Paramedic and EMT Program Performance on Certification Examinations Varies by Program Size and Geographic Location

Figures & data

Table 1. Characteristics of the included programs at the EMT and paramedic level.

EMT Programs (n = 1,939)
Annual number of program graduates testing (median, IQR)	47 (18, 116)
Total number of graduates testing per quartile
Quartile 1 (6 to 17 graduates testing, n = 455)	2,580
Quartile 2 (18 to 46 graduates testing, n = 509)	5,790
Quartile 3 (47 to 115 graduates testing, n = 486)	12,396
Quartile 4 (116 to 1,892 graduates testing, n = 489)	42,622
Program distribution by NASEMSO region, n, (%)
East	444 (23)
South	557 (29)
Great Lakes	292 (15)
Western Plains	282 (15)
West	354 (18)
Paramedic Programs (n = 602)
Annual number of program graduates testing (median, IQR)	36 (22, 58)
Total number of graduates testing per quartile
Quartile 1 (6 to 21 graduates testing, n = 146)	824
Quartile 2 (22 to 35 graduates testing, n = 153)	1,512
Quartile 3 (36 to 57 graduates testing, n = 148)	2,411
Quartile 4 (58 to 689 graduates testing, n = 155)	5,779
Program distribution by NASEMSO region, n, (%)
East	104 (18)
South	227 (39)
Great Lakes	102 (18)
Western Plains	65 (11)
West	86 (15)

Programs were evaluated as quartiles based on number of graduates testing per year. Abbreviations: EMT, emergency medical technician; IQR, interquartile range; NASEMSO, National Association of State EMS Officials.

Figure 1. Distributions of program first attempt and cumulative third attempt pass rates for emergency medical technician (EMT) and paramedic programs. The red line indicates the national individual first and third pass rate benchmark for comparison.

Table 2. EMT and Paramedic Program first and cumulative third pass rates overall and by total graduates testing annually comparing programs in the highest and lowest quartiles.

The national individual student pass rate benchmark is provided for context. Abbreviations: EMT, emergency medical technician; IQR, interquartile range. *p < 0.008 (with Bonferroni correction).

Figure 2. Regional variability in emergency medical technology (EMT) program first (1st pass) and cumulative third attempt pass rates (3rd pass). Programs were divided into National Association of State EMS Officials (NASEMSO) regions.

Figure 3. Regional variability in paramedic program first (1st pass) and cumulative third attempt pass rates (3rd pass). Programs were divided into National Association of State EMS Officials (NASEMSO) regions.

Appendix 1. Emergency medical technician (EMT) Program pass rates (median, interquartile range [IQR]) by the National Association of State EMS Officials (NASEMSO) regions demonstrating a significant variability in both first and cumulative third pass rates (Kruskal–Wallis, p < 0.001).

	First attempt Pass rate	Cumulative third attempt Pass rate	Number of program
East	61.9 (49.4 to 72.1)	74.0 (63.4 to 84.0)	444
South	62.1 (50.0 to 74.0)	75.5 (65.4 to 86.2)	557
Great Lakes	66.7 (54.6 to 77.7)	77.8 (67.8 to 86.5)	292
Western Plains	62.5 (50.0 to 74.3)	74.7 (63.6 to 85.2)	282
West	68.0 (56.5 to 80.0)	78.0 (69.9 to 87.8)	354

Appendix 2. Paramedic program pass rates (median, IQR) by National Association of State EMS Officials (NASEMSO) regions demonstrating a significant variability in both first and cumulative third pass rates (Kruskal–Wallis, p < 0.001).

	First attempt Pass rate	Cumulative third attempt Pass rate	Number of program
East	76.7 (61.3 to 87.0)	86.7 (79.7 to 96.5)	104
South	66.0 (53.2 to 76.2)	80.6 (70.0 to 91.8)	227
Great Lakes	65.0 (54.3 to 79.9)	81.8 (74.2 to 92.7)	102
Western Plains	74.1 (63.6 to 86.7)	88.4 (80.0 to 95.3)	65
West	82.7 (73.9 to 90.7)	95.4 (90.5 to 98.0)	86