECBEMS) approved refresher; or 2) continuing education topical hours, which must include both mandatory content and flexible content. No more than 10 hours of the continuing education can be magazine- or video-based, or online content. ‘

Also accepted for paramedic continuing education are college lectures, standardized courses such as Advanced Burn Life Support (ABLS), ACLS, and others.

The NREMT Paramedic Refresher 

Paramedics who choose to be recertified by examination to test their cognitive competency are not required to provide documentation of their continuing education. In order to take the exam, the paramedic must fill out a recertification by examination application at the NREMT website at www.nremt.org.

The exam fee is $110. After 24-48 hours have passed, the paramedic may print out the Authorization to Test (ATT) letter which can be found on the NREMT website, as well; the letter provides instruction on scheduling the exam, which must be taken between October 1-March 31 of the expiring year of the paramedic’s current certification.

The exam will cover the full gamut of EMS care including:  airway, ventilation, oxygenation; trauma; cardiology; medical; and EMS operations, with 85% of the patient care instruction focusing on adult patients and 15% on pediatric patients. The test will include from 80-150 items to answer, and the paramedic is given two and one-half hours to complete the exam.

For the psychomotor segment of the examination, the paramedic is faced with twelve scenarios which are based on specific skills. This tests the paramedic’s on-the-spot abilities to handle the medical emergency. The paramedic may bring his or her own equipment for this part of the examination. The equipment must be approved by the National Registry representative who is present at the examination.

A passing grade is received if the paramedic proves that he or she can provide safe, effective, entry-level emergency medical care. For details on the current national exam passing rates, check the NREMT annual report, which is available at www.nremt.org.

Upon successful completion of the exam, the paramedic will receive an abbreviated recertification application. This signed application must be returned to NREMT no later than March 31 of the year of the current certification’s expiration. The paramedic who chooses to be recertified by exam must still meet the other requirements of recertification, including CPR/ACLS certification, active affiliation/practice, verification of skills, and submission of the physician medical director signature and the felony statement.

What if the Paramedic Fails the Exam?

What If I Fail the Paramedic Refresher Class

The paramedic who fails the test may apply to take the test again after 15 days have passed. The paramedic has six chances to pass the exam as long as all the other certification requirements are satisfied. If the paramedic fails three times, he or she must provide documentation which verifies completion of 48 hours of remedial training.

A paramedic is then allowed three more attempts to pass the exam. After six failed exams, the paramedic must repeat the complete course. For help in preparing for the exam with study sheets based on the topics covered, check the NREMT website at:


The advanced level study sheet topics include bleeding control and shock management; cardiac arrest management; dynamic cardiology; intravenous therapy; joint immobilization; long bone immobilization; medical patient assessment; trauma patient assessment; pediatric respiratory compromise; pediatric ventilatory management for children under age two; spinal immobilization for seated and supine patients; static cardiology; supraglottic airway device; and ventilator management for adults.

Continuing Education for Paramedic Refresher Courses

The paramedic can also choose recertification by continuing education. Some states require the traditional refresher course and will not accept continuing education hours. Please be sure that your state will recertify you with paramedic continuing education courses if that is the option that you plan to choose.

The cost for the continuing education application is $20. The paramedic who selects the continuing ed option for recertification will need to have received instruction in both mandatory and flexible core content. Each of the topics within the mandatory core content must be covered, adding up to a total of 24 hours of instruction.

The Mandatory Core Content consists of:

  • Airways, breathing, and Cardiology (eight hours)
  • Medical Emergencies (three hours)
  • Trauma (five hours)
  • Obstetrics and Pediatrics (eight hours)

While each of the five categories in the Flexible Core Content must be covered, the paramedic is not required to cover each topic.

The Flexible Core Content consists of:

  • Airways, reaching, and Cardiology (eight hours)
  • Medical emergencies (five hours)
  • Trauma (one hour)
  • Obstetrics and Pediatrics (eight hours)
Paramedic Refresher Continuing Ed Course

Whether the refresher is by exam or continuing education, both must include 24 hours of additional EMS-related education. Twelve of the hours can be obtained from a variety of sources, including instruction in dispatch training; emergency driving; teaching CPR; online, magazine- or video based material from distributive education, as long as it’s CECBEMS- or state-approved.

Also acceptable are college courses which are relevant to the paramedic’s professional responsibilities, including anatomy, physiology, biology, chemistry, sociology, psychology, and statistics. ACLS credentials and CPR certification are also a required part of the refresher course.

NREMT outlines the recertification requirements, courses, fees, and exam details can also be found and downloaded here:


How Long is a Paramedic Refresher?

Most refresher courses have a minimum of 24 hours of course work that is spread out over two-three days, but each training site may have a different schedule. Some refresher course sites also try to be sensitive to the paramedic’s work schedule. The Department of Transportation also offers a 24-hour online paramedic course.  Please confirm that your state will accept online recertification.

In order to maintain current certification, the paramedic needs to mark the following dates on the calendar so that all forms and documents can be submitted on time.

Dates to Remember

  1. November 1: Recertification applications are mailed out
  2. February 15 (of the year of certification expiration): Submit recertification materials to NREMT for processing of National Registry card
  3. October 1 – March 15 ( of the year of certification expiration): Refresher Course examination may be taken
  4. March 31 (of the year of certification expiration): Deadline for submitting recertification application
  5. March 31: Date through which ACLS and CPR credentials must be current
  6. March 31: Deadline for submitting abbreviated recertification application following successful completion of the refresher course exam

Always remember that our paramedic school page provides you with a list of accredited programs you can apply to.

Similar Posts